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Chu Q, Tang M, Chen L, Young L, Loh A, Wang C, Lu Q. Evaluating a Pilot Culturally Sensitive Psychosocial Intervention on Posttraumatic Growth for Chinese American Breast Cancer Survivors. Behav Med 2022; 48:251-260. [PMID: 33226894 PMCID: PMC9295633 DOI: 10.1080/08964289.2020.1845600] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study investigated the potential benefit of a pilot culturally sensitive group support intervention, named Joy Luck Academy (JLA), in fostering posttraumatic growth among Chinese American breast cancer survivors. Eighty-six Chinese American breast cancer survivors participated in an eight-week single-arm pre-/post-test trial of an intervention program, which included educational lectures and peer mentor support. The JLA participants were compared with an independent sample of 109 Chinese American breast cancer survivors who went through routine care. Both groups completed baseline and eight-week follow-up assessments of the five facets of posttraumatic growth (meaningful interpersonal relationships, finding new possibilities in life, personal strength, appreciation of life, and spirituality). From baseline to follow-up, the JLA participants displayed significant improvements in the total score of posttraumatic growth, meaningful interpersonal relationships, appreciation of life, finding new possibilities in life, and personal strength. In contrast, the routine care participants showed no significant change in any of these outcome variables. The findings suggest the potential benefit of a culturally sensitive group support intervention in facilitating posttraumatic growth for Chinese American breast cancer survivors, indicating the need for a randomized controlled trial. The educational lectures and peer mentor support may be adapted to tailor the needs of other ethnic minority cancer patients.
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Affiliation(s)
- Qiao Chu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, China
| | - Moni Tang
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, TX, USA
| | - Lingjun Chen
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, TX, USA
| | | | | | | | - Qian Lu
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, TX, USA,Department of Psychology, University of Houston, TX, USA
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Jin R, Xie T, Zhang L, Gong N, Zhang J. Stigma and its influencing factors among breast cancer survivors in China: A cross-sectional study. Eur J Oncol Nurs 2021; 52:101972. [PMID: 33991869 DOI: 10.1016/j.ejon.2021.101972] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Although stigma has attracted considerable scholarly attention, few studies have focused on its influencing factors among discharged breast cancer survivors, especially in a Chinese cultural context. The present study therefore explores stigma and its influencing factors among breast cancer survivors in China. METHOD Between December 2017 and May 2018, 103 breast cancer survivors at the outpatient clinic of a tertiary cancer center in southern China were enrolled in a cross-sectional study. The research instruments comprised the Social Impact Scale (SIS), the General Self-Efficacy Scale (GSES), the Medical Coping Modes Questionnaire (MCMQ), and sociodemographic and disease-related questionnaires. Descriptive statistics, univariate analysis, and multivariable linear regression were used to explore the current status of stigma and to identify influencing factors. RESULTS Of the respondents, 76.7% and 8.7%, respectively, reported moderate and high levels of stigma. The mean SIS score was 55.20 ± 12.15 (moderate), and the SIS subscale with the highest average score was financial insecurity. The results of a multivariable linear regression showed that body image (β = 0.32, P<0.001), spousal support (β = -0.47, P < 0.001), personal acceptance of the disease (β = -0.22, P<0.001), coping modes (resignation) (β = 0.14, P < 0.001), support from medical staff (β = -0.23, P < 0.001) and self-efficacy (β = -0.10, P = 0.037) were the main factors influencing stigma among breast cancer survivors (R2 = 0.83). CONCLUSIONS Stigma, among breast cancer survivors, which is influenced by various sociocultural factors, is a neglected issue requiring attention. Healthcare professionals should therefore formulate effective measures for alleviating stigma in this group by improving their self-efficacy and acceptance of the disease, reducing their poor body image and negative coping mode, and eliciting more support from their spouses and medical staff.
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Affiliation(s)
- Ruiqi Jin
- School of Nursing, Sun Yat-sen University, Zhongshan 2 Rd 74#, Guangzhou, Guangdong, PR China
| | - Tingting Xie
- School of Nursing, Sun Yat-sen University, Zhongshan 2 Rd 74#, Guangzhou, Guangdong, PR China
| | - Lijuan Zhang
- Department of Breast Surgery, Sun Yat-sen University Cancer Center, Dongfeng 1 Rd 651#, Guangzhou, Guangdong, PR China
| | - Ni Gong
- School of Nursing, Jinan University, Huangpudadaoxi Rd 601#, Guangzhou, Guangdong, PR China
| | - June Zhang
- School of Nursing, Sun Yat-sen University, Zhongshan 2 Rd 74#, Guangzhou, Guangdong, PR China.
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Warmoth K, Wong CCY, Chen L, Ivy S, Lu Q. The role of acculturation in the relationship between self-stigma and psychological distress among Chinese American breast cancer survivors. PSYCHOL HEALTH MED 2020; 25:1278-1292. [DOI: 10.1080/13548506.2020.1734638] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Krystal Warmoth
- Krystal Warmoth, Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Celia C. Y. Wong
- Department of Psychology, The College at Brockport, State University of New York, Brockport, NY, USA
| | - Lingjun Chen
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shelby Ivy
- University of Texas at San Antonio, San Antonio, TX, USA
| | - Qian Lu
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Hu Y, Cheng C, Chee W, Im EO. Issues in internet-based support for chinese-american breast cancer survivors. Inform Health Soc Care 2019; 45:204-216. [DOI: 10.1080/17538157.2019.1624967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Yun Hu
- School of Nursing, Shanghai Jiaotong University, Shanghai, China
- School of Nursing, Duke University, DURHAM, USA
| | - Chingyu Cheng
- College of Nursing, Chang Gung University of Science and Technology, Puzi, Taiwan
| | | | - Eun-Ok Im
- School of Nursing, Duke University, DURHAM, USA
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Yeung NCY, Lu Q, Mak WWS. Self-perceived burden mediates the relationship between self-stigma and quality of life among Chinese American breast cancer survivors. Support Care Cancer 2019; 27:3337-3345. [PMID: 30617433 DOI: 10.1007/s00520-018-4630-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 12/27/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Cancer-related self-stigma (the internalized sense of shame about having cancer) has been found to associate with poorer quality of life (QoL) among cancer survivors. However, culturally salient illness beliefs (e.g., cancer is contagious; cancer is a result of karma; and cancer brings shame to the family) may make Chinese cancer survivors vulnerable to self-stigmatization. This study examined the association between self-stigma and QoL among Chinese American breast cancer survivors (BCS). To understand the potential mechanism, the mediating role of self-perceived burden to caregivers between self-stigma and QoL was also examined. METHODS Chinese American BCS (n = 136) were recruited through community-based cancer associations. Participants' self-stigma, self-perceived burden, and QoL were measured in a questionnaire package. RESULTS Structural equation modeling results supported the proposed mediation model in predicting physical QoL (χ2(100) = 123.041, CFI = 0.982, TLI = 0.975, RMSEA = 0.041) and emotional QoL (χ2(84) = 137.277, CFI = 0.958, TLI = 0.940, RMSEA = 0.069), with satisfactory model fit indices. Both the indirect effects from self-stigma to QoL via self-perceived burden (physical: β = - 0.13; 95% CI = - 0.22, - 0.07 and emotional: β = - 0.11; 95% CI = - 0.22, - 0.04) and the direct effects from self-stigma to poorer QoL were significant (physical: β = - 0.22; 95% CI = -0.34, -0.10 and emotional: β = - 0.39; 95% CI = - 0.54, - 0.23), suggesting a partial mediation effect of self-perceived burden between self-stigma and QoL. CONCLUSIONS Self-stigma could reduce physical and emotional QoL through increasing self-perceived burden. Interventions aiming to reduce Chinese American BCS' self-stigma and perceptions of burdensomeness may facilitate improvement in QoL, which in turn promotes better cancer survivorship.
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Affiliation(s)
- Nelson C Y Yeung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 508, Postgraduate Education Centre, Prince of Wales Hospital, School of Medicine, Shatin, Hong Kong.
| | - Qian Lu
- Health Disparities Research Department - UNIT 1440, UT MD Anderson Cancer Center, P.O. Box 301402, Houston, TX, 77230-1402, USA.
| | - Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Rm 354, Sino Building, Shatin, Hong Kong
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Exploring the Social Needs and Challenges of Chinese American Immigrant Breast Cancer Survivors: a Qualitative Study Using an Expressive Writing Approach. Int J Behav Med 2018; 24:827-835. [PMID: 28585073 DOI: 10.1007/s12529-017-9661-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Little is known about the psychological well-being and social barriers among immigrant Chinese American breast cancer survivors. The aim of the present study was to explore the social needs and challenges of Chinese American immigrant breast cancer survivors. METHOD This study used the expressive writing approach to explore the experiences among 27 Chinese American breast cancer survivors. The participants were recruited through community-based organizations in Southern California, most of whom were diagnosed at stages I and II (33 and 48%, respectively). Participants, on average, had been living in the USA for 19 years. Participants were asked to write three 20-min essays related to their experience with breast cancer (in 3 weeks). Participants' writings were coded with line-by-line analysis, and categories and themes were generated. RESULTS Emotion suppression, self-stigma, and perceived stigma about being a breast cancer survivor were reflected in the writings. Interpersonally, participants indicated their reluctance to disclose cancer diagnosis to family and friends and concerns about fulfilling multiple roles. Some of them also mentioned barriers of communicating with their husbands. Related to life in the USA, participants felt unfamiliar with the healthcare system and encountered language barriers. CONCLUSION Counseling services addressing concerns about stigma and communication among family members may benefit patients' adjustments. Tailor-made information in Chinese about diagnosis and treatment for breast cancer and health insurance in the USA may also help patients go through the course of recovery.
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Bressan V, Bagnasco A, Aleo G, Timmins F, Barisone M, Bianchi M, Pellegrini R, Sasso L. Mixed-methods research in nursing - a critical review. J Clin Nurs 2017; 26:2878-2890. [DOI: 10.1111/jocn.13631] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Valentina Bressan
- Unità Operativa Formazione e Aggiornamento; Department of Health Sciences; University of Genoa; Genoa Italy
| | - Annamaria Bagnasco
- Unità Operativa Formazione e Aggiornamento; Department of Health Sciences; University of Genoa; Genoa Italy
| | - Giuseppe Aleo
- Unità Operativa Formazione e Aggiornamento; Department of Health Sciences; University of Genoa; Genoa Italy
| | - Fiona Timmins
- Trinity College Dublin; School of Nursing and Midwifery; Dublin Ireland
| | | | - Monica Bianchi
- Department of Health Sciences; University of Genoa; Genoa Italy
| | | | - Loredana Sasso
- Department of Health Sciences; University of Genoa; Genoa Italy
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Schwartz CE. Introduction to special section on response shift at the item level. Qual Life Res 2016; 25:1323-5. [PMID: 27125954 DOI: 10.1007/s11136-016-1299-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Carolyn E Schwartz
- DeltaQuest Foundation, 31 Mitchell Road, Concord, MA, 01742, USA.
- Departments of Medicine and Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA, USA.
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Lee A, Brann L. Influence of Cultural Beliefs on Infant Feeding, Postpartum and Childcare Practices among Chinese-American Mothers in New York City. J Community Health 2016; 40:476-83. [PMID: 25331609 DOI: 10.1007/s10900-014-9959-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
As one of the fastest growing communities in the United States, Chinese-Americans receive relatively little research attention on their rates of breastfeeding versus formula feeding, and what factors influence that choice. This research aims to examine the influence of elders and cultural beliefs on postpartum, infant feeding, and childcare practices. Semi-structured interviews with 22 recently postpartum mothers who met the recruiting criteria were conducted between July 2012 and February 2013. The traditional postpartum practice, zuo yuezi, presented negative physical and emotional outcomes and maternal reporting of delay in lactation. Early introduction of solids for traditional reasons was reported. The support from husbands and elders were necessary for breastfeeding success, while some mothers had to first negotiate with elders for breastfeeding. The practice of sending infants back to China to be taken care of by extended families presented cultural implications related to grandparents' involvement in raising grandchildren. With the respect and appreciation for elders and traditions, it is likely that Chinese mothers negotiate between cultural traditions and societal expectation in the western home.
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Affiliation(s)
- Adele Lee
- Nutrition Program, Department of Public Health, Food Studies and Nutrition, Syracuse University, 426 Ostrom Avenue, Syracuse, NY, 13244, USA,
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Wen KY, Hu A, Ma GX, Fang CY, Daly MB. Information and communication needs of Chinese American breast cancer patients: perspectives on survivorship care planning. JOURNAL OF COMMUNITY AND SUPPORTIVE ONCOLOGY 2014; 12:439-445. [PMID: 25811036 DOI: 10.12788/jcso.0095] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The existing knowledge on the survivorship experiences of Chinese American breast cancer survivors (CABCS) has arisen largely from aggregated data across multiethnic or multicancer studies that have focused on quality of life. Little is known about Chinese American perspectives and preferences for survivorship care. OBJECTIVE To examine the experiences of CABCS to better understand their information and communication needs and their preferences for survivorship care plans (SCPs). METHODS 16 CABCS, aged 37-72 years, were recruited through community-based organizations in the Northeast United States to participate in one-on-one telephone interviews about their breast cancer survivorship experience. The semistructured interviews were conducted in Mandarin, Cantonese, or English. Two investigators transcribed and translated the audio recordings into English and analyzed the interview transcripts using established methods of qualitative content analysis. RESULTS Three main themes were identified through analysis of interview transcripts: the need for evidence-based and culturally and linguistically appropriate health information; the role of language or communication barriers and culture in accessing care and communicating with providers; and preferences for SCP elements and format. LIMITATIONS The sample may not be representative of the entire population of CABCS. CONCLUSIONS The findings provide insight into the information and communication needs and SCP preferences of CABCS. Understanding the cultural nuances that underlie these needs and preferences is critical for improving CABCS's quality of life after treatment for cancer. SCPs that incorporate Chinese-language resources and address the unique cultural needs of this population should be developed and they should include information about diet and nutrition as well as traditional Chinese medicine.
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Affiliation(s)
- Kuang-Yi Wen
- Cancer Prevention and Control Program, Fox Chase Cancer Center
| | - Angela Hu
- Cancer Prevention and Control Program, Fox Chase Cancer Center
| | - Grace X Ma
- Department of Public Health, Center for Asian Health, Temple University, Philadelphia, Pennsylvania
| | - Carolyn Y Fang
- Cancer Prevention and Control Program, Fox Chase Cancer Center
| | - Mary B Daly
- Cancer Prevention and Control Program, Fox Chase Cancer Center
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You J, Lu Q. Social constraints and quality of life among Chinese-speaking breast cancer survivors: a mediation model. Qual Life Res 2014; 23:2577-84. [PMID: 24777868 DOI: 10.1007/s11136-014-0698-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Literature has revealed detrimental effects of unsupportive interpersonal interactions on adjustment to cancer. However, no studies have examined this effect and the underlying psychological pathways among Chinese-speaking breast cancer survivors. The study investigated the relationship between social constraints and adjustment to cancer and the underlying psychological pathways among Chinese-speaking breast cancer survivors. METHODS Chinese-speaking breast cancer survivors (N = 120) completed a questionnaire package assessing social constraints, intrusive thoughts, affect, and quality of life. RESULTS Results revealed a negative relationship between social constraints and quality of life. Such a relationship between social constraints and quality of life was mediated by negative affect and intrusive thoughts, while the association of intrusive thoughts and quality of life were completely mediated by positive and negative affect. CONCLUSION Findings highlight the negative association between unsupportive interpersonal interactions and adjustment through cognitive and affective pathways among Chinese-speaking breast cancer survivors.
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Affiliation(s)
- Jin You
- Department of Psychology, Wuhan University, Wuhan, Hubei, China,
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Perceived information needs and social support of Chinese-Australian breast cancer survivors. Support Care Cancer 2014; 22:2651-9. [DOI: 10.1007/s00520-014-2252-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
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Wang JHY, Sheppard VB, Liang W, Ma GX, Maxwell AE. Recruiting Chinese Americans into cancer screening intervention trials: strategies and outcomes. Clin Trials 2014; 11:167-77. [PMID: 24567288 DOI: 10.1177/1740774513518849] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cancer is the leading cause of death among Asian Americans. While Asian Americans are the fastest growing minority population in the United States, they are underrepresented in cancer research and report poor adherence to cancer screening guidelines. PURPOSE This study utilized data from two large randomized intervention trials to evaluate strategies to recruit first-generation Chinese American immigrants from community settings and Chinese American physician practices. Findings will inform effective strategies for promoting Asian American participation in cancer control research. METHODS Chinese Americans who were non-adherent to annual mammography screening guidelines (Study 1 with 664 immigrant women > 40 years of age) and to colorectal cancer screening guidelines (Study 2 with 455 immigrants > 50 years of age) were enrolled from the greater Washington DC, New York City (NYC), and Philadelphia (PA) areas. Both studies trained bilingual staff to enroll Chinese-speaking participants with the aid of linguistically appropriate fliers and brochures to obtain consent. Study 1 adopted community approaches and worked with community organizations to enroll participants. Study 2 randomly selected potential participants through 24 Chinese American primary-care physician offices, and mailed letters from physicians to enroll patients, followed by telephone calls from research staff. The success of recruitment approaches was assessed by yield rates based on number of participants approached, ineligible, and consented. RESULTS Most participants (70%) of Study 1 were enrolled through in-person community approaches (e.g., Chinese schools, stores, health fairs, and personal networks). The final yield of specific venues differed widely (6% to 100%) due to various proportions of ineligible subjects (2%-64%) and refusals (0%-92%). The Study 2 recruitment approach (physician letter followed by telephone calls) had different outcomes in two geographic areas, partially due to differences in demographic characteristics in the DC and NYC/PA areas. The community approaches enrolled more recent immigrants and uninsured Chinese Americans than the physician and telephone call approach (p < .001). Enrollment cost is provided to inform future research studies. LIMITATIONS Our recruitment outcomes might not be generalizable to all Chinese Americans or other Asian American populations because they may vary by study protocols (e.g., length of trials), target populations (i.e., eligibility criteria), and available resources. CONCLUSIONS Use of multiple culturally relevant strategies (e.g., building trusting relationships through face-to-face enrollment, use of bilingual and bicultural staff, use of a physician letter, and employing linguistically appropriate materials) was crucial for successfully recruiting a large number of Chinese Americans in community and clinical settings. Our data demonstrate that substantial effort is required for recruitment; studies need to budget for this effort to ensure the inclusion of Asian Americans in health research.
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Affiliation(s)
- Judy Huei-yu Wang
- aDepartment of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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Wang JHY, Adams IF, Tucker-Seeley R, Gomez SL, Allen L, Huang E, Wang Y, Pasick RJ. A mixed method exploration of survivorship among Chinese American and non-Hispanic White breast cancer survivors: the role of socioeconomic well-being. Qual Life Res 2013; 22:2709-20. [PMID: 23591710 PMCID: PMC3855903 DOI: 10.1007/s11136-013-0374-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2013] [Indexed: 01/07/2023]
Abstract
PURPOSE Cancer-related stress is heavily influenced by culture. This study explored similarities and differences in survivorship care concerns among Chinese American and non-Hispanic White (NHW) breast cancer survivors. METHODS A sequential, mixed-method design (inductive/qualitative research-phase I and deductive/quantitative research-phase II) was employed. Eligible women identified from the Greater Bay Area Cancer Registry were age ≥21, diagnosed with stage 0-IIa breast cancer between 2006 and 2011, and had no recurrence or other cancers. In phase I, we conducted 4 Chinese (n = 19) and 4 NHW (n = 22) focus groups, and 31 individual telephone interviews (18 Chinese immigrants, 7 Chinese US-born, and 6 NHW). Content analysis was conducted to examine qualitative data. In phase II, another 296 survivors (148 NHW age-matched to 148 Chinese cases) completed a cross-sectional survey. Descriptive statistics and linear regression analysis were conducted to examine quantitative data. RESULTS Qualitative data revealed "socioeconomic well-being" (SWB) as a dominant survivorship concern, which was operationalized as a cancer survivor's perceived economic and social resources available to access care. Quantitative data showed that low-acculturated Chinese immigrants reported the poorest SWB, controlling for covariates. Highly acculturated Chinese immigrants and the US-born Chinese/NHW group reported similar SWB. Women who had low-income levels or chemotherapy had poorer SWB. CONCLUSIONS SWB emerged as an important aspect of breast cancer survivorship. Immigration stress, cancer care costs, and cultural values all contributed to immigrants' socioeconomic distress. Immigrant and US-born breast cancer survivors experienced different socioeconomic circumstances and well-being following treatment. Our findings warrant further investigation of socioeconomic distress and survivorship outcomes.
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Affiliation(s)
- Judy Huei-yu Wang
- Cancer Prevention and Control Program, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW., Suite 4100, Washington, DC, 20007, USA,
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Breast cancer experience and survivorship among Asian Americans: a systematic review. J Cancer Surviv 2013; 8:94-107. [PMID: 24214498 DOI: 10.1007/s11764-013-0320-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 10/11/2013] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Breast cancer is the most common cancer in Asian American women, and the number of Asian American breast cancer survivors is rapidly increasing. Although Asian Americans are one of the fastest growing and most heterogeneous ethnic groups in the United States, limited data exist in regard to their breast cancer experience and survivorship. METHODS A systematic review of the breast cancer experience literature was conducted and included studies of Asian Americans or their subgroups as a major category of study participants. Of the 125 studies reviewed, 10 qualitative studies, 10 quantitative studies, 5 studies that used a mixed-method approach, and 1 intervention study met the criteria for inclusion. RESULTS Qualitatively, Asian Americans reported unmet physical and emotional needs and challenges during survivorship. Quantitative studies consistently found that socioeconomic status, cultural health beliefs, immigration stress, acculturation level, English proficiency, social support, and spirituality associated with Asian American breast cancer patients' health behaviors and health-related quality of life (HRQOL). Studies also revealed significant variation in breast cancer reaction and HRQOL within Asian American subgroups. CONCLUSIONS Although research on Asian American breast cancer experience and survivorship is sparse, we concluded that Asian Americans experience disrupted HRQOL following breast cancer diagnosis and treatment, interwoven with their cultural and socio-ecological system, and that programs focused on improving cancer survivorship outcomes among this ethnic minority group are limited. Most studies have concentrated on the West coast population, and there is significant underrepresentation of longitudinal and intervention studies. Implications for study design, measurement, and future research areas are also included. IMPLICATIONS FOR CANCER SURVIVORS The results highlight a need to understand ethnic differences and to take into account social, cultural, and linguistic factors in breast cancer survivorship experiences among Asian American subgroups as a means to develop culturally relevant and linguistically appropriate interventions designed to improve HRQOL.
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Abstract
PURPOSE OF REVIEW Mixed methods research designs have been recognized as important in addressing complexity and are recommended particularly in the development and evaluation of complex interventions. This article reports a review of studies in palliative care published between 2010 and March 2012 that combine qualitative and quantitative approaches. RECENT FINDINGS A synthesis of approaches to mixed methods research taken in 28 examples of published research studies of relevance to palliative and supportive care is provided, using a typology based on a classic categorization put forward in 1992. SUMMARY Mixed-method studies are becoming more frequently employed in palliative care research and resonate with the complexity of the palliative care endeavour. Undertaking mixed methods research requires a sophisticated understanding of the research process and recognition of some of the underlying complexities encountered when working with different traditions and perspectives on issues of: sampling, validity, reliability and rigour, different sources of data and different data collection and analysis techniques.
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So WKW, Leung DYP, Ho SSM, Lai ETL, Sit JWH, Chan CWH. Associations between social support, prevalent symptoms and health-related quality of life in Chinese women undergoing treatment for breast cancer: a cross-sectional study using structural equation modelling. Eur J Oncol Nurs 2012; 17:442-8. [PMID: 23238353 DOI: 10.1016/j.ejon.2012.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 11/04/2012] [Accepted: 11/10/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND There is little in the literature exploring the inter-relationship of social support, prevalent symptoms and health-related quality of life (HRQoL) among breast cancer patients. This study examines the inter-relationships among the three variables using the 'Theory of Unpleasant Symptoms' as a framework. METHODS 279 Chinese breast cancer patients undergoing treatment were recruited for face-to-face interviews. The instruments used were Chinese versions of the Brief Fatigue Inventory, Brief Pain Inventory, Hospital Anxiety and Depression Scales, Medical Outcomes Study Social Support Survey and Functional Assessment of Cancer Therapy for Breast Cancer. RESULTS Goodness-of-fit and misfit indices were obtained for the final model (SRMR = 0.034, robust RMSEA = 0.051 and robust CFI = 0.981), and the results showed that social support had large total effects on social/family (total effect = 0.704, P < 0.05) and functional well-being (total effect = 0.450, P < 0.05), but a minimal effect on the breast cancer scale (total effect = 0.036, P > 0.05). CONCLUSIONS The inter-relationships among the three variables give us a better understanding of breast cancer patients' experience and provide guidance for developing effective strategies to improve their HRQoL and relieving unpleasant symptoms.
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Affiliation(s)
- Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, 7/F., Esther Lee Building, Shatin, New Territories, Hong Kong Special Administrative Region.
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Wang JHY, Adams I, Huang E, Ashing-Giwa K, Gomez SL, Allen L. Physical distress and cancer care experiences among Chinese-American and non-Hispanic White breast cancer survivors. Gynecol Oncol 2012; 124:383-8. [PMID: 22115854 PMCID: PMC3298543 DOI: 10.1016/j.ygyno.2011.11.029] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 11/14/2011] [Accepted: 11/14/2011] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The number of Chinese-American breast cancer survivors (BCS) is increasing as a result of increasing incidence rates. There has been little research on Chinese BCS' follow-up cancer care. This qualitative study aims to understand how Chinese-American BCS experience and cope with physical distress relative to non-Hispanic White (NHW) survivors. METHODS Seventy-one BCS (37 Chinese immigrant, 7 US-born Chinese, 27 NHW) were recruited from the Greater Bay Area Cancer Registry to participate in focus group discussions or one-on-one interviews about their survivorship experiences. All BCS were diagnosed with breast cancer at stage 0-IIA between 2006 and 2009, and had survived for 1-4 years without recurrence. Interviews were conducted in Cantonese, Mandarin, or English. Data analyses followed established qualitative methods of content analysis. RESULTS BCS experienced pain and side effects from radiation, surgery, and hormonal therapy. Physical distress subsequently caused emotional concerns about recurrence or metastasis. Most BCS consulted physicians about their physical distress. Chinese immigrant BCS were less likely to have their issues resolved compared to NHW and US-born Chinese who were more likely to question physicians, ask for referrals, and make repeat attempts if their problems were not resolved. Some Chinese immigrant BCS turned to Traditional Chinese Medicine for relief or accepted the idea that physical distress was part of survivorship. CONCLUSION Chinese immigrant BCS may be at risk for greater distress compared with US-born Chinese and NHW BCS because of cultural norms that make them less inclined to express their needs to physicians or challenge physicians when their needs are not met. Furthermore, they may express symptoms in culturally unique ways (e.g., hot-cold imbalances). Further research is needed to determine how to best improve survivorship care experiences in this understudied population, with the goal of decreasing BCS' physical distress and improving quality of life.
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Affiliation(s)
- Judy Huei-yu Wang
- Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW., Suite 4100, Washington DC, 20007, USA.
| | - Inez Adams
- Department of Anthropology, Michigan State University, 355 Baker Hall, East Lansing, MI 48864, USA
| | - Ellen Huang
- Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW., Suite 4100, Washington DC, 20007, USA.
| | - Kimlin Ashing-Giwa
- Center of Community Alliance for Research & Education, Department of Population Sciences, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA.
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA94538, USA ; (Scarlett Lin Gomez) and (Laura Allen)
| | - Laura Allen
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA94538, USA ; (Scarlett Lin Gomez) and (Laura Allen)
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