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Studts JL, Deffendall CM, McCubbin SL, Hamann HA, Hoover K, Brymwitt WM, Williamson TJ. Examining evidence of lung cancer stigma among health-care trainees. J Natl Cancer Inst Monogr 2024; 2024:20-29. [PMID: 38836527 PMCID: PMC11151328 DOI: 10.1093/jncimonographs/lgae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/05/2024] [Accepted: 02/21/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Innovations in lung cancer control and care have started to transform the landscape of lung cancer outcomes, but lung cancer stigma and biases have been implicated as a deterrent to realizing the promise of these innovations. Research has documented lung cancer stigma among the general public and lung cancer survivors (self-blame), as well as clinicians across many disciplines. However, studies have not explored lung cancer stigma in health-care trainees. These data seek to address that gap and inform efforts to prevent the emergence or mitigate the presence of lung cancer stigma among future clinicians. METHODS Using clinical vignettes and a 2x2 factorial design, this investigation evaluated the impact of a history of smoking (yes vs no) and cancer diagnosis (lung vs colorectal) on perceptions of the described patient among 2 groups of preclinical health-care trainees (medical = 94 and nursing = 138). A charitable giving paradigm also asked participants to donate provided funds to 1 of 2 cancer advocacy organizations: one serving the lung cancer community and one serving the colorectal cancer community. RESULTS In study 1, results revealed a consistent pattern of statistically significant and medium to large effect size differences regarding stigmatized perceptions (eg, higher stigmatizing behavior, increased pity, greater anger, and less helping) for individuals with a history of smoking but no reliable differences regarding cancer diagnosis. Analysis of data from nursing trainees in study 2 showed a similar pattern of statistically significant and medium to large effects pertaining to stigma behavior and perceptions of individuals who had a history of smoking depicted in the vignettes. The charitable giving paradigm did not identify any reliable difference between the groups in either study. CONCLUSIONS Findings revealed a consistent pattern of health-care trainee perceptions that varied by smoking status but much less evidence that the cancer diagnosis contributed to different perceptions. This suggests that efforts to integrate consideration of stigma and biases in health-care training needs to adopt an approach that seeks to mitigate or eliminate stigmatizing perceptions and behaviors toward individuals with a history of smoking.
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Affiliation(s)
- Jamie L Studts
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | - Heidi A Hamann
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Kaitlyn Hoover
- Population Health Shared Resource, University of Colorado Cancer Center, Aurora, CO, USA
| | - Whitney M Brymwitt
- Department of Psychological Science, Loyola Marymount University, Los Angeles, CA, USA
| | - Timothy J Williamson
- Department of Psychological Science, Loyola Marymount University, Los Angeles, CA, USA
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Malhotra A, Fransen HP, Quaresma M, Raijmakers N, Versluis MAJ, Rachet B, van Maaren MC, Leyrat C. Associations between treatments, comorbidities and multidimensional aspects of quality of life among patients with advanced cancer in the Netherlands-a 2017-2020 multicentre cross-sectional study. Qual Life Res 2023; 32:3123-3133. [PMID: 37389733 PMCID: PMC10522740 DOI: 10.1007/s11136-023-03460-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE To investigate associations between quality of life (QoL) and 1) immunotherapy and other cancer treatments received three months before QoL measurements, and 2) the comorbidities at the time of completion or in the year prior to QoL measurements, among patients with advanced cancer. METHODS A cross-sectional study is conducted on patients with advanced cancer in the Netherlands. The data come from the baseline wave of the 2017-2020 eQuiPe study. Participants were surveyed via questionnaires (including EORTC QLQ-C30). Using multivariable linear and logistic regression models, we explored statistical associations between QoL components and immunotherapy and other cancer treatments as well as pre-existing comorbidities while adjusting for age, sex, socio-economic status. RESULTS Of 1088 participants with median age 67 years, 51% were men. Immunotherapy was not associated with global QoL but was associated with reduced appetite loss (odds ratio (OR) = 0.6, 95%CI = [0.3,0.9]). Reduced global QoL was associated with chemotherapy (adjusted mean difference (β) = - 4.7, 95% CI [- 8.5,- 0.8]), back pain (β = - 7.4, 95% CI [- 11.0,- 3.8]), depression (β = - 13.8, 95% CI [- 21.5,- 6.2]), thyroid diseases (β = - 8.9, 95% CI [- 14.0,- 3.8]) and diabetes (β = - 4.5, 95% CI [- 8.9,- 0.5]). Chemotherapy was associated with lower physical (OR = 2.4, 95% CI [1.5,3.9]) and role (OR = 1.8, 95% CI [1.2,2.7]) functioning, and higher pain (OR = 1.9, 95% CI [1.3,2.9]) and fatigue (OR = 1.6, 95% CI [1.1,2.4]). CONCLUSION Our study identified associations between specific cancer treatments, lower QoL and more symptoms. Monitoring symptoms may improve QoL of patients with advanced cancer. Producing more evidence from real life data would help physicians in better identifying patients who require additional supportive care.
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Affiliation(s)
- Ananya Malhotra
- Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Heidi P Fransen
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Manuela Quaresma
- Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Natasja Raijmakers
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Moyke A J Versluis
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Graduate School of Social & Behavioral Sciences, Universiteit Van Tilburg, Warandelaan 2, 5037 AB, Tilburg, Nederland
| | - Bernard Rachet
- Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Marissa C van Maaren
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Clémence Leyrat
- Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Price SN, Neil JM, Flores M, Ponzani C, Muzikansky A, Ballini L, Ostroff JS, Park ER. Patient-Reported Receipt of Oncology Clinician-Delivered Brief Tobacco Treatment (5As) Six Months following Cancer Diagnosis. Oncology 2023; 101:328-342. [PMID: 36893738 PMCID: PMC10563136 DOI: 10.1159/000528963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/29/2022] [Indexed: 03/11/2023]
Abstract
INTRODUCTION Smoking after a cancer diagnosis represents a modifiable health risk. It is recommended that oncology clinicians address tobacco use among their patients using the 5As brief model: Asking about use, Advising users to quit, Assessing willingness to quit, Assisting in quit attempts (counseling and medication), and Arranging follow-up. However, cross-sectional studies have found limited adoption of 5As (especially Assist and Arrange) in oncology settings. Further investigation is needed to understand changes in, and factors associated with, 5As delivery over time. METHODS Patients recently diagnosed with cancer and reporting current smoking (N = 303) enrolled in a smoking cessation clinical trial and completed three longitudinal surveys; at pre-intervention baseline and 3- and 6-month follow-up post-enrollment. Patient-level correlates of 5As receipt at baseline, 3 months, and 6 months were identified using multilevel regression models. RESULTS At baseline, patient-reported rates of 5As receipt from oncology clinicians ranged from 85.17% (Ask) to 32.24% (Arrange). Delivery declined from baseline to 6-month follow-up for all 5As, with the largest declines observed for Ask, Advise, Assess, and Assist-Counseling. Diagnosis of a smoking-related cancer was associated with greater odds of 5As receipt at baseline but lower odds at 6-month follow-up. At each time point, female gender, religiosity, advanced disease, cancer-related stigma, and smoking abstinence were associated with lower odds of 5As receipt, while reporting a recent quit attempt prior to enrollment was associated with higher odds of 5As receipt. CONCLUSION Oncology clinicians' 5As delivery declined over time. Clinician delivery of the 5As varied based on patients' sociodemographics, clinical and smoking characteristics, and psychosocial factors.
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Affiliation(s)
- Sarah N. Price
- Department of Psychology, University of Arizona, Tucson, AZ, USA
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jordan M. Neil
- Departments of Psychiatry and Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Melissa Flores
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Colin Ponzani
- Departments of Psychiatry and Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Alona Muzikansky
- Departments of Psychiatry and Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Lauren Ballini
- Department of Community Health, Tufts University, Medford, MA, USA
| | - Jamie S. Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elyse R. Park
- Departments of Psychiatry and Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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Kaplan DM, Hamann HA, Price SN, Williamson TJ, Ver Hoeve ES, Mcconnell MH, Duchschere JE, Garland LL, Ostroff JS. Developing an ACT-based intervention to address lung cancer stigma: Stakeholder recommendations and feasibility testing in two NCI-designated cancer centers. J Psychosoc Oncol 2022; 41:59-75. [PMID: 35129091 PMCID: PMC9356115 DOI: 10.1080/07347332.2022.2033377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Objective: Few psychosocial interventions have been tailored to meet the unique needs of patients diagnosed with lung cancer. This pilot study developed and tested a six-week intervention for reducing lung cancer stigma.Design and Subjects: Guided by qualitative interviews conducted with 9 lung cancer patients and 5 thoracic oncology care providers, Acceptance and Commitment Therapy was adapted for treatment of lung cancer stigma (ACT-LCS). In a subsequent single arm pilot study, 22 lung cancer patients reporting high levels of stigma completed the intervention.Setting: NCI-designated cancer centers in the Southwestern and Eastern United States.Results: Of 46 eligible patients, 22 provided consent, with 20 completing the intervention (10 in-person, 10 telehealth). Overall stigma decreased across timepoints, largely driven by reductions in internalized stigma. There were also significant reductions in social isolation, sleep disturbance, and fatigue.Conclusions: The ACT-LCS protocol demonstrates preliminary feasibility and acceptability. This intervention may be particularly suited for helping patients navigate feelings associated with internalized stigma.
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Affiliation(s)
- Deanna M. Kaplan
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Heidi A. Hamann
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Sarah N. Price
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Timothy J. Williamson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | - Jamie S. Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Patients' Perceptions at Diagnosis: Lung Cancer Discovery and Provider Relationships. Cancer Nurs 2022; 45:397-405. [PMID: 35067577 PMCID: PMC9294071 DOI: 10.1097/ncc.0000000000001050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND In the United States, most lung cancer cases are diagnosed at advanced stages, limiting treatment options and impacting survival. This study presents patients' perspectives on the complexity of factors influencing a lung cancer diagnosis. Lung cancer awareness regarding risks, symptoms, smoking behaviors, family history, and environmental factors can lead to preventative and early detection measures. OBJECTIVE The aim of this study was to explore lung cancer patient perspectives on lung cancer awareness within the context of an earlier study to understand sleep-wake disturbances in adults with non-small cell lung cancer. METHODS A content analysis was used to analyze the original deidentified longitudinal interview data collected from 26 patients diagnosed with lung cancer. RESULTS Of the original 26 participants, 16 were included in this secondary data analysis. The participants were primarily females (n = 10) and Whites (n = 13), with ages ranging between 49 and 83 years. Half of the sample was diagnosed with stage IV lung cancer and most of the sample was on chemotherapy (n = 10). Two key themes were identified: the lung cancer discovery and the patient-physician relationship. CONCLUSIONS Unspecific initial symptoms, lack of knowledge and screening, as well as fear of the diagnosis delayed seeking medical care. Patient-physician relationships were hindered by smoking-associated stigma, inadequate sharing of information, and lack of coordinated, holistic care. Positive communication strategies are critical between patients and providers to meet patients' specific needs. IMPLICATIONS FOR PRACTICE Educational interventions that enhance lung cancer awareness may improve prevention and screening actions, improve timely healthcare intervention, and reduce incidence and mortality.
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Neil JM, Price SN, Friedman ER, Ponzani C, Ostroff JS, Muzikansky A, Park ER. Patient-Level Factors Associated with Oncology Provider-Delivered Brief Tobacco Treatment Among Recently Diagnosed Cancer Patients. Tob Use Insights 2020; 13:1179173X20949270. [PMID: 32874095 PMCID: PMC7436840 DOI: 10.1177/1179173x20949270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 05/31/2020] [Indexed: 12/25/2022] Open
Abstract
Background: A cancer diagnosis is seen as a “teachable moment” for patients to consider changing their behavioral risk factors, such as smoking. It also offers an opportunity for oncology providers to engage in a dialogue about how they can support patients changing their smoking behaviors. Brief, evidence-based tobacco cessation treatment delivered by oncology providers through the 5As (Ask, Advise, Assess, Assist Arrange) model is recommended, but provision to cancer patients remains suboptimal. Aim: Explore patient-level factors associated with 5As receipt among current smokers with a newly diagnosed cancer. Method: A total of 303 patients self-reported whether they received each of the 5As during their most recent oncology care visit. Multivariable regression analyses were conducted to identify patient-level factors associated with 5As receipt. Results: Oncology provider-delivered 5As rates ranged from 81.5% (Ask) to 30.7% (Arrange). 5As receipt was associated with: reporting lower illness-related stigma, diagnosis of a comorbid smoking-related disease, diagnosis of a smoking-related cancer, and diagnosis of a non-advanced cancer. Conclusion: Findings support previous literature in which smoking-related diagnoses were associated with greater receipt of 5As; however, disparities in the receipt of 5As existed for patients with more advanced cancer diagnoses and illness-related stigma. Inequities in the provision of quit assistance may further decrease treatment effectiveness and survival expectancy among certain patient populations. These findings are, therefore, important as they identify specific patient-level factors associated with lower 5As receipt among newly diagnosed cancer patients.
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Affiliation(s)
- J M Neil
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - S N Price
- University of Arizona, Tucson, AZ, USA
| | | | - C Ponzani
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - J S Ostroff
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - A Muzikansky
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - E R Park
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
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7
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Kostopoulou O, Nurek M, Delaney BC. Disentangling the Relationship between Physician and Organizational Performance: A Signal Detection Approach. Med Decis Making 2020; 40:746-755. [PMID: 32608327 PMCID: PMC7457451 DOI: 10.1177/0272989x20936212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 05/14/2020] [Indexed: 01/30/2023]
Abstract
Background. In previous research, we employed a signal detection approach to measure the performance of general practitioners (GPs) when deciding about urgent referral for suspected lung cancer. We also explored associations between provider and organizational performance. We found that GPs from practices with higher referral positive predictive value (PPV; chance of referrals identifying cancer) were more reluctant to refer than those from practices with lower PPV. Here, we test the generalizability of our findings to a different cancer. Methods. A total of 252 GPs responded to 48 vignettes describing patients with possible colorectal cancer. For each vignette, respondents decided whether urgent referral to a specialist was needed. They then completed the 8-item Stress from Uncertainty scale. We measured GPs' discrimination (d') and response bias (criterion; c) and their associations with organizational performance and GP demographics. We also measured correlations of d' and c between the 2 studies for the 165 GPs who participated in both. Results. As in the lung study, organizational PPV was associated with response bias: in practices with higher PPV, GPs had higher criterion (b = 0.05 [0.03 to 0.07]; P < 0.001), that is, they were less inclined to refer. As in the lung study, female GPs were more inclined to refer than males (b = -0.17 [-0.30 to -0.105]; P = 0.005). In a mediation model, stress from uncertainty did not explain the gender difference. Only response bias correlated between the 2 studies (r = 0.39, P < 0.001). Conclusions. This study confirms our previous findings regarding the relationship between provider and organizational performance and strengthens the finding of gender differences in referral decision making. It also provides evidence that response bias is a relatively stable feature of GP referral decision making.
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Affiliation(s)
- Olga Kostopoulou
- Imperial College London, Department of Surgery and Cancer, London, UK
| | - Martine Nurek
- Imperial College London, Department of Surgery and Cancer, London, UK
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de Mol M, Visser S, Aerts J, Lodder P, van Walree N, Belderbos H, den Oudsten B. The association of depressive symptoms, personality traits, and sociodemographic factors with health-related quality of life and quality of life in patients with advanced-stage lung cancer: an observational multi-center cohort study. BMC Cancer 2020; 20:431. [PMID: 32423432 PMCID: PMC7236491 DOI: 10.1186/s12885-020-06823-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 04/02/2020] [Indexed: 01/11/2023] Open
Abstract
Background Identification of patient-related factors associated with Health-Related Quality of Life (HRQoL) and Quality of Life (QoL) at the start of treatment may identify patients who are prone to a decrease in HRQoL and/or QoL resulting from chemotherapy. Identification of these factors may offer opportunities to enhance patient care during treatment by adapting communication strategies and directing medical and psychological interventions. The aim was to examine the association of sociodemographic factors, personality traits, and depressive symptoms with HRQoL and QoL in patients with advanced-stage lung cancer at the start of chemotherapy. Methods Patients (n = 151) completed the State-Trait Anxiety Inventory (trait anxiety subscale), the Neuroticism-Extraversion-Openness-Five Factor Inventory (NEO-FFI), the Center for Epidemiologic Studies Depression (CES-D), the World Health Organization Quality of Life-BREF (WHOQOL-BREF), and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Simple linear regression analyses were performed to select HRQoL and QoL associated factors (a P ≤ 0.10 was used to prevent non-identification of important factors) followed by multiple linear regression analyses (P ≤ 0.05). Results In the multiple regression analyses, CES-D score (β = − 0.63 to − 0.53; P-values < 0.001) was most often associated with the WHOQOL-BREF domains and general facet, whereas CES-D score (β = − 0.67 to − 0.40; P-values < 0.001) and Eastern Cooperative Oncology Group (ECOG) performance status (β = − 0.30 to − 0.30; P-values < 0.001) were most often associated with the scales of the EORTC QLQ-C30. Personality traits were not related with HRQoL or QoL except for trait anxiety (Role functioning: β = 0.30; P = 0.02, Environment: β = − 0.39; P = 0.007) and conscientiousness (Physical health: β = 0.20; P-value < 0.04). Conclusions Higher scores on depressive symptoms and ECOG performance status were related to lower HRQoL and QoL in patients with advanced-stage non-small cell lung cancer. Supportive care interventions aimed at improvement of depressive symptoms and performance score may facilitate an increase of HRQoL and/or QoL during treatment.
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Affiliation(s)
- Mark de Mol
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands.,Department of Pulmonary Diseases, Erasmus MC Cancer Institute, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Sabine Visser
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands.,Department of Pulmonary Diseases, Erasmus MC Cancer Institute, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Joachim Aerts
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands.,Department of Pulmonary Diseases, Erasmus MC Cancer Institute, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Paul Lodder
- Department of Methodology and Statistics, Tilburg University, P.O. Box 90151, 5000, LE, Tilburg, The Netherlands.,Department of Medical and Clinical Psychology, Centre of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, P.O. Box 90151, 5000, LE, Tilburg, The Netherlands
| | - Nico van Walree
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands
| | - Huub Belderbos
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands
| | - Brenda den Oudsten
- Department of Medical and Clinical Psychology, Centre of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, P.O. Box 90151, 5000, LE, Tilburg, The Netherlands.
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9
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Ezer N, Mhango G, Bagiella E, Goodman E, Flores R, Wisnivesky JP. Racial Disparities in Resection of Early Stage Non-Small Cell Lung Cancer: Variability Among Surgeons. Med Care 2020; 58:392-398. [PMID: 31895307 DOI: 10.1097/mlr.0000000000001280] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Racial disparities in resection of non-small cell lung cancer (NSCLC) are well documented. Patient-level and system-level factors only partially explain these findings. Although physician-related factors have been suggested as mediators, empirical evidence for their contribution is limited. OBJECTIVE To determine if racial disparities in receipt of thoracic surgery persisted after patients had a surgical consultation and whether there was a physician contribution to disparities in care. METHODS The authors identified 19,624 patients with stage I-II NSCLC above 65 years of age from the Surveillance-Epidemiology and End-Results-Medicare database. They studied black and white patients evaluated by a surgeon within 6 months of diagnosis. They assessed for racial differences in resection rates among surgeons using hierarchical linear modeling. Our main outcome was receipt of NSCLC resection. A random intercept was included to test for variability in resection rates across surgeons. Interaction between patient race and the random surgeon intercept was used to evaluate for heterogeneity between surgeons in resection rates for black versus white patients. RESULTS After surgical consultation, black patients were less likely to undergo resection (adjusted odds ratio, 0.57; 95% confidence interval, 0.47-0.69). Resection rates varied significantly between surgeons (P<0.001). A significant interaction between the surgeon intercept and race (P<0.05) showed variability beyond chance across surgeons in resection rates of black versus white patients. When the model included thoracic surgery specifalization the physician contribution to disparities in care was decreased. CONCLUSIONS Racial disparities in resection of NSCLC exist even among patients who had access to a surgeon. Heterogeneity between surgeons in resection rates between black and white patients suggests a physician's contribution to observed racial disparities. Specialization in thoracic surgery attenuated this contribution.
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Affiliation(s)
- Nicole Ezer
- Department of Medicine, Respiratory Division, Respiratory Epidemiology and Clinical Research Unit, McGill University, Montreal, QC, Canada
- Division of General Internal Medicine, Critical Care, and Sleep Medicine
| | - Grace Mhango
- Division of General Internal Medicine, Critical Care, and Sleep Medicine
| | | | - Emily Goodman
- Division of General Internal Medicine, Critical Care, and Sleep Medicine
| | | | - Juan P Wisnivesky
- Division of General Internal Medicine, Critical Care, and Sleep Medicine
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai
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10
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Feliciano J, Chang A, Venkatraman D, Brooks S, Zagaja C, Ettinger D, Hann C, Naidoo J, Voong R, Hales R, Turner M, Peterson V, Bodurtha J. Lung cancer and family-centered concerns. Support Care Cancer 2019; 28:497-505. [PMID: 31065838 DOI: 10.1007/s00520-019-04839-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 04/24/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Genetic and environmental interactions predispose certain groups to lung cancer, including families. Families or caregiving units experience the disease interdependently. We have previously evaluated the concerns and preferences of patients in addressing the lung cancer experience and cancer risks in their families. This qualitative study evaluates the concerns and preferences of family members and caregivers of patients with lung cancer in the lung cancer experience and familial cancer risks. METHODS We held focus groups to discuss the format and timing of addressing these preferences and concerns. Qualitative data generated was analyzed using a grounded theory approach. RESULTS Five focus groups totaling 19 participants were conducted. Seven themes were identified: (1) journey to lung cancer diagnosis has core dimensions for patient and family, (2) importance of communication between patients, families, and providers, (3) challenges for caregivers and family, (4) mixed perceptions of lung cancer causation among relatives, (5) discussion of cancer risk with relatives has complex dynamics, (6) impact of diagnosis on family health behaviors and screening, (7) role of genetic counseling. CONCLUSIONS Family members of patients with lung cancer are interested in discussing risk factors, prevention, and diagnoses and also would like access to other supportive services do learn about and cope with some of the stresses and barriers they experience in the family lung cancer journey. The diagnosis represents a potential teachable moment with the opportunity to reduce the risk of LC development or improve early detection in LC patient's family members.
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Affiliation(s)
- Josephine Feliciano
- Johns Hopkins Sidney Kimmel Cancer Center at Bayview, 301 Mason Lord Drive, Suite 4500, Baltimore, MD, 21224, USA.
| | - Alexander Chang
- Johns Hopkins University, 3400 North Charles Street, Baltimore, 21218, USA
| | - Deepti Venkatraman
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA
| | - Samara Brooks
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA
| | - Ciara Zagaja
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA
| | - David Ettinger
- Johns Hopkins Sidney Kimmel Cancer Center at Bayview, 301 Mason Lord Drive, Suite 4500, Baltimore, MD, 21224, USA
| | - Christine Hann
- Johns Hopkins Sidney Kimmel Cancer Center at Bayview, 301 Mason Lord Drive, Suite 4500, Baltimore, MD, 21224, USA
| | - Jarushka Naidoo
- Johns Hopkins Sidney Kimmel Cancer Center at Bayview, 301 Mason Lord Drive, Suite 4500, Baltimore, MD, 21224, USA
| | - Ranh Voong
- Johns Hopkins Department of Radiation Oncology, 401 North Broadway, Baltimore, MD, 21287, USA
| | - Russell Hales
- Johns Hopkins McKusick-Nathans Institute of Genetic Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Michelle Turner
- Johns Hopkins Sidney Kimmel Cancer Center at Bayview, 301 Mason Lord Drive, Suite 4500, Baltimore, MD, 21224, USA
| | - Valerie Peterson
- Johns Hopkins Sidney Kimmel Cancer Center at Bayview, 301 Mason Lord Drive, Suite 4500, Baltimore, MD, 21224, USA
| | - Joann Bodurtha
- Johns Hopkins McKusick-Nathans Institute of Genetic Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA
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11
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Williamson TJ, Choi AK, Kim JC, Garon EB, Shapiro JR, Irwin MR, Goldman JW, Bornyazan K, Carroll JM, Stanton AL. A Longitudinal Investigation of Internalized Stigma, Constrained Disclosure, and Quality of Life Across 12 Weeks in Lung Cancer Patients on Active Oncologic Treatment. J Thorac Oncol 2018; 13:1284-1293. [PMID: 29981926 PMCID: PMC6291203 DOI: 10.1016/j.jtho.2018.06.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/19/2018] [Accepted: 06/27/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Internalized lung cancer stigma (i.e., feelings of regret, shame, and self-blame about one's lung cancer) is related to poorer psychological outcomes. Less is known about how internalized stigma relates to physical and functional outcomes or how constrained disclosure (i.e., avoidance of or discomfort about disclosing one's lung cancer status to others) relates to well-being. Furthermore, no study has examined whether internalized stigma and constrained disclosure predict changes in well-being for lung cancer patients. This longitudinal study characterized relationships of internalized stigma and constrained disclosure with emotional and physical/functional outcomes. METHODS Participants (N = 101, 52.4% male, 63.4% currently/formerly smoked) were lung cancer patients on active medical treatment who completed questionnaires on stigma and well-being at study entry and at 6- and 12-week follow-up. Multivariable linear regressions characterized relationships of internalized stigma and constrained disclosure with emotional and physical/functional well-being at study entry and across time. RESULTS Participants who currently or formerly smoked reported higher levels of internalized stigma (but not constrained disclosure), compared to never smokers (p < 0.001). Higher internalized stigma and constrained disclosure were uniquely associated with poorer emotional and physical/functional well-being at study entry (all p < 0.05), beyond sociodemographic characteristics, time elapsed since diagnosis, and smoking status. Higher internalized stigma predicted significant declines in emotional well-being across 6 and 12 weeks (all p < 0.01) and declines in physical/functional well-being across 6 weeks (p < 0.05). CONCLUSIONS Internalized lung cancer stigma and constrained disclosure relate to emotional and physical/functional maladjustment. Findings carry implications for provider- and patient-focused interventions to reduce internalized stigma and promote well-being.
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Affiliation(s)
- Timothy J Williamson
- Department of Psychology, University of California-Los Angeles, Los Angeles, California
| | - Alyssa K Choi
- Department of Psychology, University of California-Los Angeles, Los Angeles, California
| | - Julie C Kim
- Department of Psychology, University of California-Los Angeles, Los Angeles, California
| | - Edward B Garon
- Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, California
| | - Jenessa R Shapiro
- Department of Psychology, University of California-Los Angeles, Los Angeles, California; Anderson School of Management, University of California-Los Angeles, Los Angeles, California
| | - Michael R Irwin
- Department of Psychology, University of California-Los Angeles, Los Angeles, California; Department of Psychiatry/Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, California; Cousins Center for Psychoneuroimmunology, University of California-Los Angeles, Los Angeles, California
| | - Jonathan W Goldman
- Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, California
| | - Krikor Bornyazan
- Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
| | - James M Carroll
- Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
| | - Annette L Stanton
- Department of Psychology, University of California-Los Angeles, Los Angeles, California; Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, California; Department of Psychiatry/Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, California; Cousins Center for Psychoneuroimmunology, University of California-Los Angeles, Los Angeles, California.
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12
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Hamann HA, Ver Hoeve ES, Carter-Harris L, Studts JL, Ostroff JS. Multilevel Opportunities to Address Lung Cancer Stigma across the Cancer Control Continuum. J Thorac Oncol 2018; 13:1062-1075. [PMID: 29800746 PMCID: PMC6417494 DOI: 10.1016/j.jtho.2018.05.014] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/17/2018] [Accepted: 05/17/2018] [Indexed: 12/13/2022]
Abstract
The public health imperative to reduce the burden of lung cancer has seen unprecedented progress in recent years. Fully realizing the advances in lung cancer treatment and control requires attention to potential barriers in their momentum and implementation. In this analysis, we present and evaluate the argument that stigma is a highly significant barrier to fulfilling the clinical promise of advanced care and reduced lung cancer burden. This evaluation of the stigma of lung cancer is based on a multilevel perspective that incorporates the individual, persons in the individual's immediate environment, the health care system, and the larger societal structure that shapes perceptions and decisions. We also consider current interventions and interventional needs within and across aspects of the lung cancer continuum, including prevention, screening, diagnosis, treatment, and survivorship. Current evidence suggests that stigma detrimentally affects psychosocial, communication, and behavioral outcomes over the entire lung cancer control continuum and across multiple levels. Interventional efforts to alleviate stigma in the context of lung cancer show promise, yet more work is needed to evaluate their impact. Understanding and addressing the multilevel role of stigma is a crucial area for future study to realize the full benefits offered by lung cancer prevention, control, and treatment. Coordinated, interdisciplinary, and well-conceptualized efforts have the potential to reduce the barrier of stigma in the context of lung cancer and facilitate demonstrable improvements in clinical care and quality of life.
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Affiliation(s)
- Heidi A. Hamann
- University of Arizona, Departments of Psychology and Family and Community Medicine, 1503 E University Blvd., Tucson, AZ, USA, ,
| | - Elizabeth S. Ver Hoeve
- University of Arizona, Departments of Psychology and Family and Community Medicine, 1503 E University Blvd., Tucson, AZ, USA, ,
| | - Lisa Carter-Harris
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN, USA,
| | - Jamie L. Studts
- University of Kentucky College of Medicine, Department of Behavioral Science, Lexington, KY, USA,
| | - Jamie S. Ostroff
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA,
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13
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Hamann HA, Shen MJ, Thomas AJ, Craddock Lee SJ, Ostroff JS. Development and Preliminary Psychometric Evaluation of a Patient-Reported Outcome Measure for Lung Cancer Stigma: The Lung Cancer Stigma Inventory (LCSI). STIGMA AND HEALTH 2018; 3:195-203. [PMID: 30393760 PMCID: PMC6208151 DOI: 10.1037/sah0000089] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Among patients with lung cancer, stigma is associated with negative psychosocial and behavioral outcomes. There is a need to develop psychometrically robust patient-reported outcome (PRO) measures for stigma that incorporate perspectives of patients diagnosed with lung cancer. As part of our multi-phase process of measure development and validation, we report on scale formation and preliminary psychometric evaluation of the Lung Cancer Stigma Inventory (LCSI). METHOD Building on previously reported concept elicitation (Phase I) work, Phase II of LCSI development involved item generation and refinement, informed by literature review, provider input, and patient (N=20) feedback. Phase III focused on initial psychometric scale evaluation in a unique sample of 231 lung cancer patients. RESULTS Based on provider input and patient cognitive interviews, 49 items were included in a preliminary measure. In an exploratory factor analysis (EFA) of the 37 retained items, three factors emerged: Perceived Stigma, Internalized Stigma, and Constrained Disclosure. Internal consistency of the final, 25-item LCSI scale was high (Cronbach's alpha= 0.89) and the three subscales demonstrated good internal consistency. The test-retest correlation was high (r = 0.91), suggesting strong stability of measurement over time. There was good convergent validity between the LCSI and an existing measure of lung cancer stigma, the Cataldo Lung Cancer Stigma Scale (CLCSS; r= 0.58, p< 0.001). DISCUSSION In a multi-phase process, we have developed a reliable, multi-dimensional measure of lung cancer stigma, the Lung Cancer Stigma Inventory (LCSI). Subsequent work will be conducted to establish further evidence of validity and clinically meaningful change.
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Affiliation(s)
- Heidi A Hamann
- Department of Psychology, Department of Family and Community Medicine, University of Arizona, Tucson, AZ
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX
- Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Megan J Shen
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Anna J Thomas
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
| | - Simon J Craddock Lee
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX
- Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
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Toh HJ, Low JA, Lim ZY, Lim Y, Siddiqui S, Tan L. Jonsen's Four Topics Approach as a Framework for Clinical Ethics Consultation. Asian Bioeth Rev 2018; 10:37-51. [PMID: 33717274 DOI: 10.1007/s41649-018-0047-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/03/2018] [Accepted: 03/05/2018] [Indexed: 01/24/2023] Open
Abstract
This was an in-depth qualitative study that looked at the reasons patients were referred to the Clinical Ethics Committee (CEC) of an acute hospital in Singapore and explore how the CEC approached cases referred. Jonsen's four topics approach was applied in the deliberative process for all cases. A comprehensive review of the case records of 28 patients referred consecutively to the CEC from 1 January 2012 to 31 December 2014 was conducted. Data and information was collated from the referral forms, patient medical records, and emails communicated among CEC members. A deductive approach to thematic analysis based on Jonsen's four topics approach was used to analyze the documents. Majority of the patients were male (94%), Chinese (76%), and above 65 years of age (41%). Ethical dilemmas surfaced due to differences in opinion regarding withholding of aggressive management (53%), withdrawing treatment (35%), and ascertaining patient's autonomy (12%). In most cases, the patients' preference on end-of-life care was unknown (82%). The main reasons for referral to the CEC were conflicts in clinical management and uncertainty about the decision-making capacity of patients. The CEC members tended to emphasize on "patient preference" more than the other quadrants in the four topics approach as they worked through each case. The Jonsen's four topics approach lays the groundwork to frame ethical dilemmas that can be easily applied in the clinical setting and is a useful tool for the CEC's teaching and discussion. Nonetheless, the approach only organizes ethical dilemmas and requires clinicians to apply own judgment in weighing ethical principles. Further studies can look into adapting the four topics approach to suit the local practices and context.
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Affiliation(s)
- Hui Jin Toh
- GeriCare@North, Khoo Teck Puat Hospital, Singapore, Singapore.,Education Research, Geriatric Education and Research Institute, Singapore, Singapore
| | - James Alvin Low
- GeriCare@North, Khoo Teck Puat Hospital, Singapore, Singapore.,Education Research, Geriatric Education and Research Institute, Singapore, Singapore.,Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Zhen Yu Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yvonne Lim
- Clinical Services, Khoo Teck Puat Hospital, Singapore, Singapore
| | | | - Lawrence Tan
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
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15
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Feliciano J, Becker B, Shukla M, Bodurtha J. Lung cancer and family-centered patient concerns. Support Care Cancer 2018; 26:3047-3053. [PMID: 29560503 DOI: 10.1007/s00520-018-4159-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/12/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The risk factors, diagnosis, management, and outcomes for lung cancer (LC) are a family experience. Genetic and environmental factors interact to predispose certain groups to LC, including family member, and the family or caregiving unit experiences the disease course as an interdependent group. This qualitative study examined the concerns and preferences of LC patients about incorporating family in addressing their lung cancer experiences and cancer risks. METHODS This project aims to identify concerns and preferences for addressing family history documentation, risk assessment, prevention, and follow-up issues for LC patients and their family. We held focus groups (FG) to discuss the format and timing of addressing these preferences and concerns. The qualitative data was analyzed using a grounded theory approach. RESULTS 7 FG totaling 17 participants were conducted. The mean age was 64. All patients had advanced lung cancer. Participants included five males; nine African-Americans; three current, 11 former and three never smokers. Five participants had parents or grandparents with LC. Two had siblings with LC. Six themes were identified: (1) Varied journeys to LC diagnosis. (2) Mixed patient perceptions of cancer causation. (3) Limited documentation and utilization of family history. (4) Diverse attitudes toward smoking cessation. (5) A range of discussions about cancer risk, prevention, and screening. (6) Implications for implementation of family-centered cancer care and health promotion. CONCLUSIONS The diagnosis of LC, its management, and outcomes occur in the family context. The diagnosis represents a potential teachable moment with opportunity to reduce the risk of LC development or improve early detection in a population at higher risk of developing lung cancer. Lung cancer patients are interested in discussing risk factors, prevention, and diagnosis of lung cancer for their relatives.
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Affiliation(s)
- Josephine Feliciano
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Breanna Becker
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Manish Shukla
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Joann Bodurtha
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins School of Medicine, 600 N. Wolfe St., Blalock 1008, Baltimore, MD, 21287, USA.
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16
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Baker BA, Hickman DL. Bias in Rating of Rodent Distress during Anesthesia Induction for Anesthesia Compared with Euthanasia. JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE : JAALAS 2018; 57:143-156. [PMID: 29555004 PMCID: PMC5868381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/08/2017] [Accepted: 11/06/2017] [Indexed: 06/08/2023]
Abstract
Selection of an appropriate method of euthanasia involves balancing the wellbeing of the animal during the procedure with the intended use of the animal after death and the physical and psychologic safety of the observer or operator. The recommended practices for anesthesia as compared with euthanasia are very disparate, despite the fact that all chemical methods of euthanasia are anesthetic overdoses. To explain this disparity, this study sought to determine whether perception bias is inherent in the discussion of euthanasia compared with anesthesia. In this study, participants viewed videorecordings of the anesthesia of either 4 rats or 4 mice, from induction to loss of consciousness. Half of the participants were told that they were observing anesthesia; the other half understood that they were observing euthanasia. Participants were asked to rate the distress of the animals by scoring escape behaviors, fear behaviors, respiratory distress, and other distress markers. For mice, the participants generally rated the distress as high when they were told that the mouse was being euthanized, as compared with the participants who were told that the mouse was being anesthetized. For rats, the effect was not as strong, and the distress was generally rated higher when participants were told they were watching anesthesia. Because the interpretation of distress showed bias in both species-even though the bias differed regarding the procedure that interpreted as distressing-this study demonstrates that laboratory animal professionals must consider the influence of potential perception bias when developing policies for euthanasia and anesthesia.
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Affiliation(s)
- Brittany A Baker
- Laboratory Animal Resource Center, School of Medicine, Indiana University, Indianapolis
| | - Debra L Hickman
- Laboratory Animal Resource Center, School of Medicine, Indiana University, Indianapolis;,
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17
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Goldvaser H, Milman Y, Dujovni T, Stern A, Mahamid M, Hanovich E, Zivony A, Shochat T, Yerushalmi R, Gafter-Gvili A, Brenner B, Shepshelovich D. Perception of prognosis of cancer patients by non-oncologists. Int J Clin Pract 2016; 70:1027-1032. [PMID: 28032432 DOI: 10.1111/ijcp.12909] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 10/07/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Data are lacking regarding the perception of cancer patients' prognosis by physicians who are not oncologists. METHODS This was a multicenter survey of seven university-affiliated hospitals, assessing physicians' perception of the median survival of patients with seven advanced malignancies. The study cohort included physicians from all 73 internal medicine, surgery, emergency medicine and critical care departments in the participating hospitals. Family practitioners were contacted through email. Physicians' specialty, age, professional status and hospital type (secondary vs tertiary) were noted. The primary end-point was defined as the percentage of answers with a pessimistic error of more than a year in perception of prognosis as compared with current literature. The secondary end-point was defined as any pessimistic answer. RESULTS Four hundred and eighty-eight physicians filled the questionnaire, including 429 hospital physicians and 59 family practitioners. Perception of prognosis was pessimistic when compared with current literature, with 37% and 59% of the answers meeting the primary and the secondary end-points, respectively. Younger age, resident status and work at a secondary hospital were associated with pessimistic perception (P<.001 for all variables). Pessimistic outlook was similar for all specialties and for most malignancies, including those with considerable cure rates such as Hodgkin's lymphoma and germ cell tumour. CONCLUSION Non-oncologists are considerably over pessimistic regarding their perception of the cancer patients' prognosis. A pessimistic perception of prognosis might cause undertreatment and therefore affect both patients' quality of life and their actual survival. Education regarding cancer therapy and its benefits should be emphasised for non-oncologists involved in cancer patient care.
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Affiliation(s)
- Hadar Goldvaser
- Davidoff Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, Petach Tikva, Israel
| | - Yonatan Milman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Dujovni
- Pediatric Oncology Unit, Emek Medical Center, Afula, Israel
| | - Anat Stern
- Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | | | | | - Amir Zivony
- Department of Family Medicine, Rabin Medical Center, Petach Tikva, Israel
| | - Tzippy Shochat
- Statistical Consulting Unit, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Rinat Yerushalmi
- Davidoff Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Gafter-Gvili
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Medicine A, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Baruch Brenner
- Davidoff Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Shepshelovich
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Medicine A, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
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18
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Tang PL, Mayer DK, Chou FH, Hsiao KY. The Experience of Cancer Stigma in Taiwan: A Qualitative Study of Female Cancer Patients. Arch Psychiatr Nurs 2016; 30:204-9. [PMID: 26992872 DOI: 10.1016/j.apnu.2015.08.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 08/22/2015] [Accepted: 08/25/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cancer is the leading cause of death in Taiwan. Because the causes of cancer are often difficult to identify, a diagnosis of cancer is occasionally attributed to karma and the concept of stigma. These feelings lead to a life predicament, and stigma influences these perceptions. OBJECTIVE This study intended to understand how stigma is formed in the disease-related experiences of women with cancer. METHODS Ten participants were interviewed at the time of a confirmed diagnosis of advanced cancer and completed cancer treatment with regular follow-up after treatment, and all subjects underwent 2-3 interviews. The number of interviews conducted was determined by data saturation. A content analysis method was used. RESULTS The stigma of cancer includes the concepts of "cancer equals death", including the feeling of death approaching and an awareness of disease severity. "Cancer equals menace to social life" suggests that social life is affected and includes other individuals' uncomfortable attitudes toward cancer (shame, sympathy, pity, suffering, and over-cautiousness) and external physical changes. "Cancer equals cancer-ridden life" includes being sensitive to the topics of death and calculating the number of remaining survival days. CONCLUSIONS The process from early diagnosis to the decision to receive treatment is complicated for patients with cancer. After the diagnosis is confirmed, the stigma of diagnosis significantly affects patients. Regarding social stereotypes, educating the public to resolve individuals' negative responses to cancer and further convey social and public information to women in society is necessary.
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Affiliation(s)
- Pei-Ling Tang
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Deborah K Mayer
- University of North Carolina School of Nursing, Chapell Hill, NC
| | - Fan-Hao Chou
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan.
| | - Kuan-Yin Hsiao
- Radiation Oncology Department, Kaohsiung Municipal United Hospital, Kaohsiung City, Taiwan
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19
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Sriram N, Mills J, Lang E, Dickson HK, Hamann HA, Nosek BA, Schiller JH. Attitudes and Stereotypes in Lung Cancer versus Breast Cancer. PLoS One 2015; 10:e0145715. [PMID: 26698307 PMCID: PMC4689531 DOI: 10.1371/journal.pone.0145715] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 12/08/2015] [Indexed: 11/19/2022] Open
Abstract
Societal perceptions may factor into the high rates of nontreatment in patients with lung cancer. To determine whether bias exists toward lung cancer, a study using the Implicit Association Test method of inferring subconscious attitudes and stereotypes from participant reaction times to visual cues was initiated. Participants were primarily recruited from an online survey panel based on US census data. Explicit attitudes regarding lung and breast cancer were derived from participants’ ratings (n = 1778) regarding what they thought patients experienced in terms of guilt, shame, and hope (descriptive statements) and from participants’ opinions regarding whether patients ought to experience such feelings (normative statements). Participants’ responses to descriptive and normative statements about lung cancer were compared with responses to statements about breast cancer. Analyses of responses revealed that the participants were more likely to agree with negative descriptive and normative statements about lung cancer than breast cancer (P<0.001). Furthermore, participants had significantly stronger implicit negative associations with lung cancer compared with breast cancer; mean response times in the lung cancer/negative conditions were significantly shorter than in the lung cancer/positive conditions (P<0.001). Patients, caregivers, healthcare providers, and members of the general public had comparable levels of negative implicit attitudes toward lung cancer. These results show that lung cancer was stigmatized by patients, caregivers, healthcare professionals, and the general public. Further research is needed to investigate whether implicit and explicit attitudes and stereotypes affect patient care.
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Affiliation(s)
- N. Sriram
- Psychology Department, University of Virginia, Charlottesville, Virginia, United States of America
| | - Jennifer Mills
- Genentech, Inc., South San Francisco, California, United States of America
| | - Edward Lang
- Genentech, Inc., South San Francisco, California, United States of America
| | - Holli K. Dickson
- Genentech, Inc., South San Francisco, California, United States of America
| | - Heidi A. Hamann
- Division of Hematology and Oncology Division, University of Texas Southwestern, Dallas, Texas, United States of America
- Department of Psychology University of Arizona, Tucson, Arizona, United States of America
| | - Brian A. Nosek
- Psychology Department, University of Virginia, Charlottesville, Virginia, United States of America
| | - Joan H. Schiller
- Division of Hematology and Oncology Division, University of Texas Southwestern, Dallas, Texas, United States of America
- * E-mail:
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20
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Blackhall LJ, Read P, Stukenborg G, Dillon P, Barclay J, Romano A, Harrison J. CARE Track for Advanced Cancer: Impact and Timing of an Outpatient Palliative Care Clinic. J Palliat Med 2015; 19:57-63. [PMID: 26624851 DOI: 10.1089/jpm.2015.0272] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Studies suggest that outpatient palliative care can reduce hospitalization and increase hospice utilization for patients with cancer, however there are insufficient resources to provide palliative care to all patients from time of diagnosis. It is also unclear whether inpatient consultation alone provides similar benefits. A better understanding of the timing, setting, and impact of palliative care for patients with cancer is needed. OBJECTIVES The purpose of this study was to measure timing of referral to outpatient palliative care and impact on end-of-life (EOL) care. DESIGN The Comprehensive Assessment with Rapid Evaluation and Treatment (CARE Track) program is a phased intervention integrating outpatient palliative care into cancer care. In Year 1 patients were referred at the discretion of their oncologist. SETTING Academic medical center. MEASUREMENTS We compared EOL hospitalization, hospice utilization, and costs of care for CARE Track patients compared to those never seen by palliative care or seen only in hospital. RESULTS Patients were referred a median of 72.5 days prior to death. CARE Track patients had few hospitalizations at end of life, were less likely to die in hospital, had increased hospice utilization, and decreased costs of care; these results were significant even after controlling for differences between groups. Inpatient consultation alone did not impact these variables. However, only approximately half of patients with incurable cancers were referred to this program. CONCLUSION Referral outpatient palliative care within 3 months of death improved EOL care and reduced costs, benefits not seen with inpatient care only. However, many patients were never referred, and methods of systematically identifying appropriate patients are needed.
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Affiliation(s)
- Leslie J Blackhall
- 1 Department of Palliative Care, University of Virginia , Charlottesville, Virginia.,2 Department of Internal Medicine, University of Virginia , Charlottesville, Virginia
| | - Paul Read
- 3 Department of Public Health Sciences, University of Virginia , Charlottesville, Virginia
| | - George Stukenborg
- 4 Department of Health Services Research, University of Virginia , Charlottesville, Virginia
| | - Patrick Dillon
- 5 Department of Medical Oncology, University of Virginia , Charlottesville, Virginia
| | - Joshua Barclay
- 2 Department of Internal Medicine, University of Virginia , Charlottesville, Virginia
| | - Andrew Romano
- 5 Department of Medical Oncology, University of Virginia , Charlottesville, Virginia
| | - James Harrison
- 3 Department of Public Health Sciences, University of Virginia , Charlottesville, Virginia
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21
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Kaptein AA, Kobayashi K, Matsuda A, Kubota K, Nagai S, Momiyama M, Sugisaki M, Bos BC, Warning TD, Dik H, Klink RV, Inoue K, Ramai R, Taube C, Kroep JR, Fischer MJ. We’re in this together: Patients’, caregivers’ and health care providers’ illness perceptions about non-small-cell lung cancer (NSCLC). Lung Cancer 2015; 90:575-81. [DOI: 10.1016/j.lungcan.2015.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/08/2015] [Accepted: 10/12/2015] [Indexed: 12/17/2022]
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22
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Association between patient-provider communication and lung cancer stigma. Support Care Cancer 2015; 24:2093-2099. [PMID: 26553030 DOI: 10.1007/s00520-015-3014-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/01/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE The majority (95 %) of lung cancer patients report stigma, with 48 % of lung cancer patients specifically reporting feeling stigmatized by their medical providers. Typically associated with the causal link to smoking and the historically poor prognosis, lung cancer stigma can be seen as a risk factor for poor psychosocial and medical outcomes in the context of lung cancer diagnosis and treatment. Thus, modifiable targets for lung cancer stigma-reducing interventions are needed. The present study sought to test the hypothesis that good patient-provider communication is associated with lower levels of lung cancer stigma. METHODS Lung cancer patients (n = 231) across varying stages of disease participated in a cross-sectional, multisite study designed to understand lung cancer stigma. Patients completed several survey measures, including demographic and clinical characteristics, a measure of patient-provider communication (Consumer Assessment of Healthcare Providers and Systems Program or CAHPS), and a measure of lung cancer stigma (Cataldo Lung Cancer Stigma Scale). RESULTS As hypothesized, results indicated that good patient-provider communication was associated with lower levels of lung cancer stigma (r = -0.18, p < 0.05). These results remained significant, even when controlling for relevant demographic and clinical characteristics (Stan. β = -0.15, p < 0.05). CONCLUSIONS Results indicate that good patient-provider communication is associated with lower levels of lung cancer stigma, suggesting that improving patient-provider communication may be a good intervention target for reducing lung cancer stigma.
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Shi Y, Gu F, Hou LL, Hu YQ. Self-reported depression among patients with non-small cell lung cancer. Thorac Cancer 2015; 6:334-7. [PMID: 26273380 PMCID: PMC4448394 DOI: 10.1111/1759-7714.12179] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 09/09/2014] [Indexed: 11/30/2022] Open
Abstract
Background Lung cancer is a disease with a poor prognosis and psychological impact. Lung cancer causes both physical and psychological burdens on patients, and financial burdens on families and society. The aim of this study was to examine the relationship between depression and influencing factors in non-small-cell lung cancer (NSCLC) patients. Methods A quantitative study was applied. Data was obtained from the Shanghai Pulmonary Hospital in China. One hundred and four patients with NSCLC were surveyed. Self-rating depression scale (SDS), social support rating scale (SSRS), and visual analog scale (VAS) were used. Results Among the 104 patients, 48 (46.1%) were diagnosed with depression. Gender (P = 0.000), disease duration (P = 0.006), self-care ability (P = 0.004), and pain (P = 0.003) were statistically significant predictors of self-reported depression in non-small-cell lung cancer patients. Conclusions Self-reported depression is highly prevalent in NSCLC patients. In addition, gender, disease duration, self-care ability, pain and social support may increase self-reported depression.
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Affiliation(s)
- Yan Shi
- Department of Nursing, Tenth People's Hospital of Tongji University Shanghai, China
| | - Fen Gu
- Department of Nursing, Shanghai Pulmonary Hospital of Tongji University Shanghai, China
| | - Li-Li Hou
- Department of Nursing, Shanghai Pulmonary Hospital of Tongji University Shanghai, China
| | - Yin-Qing Hu
- Department of Nursing, Shanghai Pulmonary Hospital of Tongji University Shanghai, China
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Maneeton B, Maneeton N, Reungyos J, Intaprasert S, Leelarphat S, Thongprasert S. Prevalence and relationship between major depressive disorder and lung cancer: a cross-sectional study. Onco Targets Ther 2014; 7:815-21. [PMID: 24920922 PMCID: PMC4043796 DOI: 10.2147/ott.s60000] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective The aims of this study were to estimate the prevalence and examine the factors associated with major depressive disorder (MDD) in lung cancer patients. Materials and methods This cross-sectional study was carried out in the oncology clinic of the University Hospital, Chiang Mai University, Thailand. Patients with all stages of lung cancer were included in this study. Demographic data of eligible patients were gathered. The Mini-International Neuropsychiatric Interview, Thai version 5.0.0 was used to identify MDD. The Thai version of the Personal Health Questionnaire Depression Scale was used to assess depression severity. Results A total of 146 lung cancer patients from the outpatient clinic from July to December 2012 were approached. The 104 patients were included and analyzed in this study. Based on the Mini-International Neuropsychiatric Interview, 14.4% of them were defined as having MDD. Multiple linear regression analysis revealed that Chalder Fatigue Scale, Functional Assessment of Cancer Therapy – Lung, and Pittsburgh Sleep Quality Index scores were significantly correlated with MDD in lung cancer patients. Conclusion The results suggest that MDD is more prevalent in lung cancer patients. In addition, fatigue, poor quality of life, and sleep disturbance may increase associated MDD. Because of the small sample size, further studies should be conducted to confirm these results.
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Affiliation(s)
| | - Narong Maneeton
- Department of Psychiatry, Chiang Mai University, Chiang Mai, Thailand
| | - Jirayu Reungyos
- Department of Psychiatry, Chiang Mai University, Chiang Mai, Thailand
| | - Suthi Intaprasert
- Department of Psychiatry, Chiang Mai University, Chiang Mai, Thailand
| | | | - Sumitra Thongprasert
- Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Hamann HA, Ostroff JS, Marks EG, Gerber DE, Schiller JH, Lee SJC. Stigma among patients with lung cancer: a patient-reported measurement model. Psychooncology 2013; 23:81-92. [PMID: 24123664 DOI: 10.1002/pon.3371] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 07/08/2013] [Accepted: 07/12/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Although stigma may have negative psychosocial and behavioral outcomes for patients with lung cancer, its measurement has been limited. A conceptual model of lung cancer stigma and a patient-reported outcome measure are needed to mitigate these sequelae. This study identified key stigma-related themes to provide a blueprint for item development through a thematic analysis of semi-structured interviews and focus groups with lung cancer patients. METHODS Participants were recruited from two outpatient oncology clinics and included (i) 42 lung cancer patients who participated in individual interviews and (ii) 5 focus groups (inclusive of 23 new lung cancer patients). Never smokers, long-term quitters, recent quitters, and current smokers participated. Individual interviews facilitated theme development and a conceptual model of lung cancer stigma, whereas subsequent focus groups provided feedback on the conceptual model. Qualitative data analyses included iterative coding and validation with existing theory. RESULTS Two main thematic elements emerged from interviews with lung cancer patients: perceived (felt) stigma and internalized (self) stigma. Discussions of perceived stigma were pervasive, whereas those of internalized stigma were more commonly endorsed among current and recently quit smokers. Participants also discussed maladaptive (e.g., decreased disclosure) and adaptive (e.g., increased advocacy) stigma-related consequences. CONCLUSIONS Results indicate widespread acknowledgment of perceived stigma among lung cancer patients but varying degrees of internalized stigma and associated consequences. Next steps for patient-reported outcome measure development are item consolidation, item development, expert input, and cognitive interviews before field testing and psychometric analysis. Future work should address stigma-related consequences and interventions for reducing lung cancer stigma.
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Affiliation(s)
- Heidi A Hamann
- Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA; Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA; Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA
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