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Auriol C, Cantisano N, Raynal P. Factors influencing the acceptability of alcohol drinking for a patient with colorectal cancer. PLoS One 2023; 18:e0296409. [PMID: 38153919 PMCID: PMC10754451 DOI: 10.1371/journal.pone.0296409] [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: 05/11/2023] [Accepted: 12/12/2023] [Indexed: 12/30/2023] Open
Abstract
INTRODUCTION Colorectal cancer is the second deadliest cancer worldwide. One of the risk factors for the development of this type of cancer is alcohol consumption. Patients with colorectal cancer may be stigmatized regarding their cancer and regarding drinking behaviors they may exhibit. This study aimed to analyze community persons' and health professionals' acceptability judgments regarding alcohol drinkers having colorectal cancer. METHOD This study relies on an experimental method enabling the identification of variables involved in one's judgment, based on the exhaustive combination of factors yielding several scenarios rated by participants. Scenarios implemented factors possibly influencing participants' perception of a woman character having colorectal cancer. Factors included her drinking habits, post-diagnosis drinking behavior and type of diagnosis/prognosis. The participants were community persons (N' = 132) or health professionals (N" = 126). Data were analyzed using a within-subject factorial ANOVA. RESULTS In both samples, the "Post-diagnosis behavior" factor had large effect sizes, with drinking cessation being more acceptable than other drinking behaviors. Another factor, "Drinking habits", had significant influences on participants judgments, as higher drinking was considered less acceptable. A third factor, "Diagnosis" (polyps, early- or late-stage cancer), was taken into account by participants when it interacted with "Drinking habits" and "Post-diagnosis behavior". Indeed, participants considered most acceptable to continue drinking in the case of late-stage cancer, especially in the health professional sample where the acceptability of continuing drinking was almost doubled when the character had advanced- rather than early-cancer. CONCLUSION The lesser the drinking behavior, the better the acceptability. However, advanced cancer stage attenuated the poor acceptability of drinking in both samples, as participants' attitudes were more permissive when the patient had advanced cancer.
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Affiliation(s)
- Camille Auriol
- Centre d’Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse-Jean Jaurès, Toulouse, France
| | - Nicole Cantisano
- Centre d’Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse-Jean Jaurès, Toulouse, France
| | - Patrick Raynal
- Centre d’Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse-Jean Jaurès, Toulouse, France
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Tirgari B, Azizzadeh Forouzi M, Heidarzadeh A, Khalilzadeh Ganjalikhani M. Does Resilience Predict Ostomy Adjustment in Patients With Permanent Ostomy? J Wound Ostomy Continence Nurs 2023; 50:386-391. [PMID: 37713349 DOI: 10.1097/won.0000000000001007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
PURPOSE This study aimed to evaluate associations between resilience and ostomy adjustment in a group of patients with a permanent ostomy. DESIGN Descriptive, correlational study. SUBJECTS AND SETTING One hundred participants were interviewed; most were male (N = 56; 56%), married (N = 77; 77%), illiterate (N = 46; 46%), and self-employed (N = 35; 35%). The most frequent condition leading to ostomy surgery was colorectal cancer (N = 24; 24%). A majority (N = 43; 43%) had been diagnosed with cancer 1 to 5 years before data collection, and 35 (35%) had lived with an ostomy for 1 to 5 years. Participants were recruited from an ostomy clinic of in Kerman, located in southeastern Iran. Data were collected from August to October 2019. METHODS Data were collected via interviews. A questionnaire, developed for purposes of this study, was developed that included items querying demographic and pertinent clinical characteristics and 2 validated instruments, the Resilience Scale and the Ostomy Adjustment Inventory-23 (OAI-23). Data were analyzed using t tests, analysis of variance, Pearson correlation coefficient, and linear regression. RESULTS The mean score for ostomy adjustment was 43.37 (SD = 11.57) indicating less than optimal adjustment to life with an ostomy. The mean score of the Resilience Scale was 104.56 (SD = 25.98); most participants (n = 67, 67%) had very low and low resilience. Resilience was weakly associated with ostomy adjustment; specifically, participants who scored higher on the Resilience Scale tended to score higher on the OAI-23 (r = 0.32, P = .006). Linear regression indicated that resilience had the greatest predictive effect on ostomy adjustment (P = .004). CONCLUSIONS Results suggest that higher levels of resilience may facilitate adjustment to a permanent ostomy. Findings indicate that nurses should design and implement programs to aid ostomy adjustment via resilience assessment.
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Affiliation(s)
- Batool Tirgari
- Batool Tirgari, PhD, Professor of Nursing, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Mansooreh Azizzadeh Forouzi, MSN, Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Science, Kerman, Iran
- Azam Heidarzadeh, MSN, Geriatric Research Center, School of Nursing & Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Mahboobeh Khalilzadeh Ganjalikhani, MSN, Department of Medical Surgical Nursing, Razi Faculty of Nursing & Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansooreh Azizzadeh Forouzi
- Batool Tirgari, PhD, Professor of Nursing, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Mansooreh Azizzadeh Forouzi, MSN, Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Science, Kerman, Iran
- Azam Heidarzadeh, MSN, Geriatric Research Center, School of Nursing & Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Mahboobeh Khalilzadeh Ganjalikhani, MSN, Department of Medical Surgical Nursing, Razi Faculty of Nursing & Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Azam Heidarzadeh
- Batool Tirgari, PhD, Professor of Nursing, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Mansooreh Azizzadeh Forouzi, MSN, Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Science, Kerman, Iran
- Azam Heidarzadeh, MSN, Geriatric Research Center, School of Nursing & Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Mahboobeh Khalilzadeh Ganjalikhani, MSN, Department of Medical Surgical Nursing, Razi Faculty of Nursing & Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahboobeh Khalilzadeh Ganjalikhani
- Batool Tirgari, PhD, Professor of Nursing, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Mansooreh Azizzadeh Forouzi, MSN, Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Science, Kerman, Iran
- Azam Heidarzadeh, MSN, Geriatric Research Center, School of Nursing & Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Mahboobeh Khalilzadeh Ganjalikhani, MSN, Department of Medical Surgical Nursing, Razi Faculty of Nursing & Midwifery, Kerman University of Medical Sciences, Kerman, Iran
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Streith LD, Yip SJY, Brown CJ, Karimuddin AA, Raval MJ, Phang PT, Ghuman A. Effectiveness of a rectal cancer education video on patient expectations. Colorectal Dis 2022; 24:1040-1046. [PMID: 35396809 DOI: 10.1111/codi.16143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/16/2022] [Accepted: 03/28/2022] [Indexed: 12/24/2022]
Abstract
AIM Discrepancy between patient expectations and outcomes can negatively affect patient satisfaction and quality of life. We aimed to assess patient expectations of bowel, urinary, and sexual function after rectal cancer treatments, and whether a preoperative education video changed expectations. METHODS A total of 45 patients were assessed between January 2018 and January 2021 in a tertiary care hospital in Vancouver, Canada. Patients included were rectal cancer patients who had neoadjuvant chemoradiation and were listed for low anterior resection but had not yet had surgery. Following surgical consultation but before surgery, a questionnaire assessing expectations of lifestyle after treatments was administered. Patients then watched an educational video and repeated the questionnaire to assess for changes in expectations. RESULTS Patient scores indicated expectation that control of bowel movements, urination, and sexual function would sometimes be problematic, but had a range from occasionally problematic to good function. Significant change after the video was seen in the expectation of needing medications for bowel control, and 44%-69% of individual patient answers changed from prevideo to post-video, depending on the question. The education video was scored as helpful or very helpful by 82% of patients. CONCLUSIONS Patients have varying expectations of problematic control of bowel, urinary, and sexual function following rectal cancer treatments. A pretreatment education video resulted in a trend toward changed expectations for functional outcomes in most patients. Further educational modalities for patients may provide more uniform expectations of function and increase patient satisfaction after rectal cancer treatments.
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Affiliation(s)
- Lucas D Streith
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Silas J Y Yip
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carl J Brown
- Division of General Surgery, Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Ahmer A Karimuddin
- Division of General Surgery, Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Manoj J Raval
- Division of General Surgery, Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - P Terry Phang
- Division of General Surgery, Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Amandeep Ghuman
- Division of General Surgery, Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada
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The Progress of Social Isolation in Patients with Enterostomy during Discharge Transition Period. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4940946. [PMID: 35832133 PMCID: PMC9273429 DOI: 10.1155/2022/4940946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/24/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022]
Abstract
In terms of social and psychological health of enterostomy patients during hospitalization and discharge transition period, the degree of social isolation in patients during discharge transition period is higher than that during hospitalization period, which is usually manifested by poor self-perception of body image changes. Self-esteem (shame) frustration, severe negative emotions, low psychosocial adjustment, and other factors are closely related to postoperative complications, coping self-efficacy, social support level, family living conditions, and other influencing factors. This is an important reason why patients are difficult to adapt to ostomy life and low quality of life. At present, it is believed that the social isolation related evaluation scale can be used to understand the status quo of patients with social isolation and provide nursing guidance, so as to better cope with the adverse medical outcomes caused by social isolation.
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Miller LR, Peck BM. Marginalization in the Medical Encounter: Ostomy Patients Experience of Perceived Stigmatizing Sentiments from Medical Clinicians. SAGE Open Nurs 2022; 8:23779608221095315. [PMID: 35493541 PMCID: PMC9044778 DOI: 10.1177/23779608221095315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/14/2022] [Accepted: 03/29/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Ostomy1 stigma negatively impacts the health of people with an ostomy and contributes to
a lower quality of life and health outcomes. Objective To assess whether participants experience perceived stigmatizing sentiments (SS) from
medical clinicians at the time of their ostomy procedure. Methods Using a nonprobability sample of 312 persons with an ostomy, we conducted a
retrospective descriptive study. We measured SS as patients’ self-reports of verbal and
non-verbal communication from clinicians that were perceived to be negative and may
contribute to ostomy stigma. We used thematic analyses to analyze open-ended written
comments. Results Findings indicate that ostomy patients experience stigmatizing sentiments from their
medical clinician before and after surgery. Sixteen percent of patients reported a SS,
such as clinicians stating feelings of disgust, showing visible signs of disgust, or
treating patients negatively regarding the ostomy. Conclusion The perceived treatment that this patient cohort experienced in healthcare likely
contributes to ostomy stigmatization and may impact ostomy patients’ psychosocial
adjustment. Future research should examine the specific consequences of perceived
stigmatizing sentiments from medical clinicians.
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Affiliation(s)
- Leslie Riggle Miller
- Department of Sociology, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - B. Mitchell Peck
- Department of Sociology, University of Oklahoma, Norman, Oklahoma, USA
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Sauter C, Peeken JC, Borm K, Diehl C, Münch S, Combs SE, Dapper H. Quality of life in patients treated with radiochemotherapy for primary diagnosis of anal cancer. Sci Rep 2022; 12:4416. [PMID: 35292732 PMCID: PMC8924204 DOI: 10.1038/s41598-022-08525-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/04/2022] [Indexed: 11/12/2022] Open
Abstract
Anal cancer and the related treatment are generally known to affect patients’ quality of life. The aim of this study was to assess self-reported quality of life (QoL) of anal cancer patients after combined radiation and chemotherapy, and to identify patient-, disease-, and therapy-related factors associated with QoL. A total of 94 patients treated with definitive chemoradiation for anal cancer at our institution in the period from 2004 to 2018 were identified from our database. QoL was assessed in the remaining 52 patients using the EORTC QLQ-C30 questionnaire (cancer-specific QoL) and the newly developed anal cancer module QLQ-ANL27 (site-specific QoL). Differences in QoL between anal cancer patients and a German age and sex adjusted reference population were examined. The median follow-up was 71 months (range, 7–176). In the cancer-specific QoL module, the anal cancer cohort presented with significantly lower scores in role (− 12.2 points), emotional (− 6.6 points), and social functioning (− 6.8 points), but higher scores in diarrhea (+ 36.3 points) and constipation (+ 13.3 points) than the German reference population. There were no significant differences in disease- or therapy-related factors, but age greater than 70 years and a follow-up time greater than 71 months had a negative impact on global QoL. As for the site-specific QoL, patients with a tumor relapse showed significantly higher symptom scores than patients with a complete clinical remission in all scales except of micturition frequency. Compared to 3D conformal radiotherapy, IMRT treatment seemed to improve non-stoma bowel function (+ 23.3 points), female sexual functioning (+ 24.2 points), and came along with less scores in the symptom scales pain (− 35.9 points), toilet proximity (− 28.6 points), and cleanliness (− 26.2 points). Most of the functional scores of anal cancer patients were lower compared to the general German population, but did not seem to affect the general QoL. Fatigue, physical, and role functioning had the strongest impact on global QoL causing psychological symptoms as important as physical.
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Affiliation(s)
- Christina Sauter
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Jan C Peeken
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany.,Institute for Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstr. 1, Neuherberg, Germany
| | - Kai Borm
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christian Diehl
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stefan Münch
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany.,Institute for Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstr. 1, Neuherberg, Germany
| | - Hendrik Dapper
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany
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Larkin D, Birtle AJ, Bradley L, Dey P, Martin CR, Pilkington M, Romero-Rivas C. A systematic review of disease related stigmatization in patients living with prostate cancer. PLoS One 2022; 17:e0261557. [PMID: 35148315 PMCID: PMC8836305 DOI: 10.1371/journal.pone.0261557] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/05/2021] [Indexed: 12/12/2022] Open
Abstract
Background Prostate cancer has been shown to be susceptible to significant stigmatisation, because to a large extent it is concealable, it has potentially embarrassing sexual symptoms and has significant impact on the psychosocial functioning. Methods This review included studies that focused on qualitative and/or quantitative data, where the study outcome was prostate cancer and included a measure of stigmatization. Electronic databases (CINAHL, Medline, PubMed, PsycInfo, Cochrane Library, PROSPERO, and the Joanna Briggs Institute) and one database for grey literature Opengrey.eu, were screened. We used thematic analysis, with narrative synthesis to analyse these data. We assessed risk of bias in the included studies using the RoBANS. Results In total, 18 studies met review inclusion criteria, incorporating a total of 2295 participants. All studies recruited participants with prostate cancer, however four studies recruited participants with other cancers such as breast cancer and lung cancer. Of the 18 studies, 11 studies evaluated perceived or felt stigma; four studies evaluated internalised or self-stigma; three studies evaluated more than one stigma domain. Discussion We found that patients living with prostate cancer encounter stigmatisation that relate to perception, internalisation, and discrimination experiences. We also identified several significant gaps related to the understanding of prostate cancer stigmatization, which provides an opportunity for future research to address these important public health issues. Registration This systematic review protocol is registered with PROSPERO, the international prospective register of systematic reviews in health and social care. Registration number: CRD42020177312.
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Affiliation(s)
- Derek Larkin
- Department of Psychology, Edge Hill University, Lancashire, United Kingdom
- * E-mail:
| | - Alison J. Birtle
- Department of Oncology, Rosemere Cancer Centre, Lancashire Teaching Hospitals, Preston, United Kingdom
| | - Laura Bradley
- Department of Psychology, Edge Hill University, Lancashire, United Kingdom
| | - Paola Dey
- Faculty of Health, Social Care and Medicine, Edge Hill University, Lancashire, United Kingdom
| | - Colin R. Martin
- Institute for Clinical and Applied Health Research (ICAHR), University of Hull, Hull, United Kingdom
| | - Melissa Pilkington
- Department of Psychology, Manchester Metropolitan University, Manchester, United Kingdom
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Jiang N, Zhang YX, Zhao J, Shi HY, Wang T, Jin W, Wang JW, Yu JM. The mediator role of stigma in the association of mindfulness and social engagement among breast cancer survivors in China. Support Care Cancer 2022; 30:5007-5015. [PMID: 35192056 PMCID: PMC8861258 DOI: 10.1007/s00520-022-06882-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/28/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE This study aims to explore the association between mindfulness and social engagement among Chinese breast cancer survivors (BCSs) and the mediator role of stigma in the relation of mindfulness and social engagement. METHODS This cross-sectional study was conducted among 937 BCSs from March to April 2021 in Shanghai, China. Data were collected using the Mindful Attention Awareness Scale, the Stigma Scale for Chronic Illness 8-item version, and the index of social engagement. Descriptive statistics, independent-sample t-test, one-way ANOVA, and regression analyses were used to explore the role of stigma in the association of mindfulness and social engagement among Chinese BCSs. RESULTS Social engagement levels differed significantly by participant's BMI, education level, employment status, personal monthly income, monthly per capita household income. Mindfulness was positively correlated with social engagement, and stigma was negatively correlated with mindfulness and social engagement among Chinese BCSs. Stigma plays a complete mediating role in the relationship between mindfulness and social engagement in BCSs. CONCLUSION In the practice of individual mindfulness intervention on social engagement of BCSs, health care providers should identify and eliminate the constraints, which restrain the reduction of stigma level while individual mindfulness is being enhanced.
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Affiliation(s)
- Nan Jiang
- Key Lab of Health Technology Assessment of Ministry of Health, Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
| | - Yu-Xin Zhang
- Key Lab of Health Technology Assessment of Ministry of Health, Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
| | - Jie Zhao
- Key Lab of Health Technology Assessment of Ministry of Health, Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
| | - Hong-Yan Shi
- Dental Disease Prevention and Treatment Center of Minhang District, 1038 Fanxing Road, Shanghai, 201107 China
| | - Ting Wang
- Key Lab of Health Technology Assessment of Ministry of Health, Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
| | - Wei Jin
- Department of Health Instruction, Shanghai Municipal Center for Health Promotion, Shanghai, 200040 China
| | - Ji-Wei Wang
- Key Lab of Health Technology Assessment of Ministry of Health, Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
| | - Jin-Ming Yu
- Key Lab of Health Technology Assessment of Ministry of Health, Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
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Mandizadza E, Moyo S. A phenomenological study on experiences of cancer stigma amongst selected people living with cancer in rural and urban Zimbabwe. AAS Open Res 2021; 4:48. [PMID: 34934902 PMCID: PMC8649965 DOI: 10.12688/aasopenres.13282.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Cancer is a highly stigmatized illness associated with profound adverse impact on communities, families and diagnosed individuals. Notwithstanding extensive theorizing since Erving Goffman’s classical contributions, health stigma is well explicated in context-specific and situated analysis. The current study explored the manifestations of self and enacted stigma among 20 selected people diagnosed with cancer from rural and urban Zimbabwe, who sought quaternary level of health care services in the capital, Harare. Methods: Phenomenological methodology was enlisted to capture intimate expressions of stigma as expressed about, and by people diagnosed with cancer. Data collection methods used includes semi-structured interviews, key informant interviews and focus group discussions. A semi-structured in-depth interview guide, focus group discussion guide and a key informant interview guide were the tools used to collect the data. Results: The study identified five themes of stigma, indicating pronounced, complex and multiple catalogues of stigma embedded in the existing socio-cultural milieu. Conclusions: This study stands to offer invaluable conceptual schemas and empirical insights on health-related stigma, and may aid in nursing and in the design of educational programs meant to combat health stigma.
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Affiliation(s)
- Enock Mandizadza
- Community and Social Development, University of Zimbabwe, Harare, Harare, 263, Zimbabwe
| | - Stanzia Moyo
- Demography Settlement and Development, University of Zimbabwe, Harare, Harare, 263, Zimbabwe
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10
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Tong G, Zhang G, Liu J, Zheng Z, Chen Y, Li M, Zhong Y, Niu P, Xu X. When do defecation function and quality of life recover for patients with non-ostomy and ostomy surgery of rectal cancer? BMC Surg 2020; 20:57. [PMID: 32228547 PMCID: PMC7106805 DOI: 10.1186/s12893-020-00719-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/17/2020] [Indexed: 12/15/2022] Open
Abstract
Background Rectal cancer (RC) surgery often results in permanent colostomy, seriously limiting the quality of life (QOL) in patients in terms of bowel function. This study aimed to examine defecation function and QOL in RC patients who underwent non-ostomy or ostomy surgery, at different time-points after surgery. Methods In total, 82 patients who underwent an ostomy and 141 who did not undergo an ostomy for the treatment of RC at our colorectal surgery department between January 2013 and January 2015 were enrolled. Surgical methods, tumor distance from the anal margin (TD), anastomosis distance from the anal margin (AD) and complications were compered between the non-ostomy and ostomy surgery groups. QOL was compared between the two groups at years 2, 3, and 4 after surgery. The Wexner score and the validated cancer-specific European Organization for Research and Treatment of Cancer (EORTC QLQ-CR30) questionnaire scores were assessed for all patients in January 2017. SPSS 21.0 was utilized for all data analyses. Results Surgical methods, TD, and AD significantly differed between the non-ostomy and ostomy surgery groups (all P < .001). However, no differences were found in the number of complications between the groups (P = .483). For the 192 patients undergoing Dixon surgery, role function (RF), global QOL (GQOL), sleep disturbance, and the incidence of constipation showed significant differences between the two groups (P = .012, P = .025, P = .036, and P = .015, respectively). In the 31 cases of permanent ostomy, we observed significant differences in GQOL scores, dyspnea incidence, and financial difficulties across the different years (P = .002, P = .036, and P < .01, respectively). Across all 223 cases, there were significant differences in social function and GQOL scores in the second year after surgery (P = .014 and P < .001, respectively). However, no differences were observed in the other indices across the three time-points. Conclusions RC patients undergoing ostomy surgery, especially those with low and super-low RC, revealed poorer defecation function and QOL in the present study. However, 2 years after surgery, most of the defecation and QOL indicators showed recovery.
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Affiliation(s)
- Guojun Tong
- Department of Colorectal Surgery, Huzhou Central Hospital, Zhejiang, 313000, China. .,Central Laboratory, Huzhou Central Hospital, Zhejiang, 313000, China.
| | - Guiyang Zhang
- Department of Colorectal Surgery, Huzhou Central Hospital, Zhejiang, 313000, China
| | - Jian Liu
- Department of Colorectal Surgery, Huzhou Central Hospital, Zhejiang, 313000, China.,Vice President of Huzhou Central Hospital, Zhejiang, 313000, China
| | - Zhaozheng Zheng
- Department of Colorectal Surgery, Huzhou Central Hospital, Zhejiang, 313000, China
| | - Yan Chen
- Department of Colorectal Surgery, Huzhou Central Hospital, Zhejiang, 313000, China
| | - Min Li
- Huzhou Central Hospital, Zhejiang, 313000, China
| | - Yan Zhong
- Huzhou Central Hospital, Zhejiang, 313000, China
| | - Pingping Niu
- Central Laboratory, Huzhou Central Hospital, Zhejiang, 313000, China
| | - Xuting Xu
- Central Laboratory, Huzhou Central Hospital, Zhejiang, 313000, China
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11
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Abualfaraj RJ, Mcdonald F, Daly B, Scambler S. Patients with cleft: Experiences, understanding and information provision during treatment. Orthod Craniofac Res 2019; 22:289-295. [PMID: 31306547 DOI: 10.1111/ocr.12336] [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: 05/20/2019] [Revised: 06/30/2019] [Accepted: 07/09/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To explore the knowledge of late adolescent and adults affected with cleft lip and/or palate (CL/P) about their condition and their experiences with information about treatment options and outcomes within the cleft care pathway. SETTING AND SAMPLE POPULATION Twenty-eight people with CL/P had recently finished or were about to finish their definitive orthodontic/orthognathic (OGN) treatment. Participants were purposively recruited from two cleft centres in the UK. MATERIALS AND METHODS Qualitative, semi-structured interviews were conducted and all interviews were recorded and transcribed verbatim. Thematic analysis was undertaken using the framework method. RESULT There are a broad range of interpretations and explanations for both the causes and implications of CL/P amongst those living with the condition. This resulted in confusion and left participants vulnerable to misinformation and unable to combat stigma. In addition, there was some confusion about the implication of different treatment options. Participants felt that they did not receive enough information about the nature of the treatment that they would be undergoing and the length and implications of recovery post-treatment. This was a source of concern for the participants. CONCLUSION The findings of this study suggest that there is a mismatch between the information provided to the families of people with CL/P and the levels of knowledge they have, about both their condition and the treatment options available to them. It is essential that clear, accessible information is provided at the right times in the care pathway to ensure that patients are able to make informed decisions about treatment.
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Affiliation(s)
- Raed J Abualfaraj
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK.,Department of Orthodontics, King Abdulaziz University Dental Hospital, Jeddah, Saudi Arabia
| | - Fraser Mcdonald
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Blanaid Daly
- Dublin Dental University Hospital, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Sasha Scambler
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
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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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Yuan JM, Zhang JE, Zheng MC, Bu XQ. Stigma and its influencing factors among Chinese patients with stoma. Psychooncology 2018; 27:1565-1571. [DOI: 10.1002/pon.4695] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/22/2018] [Accepted: 02/26/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Jing Min Yuan
- The Second Clinical Medical College, Yangtze University; Jingzhou Hubei Province China
| | - Jun E Zhang
- School of Nursing; Sun Yat-sen University; Guangzhou China
| | - Mei Chun Zheng
- Department of Colorectal Surgery, Cancer Centre; Sun Yat-sen University; Guangzhou China
| | - Xiu Qing Bu
- School of Nursing; Sun Yat-sen University; Guangzhou China
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14
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Maugest L, McGovern EM, Mazalovic K, Doulazmi M, Apartis E, Anheim M, Bourdain F, Benchetrit E, Czernecki V, Broussolle E, Bonnet C, Falissard B, Jahanshahi M, Vidailhet M, Roze E. Health-Related Quality of Life Is Severely Affected in Primary Orthostatic Tremor. Front Neurol 2018; 8:747. [PMID: 29379467 PMCID: PMC5775514 DOI: 10.3389/fneur.2017.00747] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/27/2017] [Indexed: 12/17/2022] Open
Abstract
Background Primary orthostatic tremor (POT) is a movement disorder characterized by unsteadiness upon standing still due to a tremor affecting the legs. It is a gradually progressive condition with limited treatment options. Impairments in health-related quality of life (HQoL) seem to far exceed the physical disability associated with the condition. Methods A multi-center, mixed-methodology study was undertaken to investigate 40 consecutive patients presenting with POT to four movement disorder centers in France. HQoL was investigated using eight quantitative scales and a qualitative study which employed semi-structured interviews. Qualitative data were analyzed with a combination of grounded-theory approach. Results Our results confirm that HQoL in POT is severely affected. Fear of falling was identified as the main predictor of HQoL. The qualitative arm of our study explored our initial results in greater depth and uncovered themes not identified by the quantitative approach. Conclusion Our results illustrate the huge potential of mixed methodology in identifying issues influencing HQoL in POT. Our work paves the way for enhanced patient care and improved HQoL in POT and is paradigmatic of this modern approach for investigating HQoL issues in chronic neurological disorders.
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Affiliation(s)
- Lucie Maugest
- Département de Neurologie, EA 4184, Hôpital universitaire de Dijon, Dijon, France
| | - Eavan M McGovern
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Katia Mazalovic
- Département de Médecine générale, Faculté de Médecine, Université de Bourgogne, Dijon, France
| | - Mohamed Doulazmi
- Sorbonne Universités, UPMC Univ Paris 06, UMR8256, INSERM, CNRS, Institut de Biologie Paris Seine, Adaptation Biologique et Vieillissement, Paris, France
| | - Emmanuelle Apartis
- Département de Neurophysiologie, Hôpital de Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mathieu Anheim
- Département de Neurologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Illkirch-Graffenstaden, France.,Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Frédéric Bourdain
- Département de Neurologie, Centre médico-chirurgical Foch, Suresnes, France
| | - Eve Benchetrit
- Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Virginie Czernecki
- Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Broussolle
- Département de Neurologie, Service de Mouvements anormaux, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Lyon I, Faculté de Médecine Lyon Sud Charles Mérieux, Institut des Sciences Cognitives Marc Jeannerod, CNRS UMR 5229, Lyon, France
| | - Cecilia Bonnet
- Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bruno Falissard
- CESP, Univ. Paris-Sud, Université Paris-Saclay, UVSQ, INSERM U1178, Paris, France
| | - Marjan Jahanshahi
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom
| | - Marie Vidailhet
- Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,UMR S 975, CNRS UMR 7225, ICM, Sorbonne Universités, UPMC Université Paris, Paris, France
| | - Emmanuel Roze
- Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,UMR S 975, CNRS UMR 7225, ICM, Sorbonne Universités, UPMC Université Paris, Paris, France
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15
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Sarabi N, Navipour H, Mohammadi E. Relative Tranquility in Ostomy Patients' Social Life: A Qualitative Content Analysis. World J Surg 2018; 41:2136-2142. [PMID: 28321552 DOI: 10.1007/s00268-017-3983-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Ostomy significantly alters one's elimination pattern and can affect the individual in physiological, psychosocial and spiritual aspects. Over time, the ostomy patient's experience changes and they develop coping strategies to handle the new reality. The aims of this study sought Iranian ostomy patients' main problem, how they deal and the outcome of their efforts to manage that problem in their daily lives. METHOD A qualitative content analysis was conducted involving twenty-seven ostomy patients that were chosen by purposeful sampling and referred to the Iranian Ostomy Association from October 2015 to June 2016. RESULTS The mean age of the participants was 55 years, 15 were males, the major cause of ostomy was colorectal cancer and the colostomy was the most common type of ostomy, and nineteen of them between one and twenty years lived with an ostomy. Most of them were married, had bachelor degree and received adjuvant therapy, and few were employed. Guarantee indecisive to maintain a stable life with an ostomy and the possibility of ostomy disclosure unpredictability show relative tranquility in patients' social life. CONCLUSION Because of the ostomy nature, there is not the possibility of full control over life with an ostomy and this issue is causing concerns in their family and social life.
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Affiliation(s)
- Nasrin Sarabi
- Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, P.O. Box: 14115-331, Tehran, Iran
| | - Hassan Navipour
- Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, P.O. Box: 14115-331, Tehran, Iran.
| | - Eesa Mohammadi
- Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, P.O. Box: 14115-331, Tehran, Iran
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16
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Dibley L, Czuber-Dochan W, Wade T, Duncan J, Burch J, Warusavitarne J, Norton C, Artom M, O'Sullivan L, Verjee A, Cann D. Patient Decision-Making About Emergency and Planned Stoma Surgery for IBD: A Qualitative Exploration of Patient and Clinician Perspectives. Inflamm Bowel Dis 2018; 24:235-246. [PMID: 29361098 DOI: 10.1093/ibd/izx043] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Many inflammatory bowel disease (IBD) patients worry about stoma-forming surgery (SFS), sometimes enduring poor bowel-related quality of life to avoid it. Anticipation of SFS and whether expectations match experience is underreported. This qualitative study explored influences on patients' SFS decision-making and compared preoperative concerns with postoperative outcomes. METHODS We purposively recruited participants with IBD from UK hospital outpatient and community sources, and IBD clinicians from public hospitals. Four focus groups, 29 semistructured patient participant interviews, and 18 clinician interviews were audio recorded, transcribed, and analysed thematically. Participants had a current temporary, recently-reversed, or permanent stoma, or were stoma naive. RESULTS Four themes emerged: Preoperative concerns and expectations, Patient decision-making, Surgery and recovery, and Long-term outcomes. Participants and clinicians agreed about most preoperative concerns, that outcomes were often better than expected, and support from others with a stoma is beneficial. Patient decision-making involves multiple factors, including disease status. Some clinicians avoid discussing SFS, and the phrase 'last resort' can bias patient perceptions; others recommend early discussion, increasing dialogue when medical management becomes ineffective. The postoperative period is particularly challenging for patients. Stoma acceptance is influenced by personal perceptions and pre- and postoperative clinical and social support. CONCLUSION Patients need balanced information on all treatment options, including surgery, from an early stage. Early multidisciplinary team dialogue about SFS, and contact with others living well with a stoma, could enable informed decision-making. Life with a stoma is often better than anticipated, improving quality of life and control. Ongoing specialist nursing support aids recovery and adjustment.
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Affiliation(s)
- Lesley Dibley
- Faculty of Education and Health, University of Greenwich, London, UK.,Bart's Health NHS Trust, London, UK
| | | | - Tiffany Wade
- Florence Nightingale Faculty of Nursing & Midwifery, King's College London, UK
| | | | | | | | - Christine Norton
- Florence Nightingale Faculty of Nursing & Midwifery, King's College London, UK
| | - Micol Artom
- Florence Nightingale Faculty of Nursing & Midwifery, King's College London, UK
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Abstract
This short-term longitudinal study examined the effect of perceived stigma on perceived support availability, negative interactions, and depression. Two interviews were conducted over a 4-month period with 109 parents of special needs children. Cross-sectional analyses revealed that perceived stigma was consistently related to less perceived support availability from respondents’ parents (i.e., the child’s grandparents), more negative interactions with spouse and grandparents, and increased depressive symptomatology. Longitudinal analyses indicated that perceived stigma increased negative interactions with grandparents as well as the respondent’s depression over time. Structural equation modeling also suggested that perceived support availability of grandparents partially mediated the longitudinal relation between perceived stigma and depression. Findings highlight the need for future studies to examine the complex relation between stressor dimensions, social support processes, and mental health.
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18
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Exploration of health status, illness perceptions, coping strategies, and psychological morbidity in stoma patients. J Wound Ostomy Continence Nurs 2016; 41:573-80. [PMID: 25377108 DOI: 10.1097/won.0000000000000073] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We employed the Common Sense Model (CSM) of illness perceptions to examine the relative contribution of illness perceptions, stoma self-efficacy, and coping strategies in explaining anxiety and depression symptoms in patients with a fecal ostomy. The CSM suggests that the consequences of illness activity, such as psychological distress, are influenced by an individual's illness perceptions as well as what coping strategies they engage in. DESIGN Descriptive, cross-sectional questionnaire-based study. SUBJECTS AND SETTING One hundred fifty adults with a stoma (54 males, and 96 females; mean age 44 years) completed an online survey. METHODS Several instruments were used to measure study outcomes, including the Health Perceptions Questionnaire, Brief Illness Perceptions Questionnaire, Carver Brief Coping Questionnaire, Stoma Self-Efficacy Scale, and the Hospital Anxiety and Depression Scale. Participants were advised of the study through online forums containing a link to the survey. Outcome measures used in the current study are valid and reliable and have been extensively used in medically ill patients. RESULTS Using structural equation modeling, the final model provided an excellent fit to the data (χ23= 16.53, P = .22, χ/N = 1.27, SRMR < 0.03, RMSEA < 0.05, GFI > 0.97, CFI > 0.99). There was a direct pathway from health status to illness perceptions months since surgery directly influenced health status, illness beliefs, and adaptive emotion-focused coping (β= .81, P < .001). Several indirect (mediating) pathways were also identified. Illness perceptions mediated the relationship between health status and stoma self-efficacy and maladaptive and adaptive emotion-focused coping. Maladaptive coping mediated the relationship between illness perceptions and depression and anxiety, and adaptive emotion-focused coping mediated the relationship between illness perception and depression. The final model provided support for the CSM, in that illness perceptions were directly related to illness status, and that both illness perceptions and coping strategies directly influenced anxiety and depression. More specifically, maladaptive coping style (eg, ignore problems) exacerbated depression and anxiety symptoms, while self-efficacy and emotion-focused coping style (eg, seek advice) ameliorate depression, but not anxiety. Months since surgery was associated with improved health status, reduced poorer illness perceptions, and increased emotional-focused coping. CONCLUSIONS Illness perceptions and coping were found to mediate anxiety and depression. The results confirm that how individuals perceive their illness and what coping strategies they engage in impacts their psychological well-being. Study findings support the need for designing targeting psychological interventions based on individual illness perceptions and self-efficacy rather than exclusively focusing on coping strategies in patients with a stoma.
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19
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Allensworth-Davies D, Talcott JA, Heeren T, de Vries B, Blank TO, Clark JA. The Health Effects of Masculine Self-Esteem Following Treatment for Localized Prostate Cancer Among Gay Men. LGBT Health 2015; 3:49-56. [PMID: 26698658 DOI: 10.1089/lgbt.2015.0090] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To identify factors associated with masculine self-esteem in gay men following treatment for localized prostate cancer (PCa) and to determine the association between masculine self-esteem, PCa-specific factors, and mental health factors in these patients. METHODS A national cross-sectional survey of gay PCa survivors was conducted in 2010-2011. To be eligible for the study, men needed to be age 50 or older, reside in the United States, self-identify as gay, able to read, write, and speak English, and to have been treated for PCa at least 1 year ago. One hundred eleven men returned surveys. RESULTS After simultaneously adjusting for the factors in our model, men aged 50-64 years and men aged 65-74 years reported lower masculine self-esteem scores than men aged 75 years or older. Lower scores were also reported by men who reported recent severe stigma. Men who reported feeling comfortable revealing their sexual orientation to their doctor reported higher masculine self-esteem scores than men who were not. The mental component score from the SF-12 was also positively correlated with masculine self-esteem. CONCLUSION PCa providers are in a position to reduce feelings of stigma and promote resiliency by being aware that they might have gay patients, creating a supportive environment where gay patients can discuss specific sexual concerns, and engaging patients in treatment decisions. These efforts could help not only in reducing stigma but also in increasing masculine self-esteem, thus greatly influencing gay patients' recovery, quality of life, and compliance with follow-up care.
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Affiliation(s)
- Donald Allensworth-Davies
- 1 School of Health Sciences, College of Sciences and Health Professions, Cleveland State University , Cleveland, Ohio
| | - James A Talcott
- 2 Center for Health Care Quality and Outcomes Research, Continuum Cancer Centers of New York , New York, New York
| | - Timothy Heeren
- 3 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts
| | - Brian de Vries
- 4 Gerontology Program, San Francisco State University , San Francisco, California
| | - Thomas O Blank
- 5 Human Development and Family Studies, University of Connecticut , Storrs, Connecticut
| | - Jack A Clark
- 6 Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital , Bedford, Massachusetts.,7 Department of Health Policy and Management, Boston University School of Public Health , Boston, Massachusetts
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20
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Chongpison Y, Hornbrook MC, Harris RB, Herrinton LJ, Gerald JK, Grant M, Bulkley JE, Wendel CS, Krouse RS. Self-reported depression and perceived financial burden among long-term rectal cancer survivors. Psychooncology 2015; 25:1350-1356. [PMID: 26365584 DOI: 10.1002/pon.3957] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 08/05/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Types of surgery for rectal cancer (RC), including permanent ostomy (PO) or temporary ostomy followed by anastomosis (TO) or initial anastomosis (AN), can affect psychological and financial well-being during active treatment. However, these relationships have not been well studied among long-term survivors (≥5 years post-diagnosis). METHODS A mailed survey with 576 long-term RC survivors who were members of Kaiser Permanente was conducted in 2010-2011. Prevalence of current depression was ascertained using a score of ≤45.6 on the Short Form-12 version 2 mental component summary. Perceived financial burden was assessed using a Likert scale ranging from 0 (none) to 10 (severe). Regression analyses were used to measure associations after adjustment for covariates. RESULTS The overall prevalence of depression was 24% among RC survivors with the highest prevalence among those with a history of PO (31%). The adjusted odds of depression among TO and AN survivors were lower than that among PO survivors, 0.42 (CI95% 0.20-0.89) and 0.59 (CI95% 0.37-0.93), respectively. Twenty-two percent perceived moderate-to-high current financial burden (≥4 points). PO survivors also reported higher mean financial burden than AN survivors (2.6 vs. 1.6, respectively; p = 0.002), but perceived burden comparably to TO survivors (2.3). Self-reported depression was associated with higher perceived financial burden (p < 0.001); surgical procedure history did not modify this relationship. CONCLUSIONS Depression was reported frequently among these long-term RC survivors, particularly among PO survivors. Depression was associated with greater perception of financial burden. Screening for depression and assessing financial well-being might improve care among long-term RC survivors.Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Yuda Chongpison
- The University of Arizona College of Public Health, 1295 N. Martin Ave., Tucson, AZ, 85724, USA.
| | - Mark C Hornbrook
- Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Robin B Harris
- The University of Arizona College of Public Health, 1295 N. Martin Ave., Tucson, AZ, 85724, USA
| | - Lisa J Herrinton
- Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Joe K Gerald
- The University of Arizona College of Public Health, 1295 N. Martin Ave., Tucson, AZ, 85724, USA
| | - Marcia Grant
- City of Hope Medical Center/Beckman Research Institute, 1500 East Duarte Road Duarte, CA, 91010, USA
| | - Joanna E Bulkley
- Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Christopher S Wendel
- Southern Arizona Veterans Affairs Health Care System, 3601 S. 6th Ave., Tucson, AZ, 85723, USA.,The University of Arizona College of Medicine, 1501 N. Campbell Ave., Tucson, AZ, 85724, USA
| | - Robert S Krouse
- Southern Arizona Veterans Affairs Health Care System, 3601 S. 6th Ave., Tucson, AZ, 85723, USA.,The University of Arizona College of Medicine, 1501 N. Campbell Ave., Tucson, AZ, 85724, USA
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Mosher CE, Winger JG, Given BA, Helft PR, O'Neil BH. Mental health outcomes during colorectal cancer survivorship: a review of the literature. Psychooncology 2015; 25:1261-1270. [PMID: 26315692 DOI: 10.1002/pon.3954] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 06/24/2015] [Accepted: 08/05/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This article reviews literature on adults' mental health outcomes during acute and long-term colorectal cancer (CRC) survivorship. METHODS We identified articles that included at least one measure of psychological symptoms or mental quality of life or well-being through a search of databases (CINAHL, MEDLINE, PsycINFO, and PsycARTICLES). Articles were published between January 2004 and April 2015. RESULTS A significant proportion of CRC survivors experience clinically meaningful levels of anxiety and depressive symptoms or reduced mental well-being across the trajectory of the illness. Demographic, medical, and psychosocial predictors of mental health outcomes were identified. However, few studies were theory-driven, and gaps remain in our understanding of risk and protective factors with respect to mental health outcomes, especially during long-term CRC survivorship. CONCLUSIONS Theory-driven longitudinal research with larger samples is required to identify subgroups of CRC survivors with different trajectories of psychological adjustment. Such research would assess adjustment as a function of internal resources (e.g., personality and coping) and external resources (e.g., finances and social support) to inform future interventions for CRC survivors. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
| | - Joseph G Winger
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Barbara A Given
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Paul R Helft
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Bert H O'Neil
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Abstract
Cancer stigma has undergone an important transformation in recent decades. In general, this disease no longer fits squarely into Goffman’s classic taxonomy of stigmatized conditions. This review will demonstrate that, with important adaptations, an identity-threat model of stigma can be used to organize cancer stigma research post-Goffman. This adapted model postulates that one’s personal attributions, responses to situational threat, and disease/treatment characteristics can be used to predict identity threat and well-being of individuals with cancer. Implications for further research and clinical practice are discussed.
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Munro H, Scott SE, King A, Grunfeld EA. Patterns and predictors of disclosure of a diagnosis of cancer. Psychooncology 2014; 24:508-14. [PMID: 25251666 DOI: 10.1002/pon.3679] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 08/11/2014] [Accepted: 08/18/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND The value of talking (i.e. disclosing ones innermost thoughts and feelings) has been recognised as playing an important role in helping people work through their difficulties. Although disclosing a diagnosis of cancer has been identified to be one of the hardest aspects of having the disease, relatively little is known about the extent to which people talk about their diagnosis of cancer. This study aimed to identify disclosure patterns among patients with cancer and to determine the factors associated with disclosure. METHODS Patients (n = 120) who had received a diagnosis of either lung, colorectal or skin cancer completed a questionnaire assessing potential psychosocial predictors of disclosure. RESULTS Results indicated that the majority of patients (95%) found it helpful to disclose information and did so to a variety of social targets, with the highest levels of disclosure being reported to medical personnel (38% talked 'very much'), followed by family members (24%) and then friends (12%). There were no differences in disclosure across cancer types, with the exception of patients with colorectal cancer who disclosed information more to nurses and other cancer patients. Men disclosed information more than women to some social targets. Dispositional openness (B = .233, p < 0.05) and treatment type (B = -.240, p < 0.01) were found to predict 13% of the variance in degree of disclosure. CONCLUSIONS The results suggest that individual differences and social and clinical factors impact on disclosure and that medical professionals play an important role in the disclosure process.
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Affiliation(s)
- Heather Munro
- Central and North West London NHS Foundation Trust, London, UK
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Tucker J, Clifton V, Wilson A. Teetering near the edge; women's experiences of anal incontinence following obstetric anal sphincter injury: an interpretive phenomenological research study. Aust N Z J Obstet Gynaecol 2014; 54:377-81. [DOI: 10.1111/ajo.12230] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 05/25/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Julie Tucker
- Robinson Institute School Paediatrics and Reproductive Health; University of Adelaide; Adelaide South Australia Australia
| | - Vicki Clifton
- Robinson Institute School Paediatrics and Reproductive Health; University of Adelaide; Adelaide South Australia Australia
| | - Anne Wilson
- School of Medicine; Flinders University South Australia; Adelaide South Australia Australia
- Prince of Wales Clinical School; University of New South Wales; Sydney New South Wales Australia
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Damm K, Vogel A, Prenzler A. Preferences of colorectal cancer patients for treatment and decision-making: a systematic literature review. Eur J Cancer Care (Engl) 2014; 23:762-72. [PMID: 24840999 DOI: 10.1111/ecc.12207] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2014] [Indexed: 11/30/2022]
Abstract
Treatment decisions in life-threatening diseases, like colorectal cancer (CRC), are crucial, since they have a great impact on patient's survival and health-related quality of life. Thereby, the inclusion of patient's preferences becomes more and more important; however, these first need to be identified. Therefore, we conducted a systematic literature review in 12 electronic databases, published between 2000 and 2012, in order to identify patient's preferences concerning treatment preferences and involvement in the decision-making process. Nineteen studies were included and thoroughly analysed. This review shows that CRC patients do have preferences regarding different treatment options and outcomes; however, these preferences are not homogenous and seem to depend on personal factors like age and gender. Despite the existence of these preferences, the majority of patients prefer a passive role in the decision-making process, which in part may be explained by the severity of the disease. Again, subgroup analyses reveal the impact of personal factors like gender and education on the preference. Due to the importance of personal factors in the analysis of patient preferences, we identified an urgent need for larger studies that are suitable for subgroup analyses and incorporate multi-attributive measurement techniques, like discrete choice methods.
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Affiliation(s)
- K Damm
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hannover, Germany
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Marlow LAV, Wardle J. Development of a scale to assess cancer stigma in the non-patient population. BMC Cancer 2014; 14:285. [PMID: 24758482 PMCID: PMC4021096 DOI: 10.1186/1471-2407-14-285] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 04/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Illness-related stigma has attracted considerable research interest, but few studies have specifically examined stigmatisation of cancer in the non-patient population. The present study developed and validated a Cancer Stigma Scale (CASS) for use in the general population. METHODS An item pool was developed on the basis of previous research into illness-related stigma in the general population and patients with cancer. Two studies were carried out. The first study used Exploratory factor analysis to explore the structure of items in a sample of 462 postgraduate students recruited through a London university. The second study used Confirmatory factor analysis to confirm the structure among 238 adults recruited through an online market research panel. Internal reliability, test-retest reliability and construct validity were also assessed. RESULTS Exploratory factor analysis suggested six subscales, representing: Awkwardness, Severity, Avoidance, Policy Opposition, Personal Responsibility and Financial Discrimination. Confirmatory factor analysis confirmed this structure with a 25-item scale. All subscales showed adequate to good internal and test-retest reliability in both samples. Construct validity was also good, with mean scores for each subscale varying in the expected directions by age, gender, experience of cancer, awareness of lifestyle risk factors for cancer, and social desirability. Means for the subscales were consistent across the two samples. CONCLUSIONS These findings highlight the complexity of cancer stigma and provide the Cancer Stigma Scale (CASS) which can be used to compare populations, types of cancer and evaluate the effects of interventions designed to reduce cancer stigma in non-patient populations.
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Affiliation(s)
- Laura AV Marlow
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, Gower Street, London WC1E 6BT, UK
| | - Jane Wardle
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, Gower Street, London WC1E 6BT, UK
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Stephens M, McKenzie H, Jordens CFC. The work of living with a rare cancer: multiple myeloma. J Adv Nurs 2014; 70:2800-9. [PMID: 24725097 DOI: 10.1111/jan.12430] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2014] [Indexed: 01/17/2023]
Abstract
AIM To report findings from a qualitative study of the experiences of long-term survivors of multiple myeloma. BACKGROUND Multiple Myeloma is a malignant disease of the bone marrow. Until recently, it was rapidly fatal. Although it remains incurable, people diagnosed with it are living longer on average, largely due to new treatments, some of which have onerous side effects. DESIGN Prospective descriptive study. METHOD A series of 47 in-depth interviews were conducted at 6-12 month intervals over 18 months in 2008-2010 with 10 long-term survivors of myeloma and their primary support person. Interviews were analysed using the constant comparative method (Grounded Theory). FINDINGS To adapt to the effects of both the disease and ongoing medical treatments, participants undertook extensive 'illness work'. Most of this work fell into two broad categories. Risk work aimed to mitigate risks to the well-being of both the person with myeloma and his/her carer. Emotion work aimed to manage the feelings of self and others in a protracted cycle of remission and relapse. CONCLUSION The experience of myeloma is increasingly characterized by issues associated with chronic disease and 'survivorship'. It is important for nurses working with people with myeloma to understand the overwhelming nature of illness work in this context. Nurses can put in place supportive measures to address the two main 'drivers' of this work: constant risk to well-being of survivors (including carers) and the recurrent need to manage emotions in social interactions.
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Affiliation(s)
- Moira Stephens
- School of Nursing and Midwifery, University of Wollongong, New South Wales, Australia; Centre for Values, Ethics & Law in Medicine (VELIM), School of Public Health, University of Sydney, New South Wales, Australia
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Zullig LL, Jackson GL, Provenzale D, Griffin JM, Phelan S, Nieuwsma JA, van Ryn M. Utilization of hospital-based chaplain services among newly diagnosed male Veterans Affairs colorectal cancer patients. JOURNAL OF RELIGION AND HEALTH 2014; 53:498-510. [PMID: 23054482 PMCID: PMC3578120 DOI: 10.1007/s10943-012-9653-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The aim of the study was to examine utilization of chaplain services among Veterans Affairs patients with colorectal cancer (CRC). In 2009, the Cancer Care Assessment and Responsive Evaluation Studies questionnaire was mailed to VA CRC patients diagnosed in 2008 (67 % response rate). Multivariable logistic regression examined factors associated with chaplain utilization. Of 918 male respondents, 36 % reported utilizing chaplains. Chaplain services were more likely to be utilized by patients with higher pain levels (OR = 1.017; 95 % CI = 0.999-1.035), younger age (age OR = 0.979; 95 % CI = 0.964-0.996), and later cancer stage (early stage OR = 0.743; 95 % CI = 0.559-0.985). Chaplain services are most utilized by younger, sicker patients.
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Affiliation(s)
- Leah L Zullig
- Health Services Research and Development (152), Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC, 27705, USA,
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Maguire R, Stoddart K, Flowers P, McPhelim J, Kearney N. An Interpretative Phenomenological Analysis of the lived experience of multiple concurrent symptoms in patients with lung cancer: a contribution to the study of symptom clusters. Eur J Oncol Nurs 2014; 18:310-5. [PMID: 24685125 DOI: 10.1016/j.ejon.2014.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 02/05/2014] [Accepted: 02/14/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE OF THE RESEARCH To explore the lived experience of multiple concurrent symptoms in people with advanced lung cancer to contribute to the understanding of the experience of symptom clusters. METHODS AND SAMPLE Purposive sampling recruited ten people with advanced lung cancer who were experiencing three or more concurrent symptoms, were at least 18 years of age and were able to provide written informed consent. The participants took part in two consecutive, in-depth interviews, 3-5 weeks apart. Interpretative Phenomenological Analysis was used to analyse the data. FINDINGS Participants experienced 4-11 concurrent symptoms with fatigue, cough, pain and breathlessness featuring prominently in their interviews. The participants commonly identified associations between the symptoms that they experienced, with the occurrence of one symptom often used to explain the occurrence of another. Reductions in physical and social functioning were often associated with the experience of multiple concurrent symptoms, particularly at times of high symptom severity. The participants' highlighted breathlessness and cough as being of particular salience, due to the association of these symptoms with fear of death and visibility and embarrassment in public. CONCLUSIONS People with lung cancer experience multiple concurrent symptoms and perceive relationships between the symptoms experienced. Within the experience of multiple symptoms, people with lung cancer highlight individual symptoms that are of particular importance, based on their concomitant meanings. Such findings provide vital information for the future development of meaning-based symptom cluster interventions.
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Affiliation(s)
- Roma Maguire
- School of Health and Social Care, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7TE, UK.
| | - Kathleen Stoddart
- School of Nursing, Midwifery and Health, University of Stirling, Stirling FK9 4LA, UK.
| | - Paul Flowers
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 OBA, Scotland, UK.
| | - John McPhelim
- Hairmyres Hospital, NHS Lanarkshire, Eaglesham Road, East Kilbride, G75 8RG, UK.
| | - Nora Kearney
- School of Health and Social Care, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7TE, UK.
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Knowles SR, Cook SI, Tribbick D. Relationship between health status, illness perceptions, coping strategies and psychological morbidity: a preliminary study with IBD stoma patients. J Crohns Colitis 2013; 7:e471-8. [PMID: 23541738 DOI: 10.1016/j.crohns.2013.02.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 02/18/2013] [Accepted: 02/28/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Individuals living with IBD and a stoma are at an increased risk of anxiety and depression and it is likely that several factors mediate these relationships, including illness perceptions and coping strategies. Using the Common Sense Model (CSM), this study aimed to characterize the mediators of anxiety and depression in an IBD stoma cohort. METHODS Eighty-three adults (23 males) with a stoma (25 ileostomy, 58 colostomy; 26 emergency, 57 planned, 55 permanent, 28 temporary) completed an online survey. Health status was measured with the Health Orientation Scale (HOS), coping styles assessed with the Carver Brief COPE scale, illness perceptions explored with the Brief Illness Perceptions Questionnaire (BIPQ), and anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). RESULTS Combining the questionnaire data using structural equation modeling resulted in a final model with an excellent fit (χ(2) (11)=12.86, p=0.30, χ(2)/N=1.17, SRMR<0.05, RMSEA<0.05, GFI>0.96, CFI>0.99). Consistent with the CSM, health status directly influenced illness perceptions, which in turn, influenced coping (emotion-focused and maladaptive coping). Interestingly, months since surgery was found to influence illness perceptions and emotion-focused coping directly, but not health status. While depression was influenced by illness perceptions, emotion-focused coping and maladaptive coping, anxiety was only influenced by illness perceptions and maladaptive coping. CONCLUSIONS The preliminary results provide further evidence for the complex interplay between psychological processes. In terms of directions for psychological interventions, a focus on identifying and working with illness perceptions is important.
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Affiliation(s)
- S R Knowles
- Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne, Australia; Faculty of Medicine, Dentistry, & Health Sciences, The University of Melbourne, Melbourne, Australia; Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Melbourne, Australia.
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Danielsen AK, Burcharth J, Rosenberg J. Patient education has a positive effect in patients with a stoma: a systematic review. Colorectal Dis 2013; 15:e276-83. [PMID: 23470040 DOI: 10.1111/codi.12197] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 11/23/2012] [Indexed: 12/12/2022]
Abstract
AIM A systematic review was performed to assess whether education of patients having stoma formation improves quality of life and whether it is cost effective. METHOD A literature search was performed to identify studies on the structured education of ostomates and outcome using the following databases: MEDLINE, Cinahl, Embase, Cochrane and PsycInfo. Inclusion criteria were: clinical studies reporting effects of educational interventions in relation to patients with a stoma. Commentaries or studies not testing an intervention were excluded. RESULTS Seven articles met the inclusion criteria of having rigorously evaluated an educational programme related to living with a stoma. The programmes were organized in different ways and had explored various interventions. The results showed an increase in health-related quality of life, as measured using a stoma quality of life instrument (P = 0.00001) and with the Short Form 36 (SF-36) (P = 0.000-0.006), an increase in proficiency in management of the stoma (P = 0.0005), two studies pointed to a reduction in postoperative hospital stay (8 days vs 10 days, P = 0.029; and 8 days vs 14 days, P = 0.17), a significant reduction in cost in the intervention group ($US 8570.54) compared with the control group ($US 7396.90) as well as higher effectiveness scores in the intervention group (166.89) compared with the control group (110.98), a significant rise in stoma-related knowledge (P = 0.0000) and an increase in psychosocial adjustment (P = 0.000). CONCLUSION Structured patient education aimed at patients' psychosocial needs seems to have a positive effect on quality of life as well as on cost. The interventions may be performed before, during or after hospital stay. However, the available data come from few studies with differences in interventions and in study design, and further studies are therefore needed before a final conclusion can be drawn.
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Affiliation(s)
- A K Danielsen
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
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Abstract
OBJECTIVES This article explores the associations between medical care providers' attitudes towards patients living with HIV (PLH) and the service satisfaction reported from general patients. METHODS Data were collected from 40 county-level hospitals in China, including 1760 service providers and 1000 patients receiving medical services from the hospitals. Provider and patient assessments were conducted by self-administered questionnaires and face-to-face interviews, respectively. Random-effect regression models were used to examine relationships between the providers' avoidance attitudes and patient satisfaction at the hospital level while taking into account variations in demographics and professional experience within each hospital. RESULTS AND CONCLUSIONS Service providers' avoidance attitudes towards PLH were negatively associated with general patients' satisfaction with service providers at the hospital level. The relationship was strong and significant whether or not adjustments were made for background characteristics. Medical care providers' stigmatizing attitudes towards PLH could be a reflection of the providers' general outlook with all patients. This study underscores a broader focus for HIV-related stigma reduction interventions in medical settings at both individual and institutional levels, targeting attitudes towards both patients with HIV/AIDS and the general patient population.
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Affiliation(s)
- Li Li
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA 90024, USA.
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Reynolds LM, Consedine NS, Pizarro DA, Bissett IP. Disgust and behavioral avoidance in colorectal cancer screening and treatment: a systematic review and research agenda. Cancer Nurs 2013; 36:122-30. [PMID: 23047793 DOI: 10.1097/ncc.0b013e31826a4b1b] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The emotion of disgust appears to promote psychological and behavioral avoidance, a dynamic that has significant implications in physical and psychological outcomes in colorectal cancer (CRC). Patients, caregivers, and health professionals alike are all potentially susceptible to responding with disgust and the associated avoidance. OBJECTIVE This article aimed to review the early-stage literature related to disgust and CRC, consider the clinical implications, and suggest an appropriate research agenda. METHODS Given limited research in this area, a systematic review of the literature was broadened to include disgust and all cancers. MEDLINE, Web of Science, SCOPUS, and ProQuest Dissertations and Theses databases were searched, with additional works sourced by reviewing citation lists and/or by contacting the lead authors. RESULTS Nine studies were identified relating to disgust and cancer screening, and 6 related to disgust and cancer treatment. Two broad findings emerged: (1) disgust appears to be promoting aversion to (and avoidance of) CRC screening, and (2) several known elicitors of disgust are widely apparent in CRC contexts. CONCLUSIONS Disgust likely represents a key emotional substrate for avoidance among CRC patients, caregivers, and health professionals. Further research is required to identify disgust's elicitors and effects in CRC contexts, informing interventions that target early identification of persons at risk of maladaptive outcomes. Exposure therapies and mindfulness training may be well suited to treating disgust-generated avoidance. IMPLICATIONS FOR PRACTICE Disgust has significant implications in CRC contexts. Oncology nurses are uniquely positioned to guide clinical interventions and ultimately improve outcomes in this area.
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Affiliation(s)
- Lisa M Reynolds
- Departments of Psychological Medicine, University of Auckland, New Zealand.
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Danielsen AK, Soerensen EE, Burcharth K, Rosenberg J. Impact of a temporary stoma on patients' everyday lives: feelings of uncertainty while waiting for closure of the stoma. J Clin Nurs 2013; 22:1343-52. [PMID: 23279240 DOI: 10.1111/jocn.12011] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Anne K Danielsen
- Department of Surgery; Herlev Hospital; University of Copenhagen; Herlev Denmark
| | - Erik E Soerensen
- Aalborg Hospital Science and Innovation Center; Aalborg University Hospital; Aalborg Denmark
| | - Kirsten Burcharth
- Department of Surgery; Herlev Hospital; University of Copenhagen; Herlev Denmark
| | - Jacob Rosenberg
- Department of Surgery; Herlev Hospital; University of Copenhagen; Herlev Denmark
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Pachler J, Wille-Jørgensen P. Quality of life after rectal resection for cancer, with or without permanent colostomy. Cochrane Database Syst Rev 2012; 12:CD004323. [PMID: 23235607 PMCID: PMC7197443 DOI: 10.1002/14651858.cd004323.pub4] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND For almost one hundred years abdominoperineal excision has been the standard treatment of choice for rectal cancer. With advances in the techniques for rectal resection and anastomosis, anterior resection with preservation of the sphincter function has become the preferred treatment for rectal cancers, except for those cancers very close to the anal sphincter. The main reason for this has been the conviction that the quality of life for patients with a colostomy after abdominoperineal excision was poorer than for patients undergoing an operation with a sphincter-preserving technique. However, patients having sphincter-preserving operations may experience symptoms affecting their quality of life that are different from stoma-patients. OBJECTIVES To compare the quality of life in rectal cancer patients with or without permanent colostomy. SEARCH METHODS We searched PUBMED, EMBASE, LILACS, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Colorectal Cancer Group's specialised register. Abstract books from major gastroenterological and colorectal congresses were searched. Reference lists of the selected articles were scrutinized. SELECTION CRITERIA All controlled clinical trials and observational studies in which quality of life was measured in patients with rectal cancer having either abdominoperineal excision/Hartmann's operation or low anterior resection, using a validated quality of life instrument, were considered. DATA COLLECTION AND ANALYSIS One reviewer (JP) checked the titles and abstracts identified from the databases and hand search. Full text copies of all studies of possible relevance were obtained. The reviewer decided which studies met the inclusion criteria. Both reviewers independently extracted data. If information was insufficient the original author was contacted to obtain missing data. Extracted data were cross-checked and discrepancies resolved by consensus. MAIN RESULTS Sixty-nine potential studies were identified. Thirty-five of these, all non-randomised and representing 5127 participants met the inclusion criteria. Fourteen trials found that people undergoing abdominoperineal excision/Hartmann's operation did not have poorer quality of life measures than patients undergoing anterior resection. The rest of the studies found some difference, but not always in favour of non-stoma patients. Due to clinical heterogeneity and the fact that all studies were observational trials, meta-analysis of the included studies was not possible. AUTHORS' CONCLUSIONS The studies included in this review do not allow firm conclusions as to the question of whether the quality of life of people after anterior resection is superior to that of people after abdominoperineal excision/Hartmann's operation. The included studies challenges the assumption that anterior resection patients fare better. Larger, better designed and executed prospective studies are needed to answer this question.
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Affiliation(s)
- Jørn Pachler
- Gastroenterology Unit, Hvidovre Hospital, Hvidovre, Denmark.
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Ehiwe E, McGee P, Filby M, Thomson K. Black African migrants' perceptions of cancer: are they different from those of other ethnicities, cultures and races? ACTA ACUST UNITED AC 2012. [DOI: 10.1108/17570981211286732] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Phelan SM, Griffin JM, Jackson GL, Zafar SY, Hellerstedt W, Stahre M, Nelson D, Zullig LL, Burgess DJ, van Ryn M. Stigma, perceived blame, self-blame, and depressive symptoms in men with colorectal cancer. Psychooncology 2011; 22:65-73. [PMID: 21954081 DOI: 10.1002/pon.2048] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 06/30/2011] [Accepted: 07/08/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND We measured the prevalence of stigma, self-blame, and perceived blame from others for their illness among men with colorectal cancer (CRC) and examined whether these factors were associated with depressive symptoms, independent of clinical and sociodemographic factors. METHODS Self-administered questionnaires were returned in the fall of 2009 by 1109 eligible male US veterans who were diagnosed with CRC at any Veterans Affairs facility in 2008. Questionnaires assessed stigma, feelings of blame, and depressive symptoms as well as other facets of health, cancer characteristics, and quality and type of medical care. We report the prevalence of cancer stigma, self-blame, and perceived blame from others. We used multivariate linear regression to assess the association between these factors and a measure of depressive symptoms. Covariates included several measures of overall health, cancer progression, symptom severity, and sociodemographic factors. RESULTS Thirty one percent of respondents endorsed at least one item in a measure of cancer stigma and 25% reported feeling that it was at least 'a little true' that they were to blame for their illness. All three independent variables were associated with depressive symptoms in bivariate models; cancer stigma and self-blame were significantly associated with depressive symptoms in the multivariate model. CONCLUSIONS Cancer stigma and self-blame are problems for a significant minority of men with CRC and are independent predictors of depressive symptoms. They may represent an important source of stress in men with CRC.
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Affiliation(s)
- Sean M Phelan
- University of Minnesota, Family Medicine and Community Health, Minneapolis, MN 55414, USA.
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Vassilev I, Rogers A, Sanders C, Kennedy A, Blickem C, Protheroe J, Bower P, Kirk S, Chew-Graham C, Morris R. Social networks, social capital and chronic illness self-management: a realist review. Chronic Illn 2011; 7:60-86. [PMID: 20921033 DOI: 10.1177/1742395310383338] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Existing literature on the design of interventions and health policy about self-management have tended to focus on individual-centred definitions of self-care and there is growing recognition of the need to extend consideration beyond individual factors, which determine self-care, to examine wider influences such as the health service, the family and the wider social context. AIMS To explore the theoretical and empirical links between social networks, social capital and the self-care practices associated with chronic illness work and management in the context of people's everyday lives. METHOD A realist review method was used to search and appraise relevant quantitative and qualitative literature. FINDINGS The review findings indicate that social networks play an important part in the management of long-term conditions. We found that social networks tend to be defined narrowly and are primarily used as a way of acknowledging the significance of context. There is insufficient discussion in the literature of the specific types of networks that support or undermine self-care as well as an understanding of the processes involved. This necessitates shifting the emphasis of self-care towards community and network-centred approaches, which may also prove more appropriate for engaging people in socially and economically deprived contexts.
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Affiliation(s)
- Ivaylo Vassilev
- Health Sciences Research Group-Primary Care, School of Community Based Medicine, University of Manchester, UK.
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Tsuchiya M, Horn S, Ingham R. Development of the Psycho-social Discomfort Scale (PsDS): investigation of psychometric properties among Japanese breast cancer survivors. Psychooncology 2010; 21:161-7. [PMID: 22271536 DOI: 10.1002/pon.1880] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 10/13/2010] [Accepted: 10/13/2010] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To develop a new scale to assess psycho-social discomfort in breast cancer (BC) survivors in Japanese society and to investigate its psychometric properties. METHOD A total of 248 Japanese BC survivors completed both the Psycho-social Discomfort Scale (PsDS) and WHO Quality of Life BREF Japanese version (WHO QoL-Jp). A principal component factor analysis (with promax rotation) was performed, and internal consistency was examined using Cronbach's alpha. Divergent and convergent validities and criterion validity were examined using the Spearman's R. RESULTS The factor analysis extracted three factors: 'internalised stigma (IS)', 'social disclosure of BC (SD)', and 'psychological resources to live with BC (PR)'. The factors were moderately correlated. The scale had good internal consistency (alpha = 0.80). All sub-scales were inversely correlated with all the domains in the WHO QoL-Jp (r = -0.09 to -0.47). BC stage was significantly correlated with the SD sub-scale, and type of surgery was significantly correlated with the IS sub-scale. CONCLUSIONS The PsDS has 25 items. It measures psycho-social discomfort that Japanese BC survivors experienced or were experiencing in their community. It has a simple factor structure, relatively good internal consistency, and a satisfactory divergent validity.
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Affiliation(s)
- Miyako Tsuchiya
- School of Psychology, University of Southampton, Highfield, Southampton, UK.
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Smith-Gagen J, Cress RD, Drake CM, Romano PS, Yost KJ, Ayanian JZ. Quality-of-life and surgical treatments for rectal cancer--a longitudinal analysis using the California Cancer Registry. Psychooncology 2010; 19:870-8. [PMID: 19862692 DOI: 10.1002/pon.1643] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Heterogeneous results for research investigating health-related quality of life (HRQL) in patients undergoing sphincter-ablating procedures for rectal cancer are likely due to single institution experiences and measurement of HRQL. To address this heterogeneity, we evaluated HRQL in patients with rectal cancer by type of surgery, location of tumor, and receipt of adjuvant therapy using an HRQL instrument that has not been used to address rectal cancer patients in a population-based sample over time. METHODS The Functional Assessment of Cancer Therapy-Colorectal instrument was administered at 9 and 19 months after diagnosis to a consecutive sample of 160 patients in Northern California identified by the California Cancer Registry. A broad multidimensional interpretation of HRQL was used to examine the impact of tumor location and treatment status, stage of disease, age, and gender. RESULTS In general, men had lower social well-being scores, and younger patients had lower physical and emotional well-being scores and colorectal concerns scores. We found no differences in HRQL by either tumor location or type of surgery, at either 9 or 19 months after diagnosis. Lower physical well-being and greater adverse colorectal concerns were reported at 9 months among patients who received adjuvant therapy; however, only adverse colorectal concerns persisted over time. CONCLUSIONS This study provides additional evidence that sphincter-ablating procedures do not necessarily reduce quality of life in patients with rectal cancer. Distinctive features of this study include a broad multidimensional interpretation of HRQL, the 19 months of longitudinal follow-up, and a prospective population-based study design.
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Affiliation(s)
- Julie Smith-Gagen
- School of Community Health Sciences, University of Nevada, Reno, NV 89557-0208, USA.
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Landsbergen KM, Prins JB, Brunner HG, Kraaimaat FW, Hoogerbrugge N. Genetic testing for Lynch syndrome in the first year of colorectal cancer: a review of the psychological impact. Fam Cancer 2009; 8:325-37. [PMID: 19330464 PMCID: PMC2771129 DOI: 10.1007/s10689-009-9239-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 03/14/2009] [Indexed: 01/15/2023]
Abstract
An increasing number of patients with colorectal cancer (CRC) receive genetic counselling within 1 year after diagnosis. Little is known whether specific subgroups are more vulnerable for genetic testing related distress. A literature review was conducted to identify the psychological impact of CRC in the first year, and the additional impact of genetic testing. The electronic databases of PubMed, PsychInfo, Embase and the Cochrane Library were searched to identify all reports published between January 1997 and October 2007 on the psychological impact of (1) CRC-diagnosis up to 1 year after treatment and of (2) genetic testing for Lynch syndrome in patients with CRC. Studies on the psychological impact of genetic testing in newly diagnosed patient with CRC were not available. Either CRC patients diagnosed several years ago were studied and the focus was also often on the psychological impact of genetic testing prior to DNA-test disclosure. They show that limitations in emotional and social functioning can persist up to 1 year after CRC treatment, especially in those with a stoma or diagnosed before age 60. Female patients and male patients diagnosed before age 50 appear to be more vulnerable to genetic test-related distress. It is well known that being treated for CRC has great impact on psychological functioning. Little is known about the psychological impact during the first year after diagnosis and very little is known about the additional psychological effect of genetic testing for hereditary cancer in this period. We found presumptive evidence that specific subgroups of patients with CRC are more vulnerable for genetic-testing-related distress.
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Affiliation(s)
- Karin M Landsbergen
- Department of Human Genetics, Raboud University Nijmegen Medical Centre, 6525 GA Nijmegen, The Netherlands.
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Lebel S, Devins GM. Stigma in cancer patients whose behavior may have contributed to their disease. Future Oncol 2008; 4:717-33. [PMID: 18922128 DOI: 10.2217/14796694.4.5.717] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The purpose of the present review is to examine stigma and its consequences among people with cancer, with an emphasis on the situation in which one's behavior may have contributed to the disease. We examine whether voluntarily engaging in behavior that adds to cancer risk leads to increased stigma after cancer onset, as compared with when one's behavior is not considered (by the affected individual or by others) to have contributed to the onset of cancer. We conducted literature searches in PsychInfo and Medline and identified 38 published papers that empirically addressed cancer-related stigma. We found evidence of increased negative attitudes and more severe consequences of stigma among people that have engaged in a behavior that is perceived to have contributed to their cancer, compared with those who are not perceived to have contributed to their disease.
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Affiliation(s)
- Sophie Lebel
- School of Psychology, University of Ottawa, Ontario, Canada.
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Mickelson KD, Williams SL. Perceived Stigma of Poverty and Depression: Examination of Interpersonal and Intrapersonal Mediators. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2008. [DOI: 10.1521/jscp.2008.27.9.903] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Impact of colorectal cancer on patient and family: Implications for care. Eur J Oncol Nurs 2008; 12:217-26. [DOI: 10.1016/j.ejon.2007.11.005] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Revised: 10/31/2007] [Accepted: 11/04/2007] [Indexed: 11/18/2022]
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Owen J, Papageorgiou A. The lived experience of stigmatisation in patients after stoma reversal. ACTA ACUST UNITED AC 2008. [DOI: 10.12968/gasn.2008.6.4.29384] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aim: This small−scale, exploratory, qualitative study was conducted to investigate how the experiences of having a stoma and subsequent stoma reversal affected the lives of the participants.Method: Five participants were interviewed about their experiences. Manual thematic analysis, using Interpretive Phenomenological Analysis (IPA), was employed to interpret the data. Results: Common themes were identified as emerging from the data. Themes before reversal were: acceptance and coping; social impact; and anticipation of returning to normal. Post−reversal themes were: returning to normal; interference with anticipated return to normal; and ongoing social impact. Conclusion: This exploratory study provides a rich account of the experiences of stoma patients who underwent reversal operations. It enhances our understanding of the transition encountered when changing from a person with a stoma into someone without one. This research has found that the anticipated return to normal can be hampered by a mix of physical and psychological processes.
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Affiliation(s)
- John Owen
- Department of Colorectal Surgery, James Paget University Hospital, Great Yarmouth
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Jain S, McGory ML, Ko CY, Sverdlik A, Tomlinson JS, Wendel CS, Coons SJ, Rawl SM, Schmidt CM, Grant M, McCorkle R, Mohler MJ, Baldwin CM, Krouse RS. Comorbidities play a larger role in predicting health-related quality of life compared to having an ostomy. Am J Surg 2007; 194:774-9; discussion 779. [DOI: 10.1016/j.amjsurg.2007.08.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Revised: 08/13/2007] [Accepted: 08/13/2007] [Indexed: 10/22/2022]
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Coco C, Valentini V, Manno A, Rizzo G, Gambacorta MA, Mattana C, Verbo A, Picciocchi A. Functional results after radiochemotherapy and total mesorectal excision for rectal cancer. Int J Colorectal Dis 2007; 22:903-10. [PMID: 17294197 DOI: 10.1007/s00384-007-0276-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2007] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to prospectively define and measure evacuation and continence disorders after preoperative radiochemotherapy and total mesorectal excision (TME) for rectal cancer 1 year after surgery. MATERIALS AND METHODS We submitted 100 patients, who underwent neoadjuvant treatment and anterior resection with TME from 1996 to 2003, to a questionnaire on postoperative continence and evacuation. Anal sphincter function was further assessed by the Memorial Sloan-Kettering score. Factors influencing anorectal function were examined in univariate and multivariate analysis. RESULTS Median evacuation score was 16.12 +/- 5.12 (range 0-28). Sensation of incomplete evacuation was reported in 58% of cases, necessity to return to the bathroom <15 min in 37% and inability to evacuate completely <15 min in 35%. Median continence score was 13.7 +/- 4.79 (range 0-20). Incontinence to flatus was reported in 46% of cases. Colonic J-pouch allows better evacuation and continence. Continence was also better in absence of postoperative complications. Sphincter function resulted excellent or good in 75% of patients according to the Memorial Sloan-Kettering score. CONCLUSIONS The most frequent symptoms in our series are the sensation of incomplete evacuation, the incontinence to flatus, and the necessity to return to the bathroom <15 min. Colonic J-pouch warrants a better function. Postoperative complications compromise good functional results.
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Affiliation(s)
- C Coco
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
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