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Du S, Zhou Z, Wang C, Luan Z, Wu N, Chen Y, Peng X. Spiritual needs of women with breast cancer: A structural equation model. Eur J Oncol Nurs 2024; 71:102647. [PMID: 38991356 DOI: 10.1016/j.ejon.2024.102647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/11/2024] [Accepted: 06/22/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE The purpose of this study was to develop a structural equation model (SEM) to explore the factors influencing the spiritual needs of breast cancer patients. METHODS A cross-sectional study was conducted in the breast surgery department of a tertiary hospital in China from September 2020 to December 2020; convenience sampling and questionnaires were used to facilitate sampling and data collection. A total of 220 female breast cancer patients were included in the study. The data were analysed using multiple linear regression and structural equation modelling. RESULTS Compared with patients with other diseases, patients with breast cancer have greater spiritual needs (76.16 ± 13.19). Multivariate analysis revealed that religious beliefs, education level, social support, and resilience are important factors affecting the mental health of women with cancer (p < 0.05). The structural equation model fit well (RMSEA = 0.056, χ2p = 0.002). Social support directly affected spiritual needs (β = 0.607, p < 0.001) and indirectly affected spiritual needs through resilience (β = 0.353, p < 0.001). Resilience directly affected spiritual needs (β = 0.386, p < 0.05). Education level indirectly affected spiritual needs through social support (β = 0.307, p < 0.001). CONCLUSION This study provides a theoretical basis for intervention measures to improve the spiritual needs of female breast cancer patients. Paying more attention to social support and resilience may help solve the problem of meeting the high spiritual needs of breast cancer patients. Further research is needed to develop interventions.
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Affiliation(s)
- Shiyuan Du
- School of Nursing, Jilin University, Changchun, 130021, China
| | - Zijun Zhou
- Breast Surg, Jilin Cancer Hospital, Changchun, 130021, China
| | - Canfei Wang
- The First Affiliated Hospital of Hainan Medical College, Haikou, 570102, China
| | - Ze Luan
- The First Hospital of Jilin University, Changchun, 130021, China
| | - Nan Wu
- School of Nursing, Jilin University, Changchun, 130021, China
| | - Yulu Chen
- School of Nursing, Jilin University, Changchun, 130021, China
| | - Xin Peng
- School of Nursing, Jilin University, Changchun, 130021, China.
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Leung YW, Kwong EWY, Wong KLY, So J, Poon F, Cheng T, Chen E, Molasiotis A, Howell D. Understanding Elderly Chinese Cancer Patients in a Multicultural Clinical Setting: Embracing Mortality and Addressing Misperceptions of Vulnerability. Curr Oncol 2024; 31:2620-2635. [PMID: 38785478 PMCID: PMC11119118 DOI: 10.3390/curroncol31050197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/25/2024] Open
Abstract
Chinese patients face higher risks of gastrointestinal (GI) cancers and greater cancer-related deaths than Canadian-born patients. The older population encounters barriers to quality healthcare, impacting their well-being and survival. Previous studies highlighted Chinese immigrant perceptions of not requiring healthcare support. During the COVID-19 pandemic, their underutilization of healthcare services garnered attention. The present study explores the experiences of older Chinese cancer patients to improve culturally sensitive cancer care. A total of twenty interviews carried out in Cantonese and Mandarin were conducted with Chinese immigrants, aged 60 or above, diagnosed with Stage 3 or 4 GI cancer. These interviews were transcribed verbatim, translated, and subjected to qualitative descriptive analysis. Among older Chinese immigrant patients, a phenomenon termed "Premature Acceptance: Normalizing Death and Dying" was observed. This involved four key themes: 1. acceptance and letting go, 2. family first, 3. self-sufficiency, and 4. barriers to supportive care. Participants displayed an early acceptance of their own mortality, prioritizing family prosperity over their own quality of life. Older Chinese patients normalize the reality of facing death amidst cancer. They adopt a pragmatic outlook, acknowledging life-saving treatments while willingly sacrificing their own support needs to ease family burdens. Efforts to enhance health literacy require culturally sensitive programs tailored to address language barriers and differing values among this population. A strengths-based approach emphasizing family support and practical aspects of care may help build resilience and improve symptom management, thereby enhancing their engagement with healthcare services.
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Affiliation(s)
- Yvonne W. Leung
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A1, Canada
- College of Professional Studies, Northeastern University, Boston, MA 02115, USA
| | - Enid W. Y. Kwong
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Karen Lok Yi Wong
- School of Social Work, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Jeremiah So
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Frankie Poon
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Terry Cheng
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Eric Chen
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Alex Molasiotis
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Doris Howell
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada
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Cheng WH, Teo RH, Cheng LJ, Lau Y, Lau ST. Global prevalence of sleep disturbances among breast cancer survivors: A systematic review with meta-analysis. Sleep Health 2023; 9:704-716. [PMID: 37453906 DOI: 10.1016/j.sleh.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 07/18/2023]
Abstract
Breast cancer is a common cancer in which patients are highly susceptible to different sleep disturbances. However, current evidence lacked consistency in methodologies in investigating the prevalence of sleep disturbances among breast cancer survivors. The review aims to (1) investigate the global prevalence of sleep disturbances among breast cancer survivors; and (2) investigate the factors influencing the prevalence estimates. A comprehensive search was conducted in 8 databases using a 3-step approach, up to January 2022. The Newcastle-Ottawa Scale and Cochrane risk of bias tool were used to evaluate the quality of individual studies. Meta-analysis, meta-regression, and subgroup analysis were performed using R software. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluations criteria. A total of 51 studies were selected involving 28,036 breast cancer survivors across 17 countries. The global prevalence of poor sleep quality was 62%, different severities of insomnia were 3%-32%, and excessive daytime sleepiness was 24%. Subgroup analyses showed that a significantly higher prevalence of poor sleep quality was found in breast cancer survivors during treatment compared with pre- or post-treatment. No significant covariates were found in a series of meta-regression analyses. The majority (73.5%) of individual studies were high quality but the certainty of the evidence was low or very low according to Grading of Recommendations, Assessment, Development, and Evaluations criteria. More than half of breast cancer survivors have sleep disturbances, so developing a strategic intervention is warranted. Given the low or very low certainty of the evidence, a robust design for large-scale research is crucial in the future.
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Affiliation(s)
- Wen Hui Cheng
- Nursing Division, Singapore General Hospital, Singapore Health Services, Singapore
| | - Rui Hong Teo
- Nursing Division, Singapore General Hospital, Singapore Health Services, Singapore
| | - Ling Jie Cheng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Li C, Ure C, Zheng W, Zheng C, Liu J, Zhou C, Jian B, Sun L, Li W, Xie L, Mai Y, Zhao H, Liu Y, Lai J, Fu J, Wu Y. Listening to voices from multiple sources: A qualitative text analysis of the emotional experiences of women living with breast cancer in China. Front Public Health 2023; 11:1114139. [PMID: 36817918 PMCID: PMC9935709 DOI: 10.3389/fpubh.2023.1114139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/13/2023] [Indexed: 02/05/2023] Open
Abstract
Background Receiving a breast cancer diagnosis and treatment is both a physical and emotional journey. Previous studies using single-source data have revealed common and culture-specific emotional experiences of patients living with breast cancer. However, few studies have combined such data from multiple sources. Thus, using a variety of data sources, the current study sought to explore the emotional experiences of women in China newly diagnosed, post-operative, or undergoing chemotherapy. We posited that even though women living with breast cancer in China have multiple channels through which they can express these emotional experiences, little variance would be found in their emotional expressivity and the themes they want to express due to cultural inhibitions. Methods Text data from female patients newly diagnosed, post-operative, or undergoing chemotherapy were collected between June 2021 and January 2022 via a Python web crawler, semi-structured interviews, and an expressive writing intervention. Data were transcribed and subjected to thematic analysis. Reporting followed the consolidated criteria for reporting qualitative studies (COREQ) guidelines. Results Analyses were based on 5,675 Weibo posts and comments published by 448 posters and 1,842 commenters, transcription texts from 17 semi-structured interviews, and 150 expressive writing texts. From this total collection of 461,348 Chinese characters, three major themes emerged: (i) conflicting emotions after diagnosis; (ii) long-term suffering and treatment concerns; and (iii) benefit finding and cognitive reappraisal. Conclusions Despite gathering information from various sources, we found that distress from body-image disturbances, gender role loss and conflict, and changes in sexuality and fertility, were consistent among this sample of female Chinese patients with breast cancer. However, when women engaged actively in benefit finding and cognitive reappraisal with strong social support, patients were able to find ways to adapt and reported post-traumatic growth. Strong social support was an important facilitator in this growth. These study findings emphasize that healthcare professionals ought to increase cultural sensitivity, provide multiple channels to encourage patients to express their emotions, and incorporate screening for patients' emotional distress at all diagnostic and treatment phases as part of routine nursing care.
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Affiliation(s)
- Chaixiu Li
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China,School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Cathy Ure
- Directorate of Allied and Public Health, School of Health and Society, University of Salford, Salford, Manchester, United Kingdom
| | - Wanting Zheng
- Vascular Thyroid Breast Surgery Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Chunrao Zheng
- Department of General Surgery, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Jianhong Liu
- Office of Retirement Work, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Chunlan Zhou
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Biao Jian
- Software Quality Engineering Center, China Electronic Product Reliability and Environmental Testing Research Institute, Guangzhou, Guangdong, China
| | - Lijun Sun
- Reliability and Environmental Test Engineering Center, China Electronic Product Reliability and Environmental Testing Research Institute, Guangzhou, Guangdong, China
| | - Wenji Li
- Department of Breast Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Lijun Xie
- Vascular Thyroid Breast Surgery Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Yuchang Mai
- Department of General Surgery, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Huihui Zhao
- Department of Breast Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yusheng Liu
- Department of Breast Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jie Lai
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China,School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Jiaqi Fu
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China,School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Yanni Wu
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China,*Correspondence: Yanni Wu ✉
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Profiles of social constraints and associated factors among breast cancer patients: a latent profile analysis. BMC Psychiatry 2022; 22:750. [PMID: 36451108 PMCID: PMC9714186 DOI: 10.1186/s12888-022-04407-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/18/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The present study aimed to identify profiles of social constraints among Chinese breast cancer patients and to explore the variables associated with these patterns. METHODS The study recruited 133 Chinese breast cancer patients in Liaoning Province, China, between June 2021 and February 2022. The questionnaire package included the Social Constraints Scale (SCS), the Multidimensional Scale of Perceived Social Support (MSPSS), the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), and the Social Impact Scale (SIS). The methods of statistical analysis used included latent profile analysis (LPA) and multinomial logistic regression. RESULTS Three latent patterns of social constraints were found: class 1-the low social constraints group (51.9%), class 2-the moderate social constraints group (35.3%), and class 3-the high social constraints group (12.8%). Patients with high social support were more likely to report a low level of social constraint, while patients with a greater fear of progression were more likely to report a moderate or high level of social constraints. Significant differences existed among the latent classes identified by reference to social constraint in terms of education. CONCLUSION These results suggest that breast cancer patients' perceptions of social constraints vary and exhibit individual differences. Health care providers should take into account patients' fear of progression as well as their social support when developing interventions for patients with a high level of social constraints.
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The association between comorbidities and stigma among breast cancer survivors. Sci Rep 2022; 12:13682. [PMID: 35953505 PMCID: PMC9368698 DOI: 10.1038/s41598-022-15460-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/23/2022] [Indexed: 01/10/2023] Open
Abstract
This study aimed to explore the association between types and numbers of comorbidities and stigma among breast cancer survivors (BCSs). A cross-sectional study was conducted among 937 BCSs in Shanghai Cancer Rehabilitation Club. All participants were asked to fill in an online questionnaire including Stigma Scale for Chronic Illnesses 8-item version (SSCI-8) and questions on sociodemographic characteristics and health status. Multivariate linear regression was used to analyze the association between comorbidities and stigma, adjusting for confounding factors. Results showed that nearly 70% of the participants had one or more comorbidities. The participants with stroke, digestive diseases or musculoskeletal diseases had significantly higher stigma than those without the above comorbidities. In addition, stigma was higher among survivors in the group with a greater number of comorbidities. Thus, it is important to strengthen the management of stigma in BCSs, especially for those with comorbidities.
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Chu Q, Tang M, Chen L, Young L, Loh A, Wang C, Lu Q. Evaluating a Pilot Culturally Sensitive Psychosocial Intervention on Posttraumatic Growth for Chinese American Breast Cancer Survivors. Behav Med 2022; 48:251-260. [PMID: 33226894 PMCID: PMC9295633 DOI: 10.1080/08964289.2020.1845600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study investigated the potential benefit of a pilot culturally sensitive group support intervention, named Joy Luck Academy (JLA), in fostering posttraumatic growth among Chinese American breast cancer survivors. Eighty-six Chinese American breast cancer survivors participated in an eight-week single-arm pre-/post-test trial of an intervention program, which included educational lectures and peer mentor support. The JLA participants were compared with an independent sample of 109 Chinese American breast cancer survivors who went through routine care. Both groups completed baseline and eight-week follow-up assessments of the five facets of posttraumatic growth (meaningful interpersonal relationships, finding new possibilities in life, personal strength, appreciation of life, and spirituality). From baseline to follow-up, the JLA participants displayed significant improvements in the total score of posttraumatic growth, meaningful interpersonal relationships, appreciation of life, finding new possibilities in life, and personal strength. In contrast, the routine care participants showed no significant change in any of these outcome variables. The findings suggest the potential benefit of a culturally sensitive group support intervention in facilitating posttraumatic growth for Chinese American breast cancer survivors, indicating the need for a randomized controlled trial. The educational lectures and peer mentor support may be adapted to tailor the needs of other ethnic minority cancer patients.
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Affiliation(s)
- Qiao Chu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, China
| | - Moni Tang
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, TX, USA
| | - Lingjun Chen
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, TX, USA
| | | | | | | | - Qian Lu
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, TX, USA,Department of Psychology, University of Houston, TX, USA
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Characteristics of Asian-American Breast Cancer Survivors Retained in a 3-Month Technology-Based Intervention. Cancer Nurs 2022; 45:E766-E774. [PMID: 34661563 PMCID: PMC9001739 DOI: 10.1097/ncc.0000000000001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Technology-based intervention programs are known to be effective in approaching socially excluded groups or racial/ethnic minorities, including this specific population. However, the retention of participants in technology-based intervention studies is far more complicated and challenging compared with conventional studies targeting racial/ethnic minorities. OBJECTIVE This study aimed to identify the complex characteristics of the groups within Asian American breast cancer survivors who were successfully retained in a 3-month technology-based intervention study. METHODS This secondary analysis of the data from a larger ongoing intervention study included 155 Asian American breast cancer survivors. Major variables were measured using multiple instruments including the questions on characteristics of the participants, the Personal Resource Questionnaire, perceived isolation, Memorial Symptom Assessment Scale-Short Form, Cancer Behavior Inventory, 34-item Supportive Care Needs Survey Short Form, and Functional Assessment of Cancer Therapy Scale-Breast Cancer. Data analyses were done through χ2 tests, t tests, and decision tree analyses. RESULTS The retention rates differed by subethnicity (P = .025), immigration age (P < .001), and stage of breast cancer (P = .003). The decision tree indicated four groups with the highest probability of retention: (a) those who were diagnosed with stage II, III, or IV breast cancer, (b) those who immigrated to the United States after turning 31 years old, and (c) those who had high perceived barriers. CONCLUSION This study provides directions for future retention strategies for technology-based interventions among Asian American breast cancer survivors. IMPLICATIONS FOR PRACTICE Participants' characteristics need to be considered in developing retain strategies for technology-based interventions among Asian American breast cancer survivors.
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The prevalence of perceived stigma and self-blame and their associations with depression, emotional well-being and social well-being among advanced cancer patients: evidence from the APPROACH cross-sectional study in Vietnam. BMC Palliat Care 2021; 20:104. [PMID: 34233662 PMCID: PMC8265020 DOI: 10.1186/s12904-021-00803-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 06/28/2021] [Indexed: 12/24/2022] Open
Abstract
Background There is very limited evidence on the existence of cancer-related perceived stigma and self-blame among patients with advanced cancer in Asia, and how they are associated with psychosocial outcomes. This study aimed to address the gap in the current literature by (1) assessing perceived stigma, behavioural self-blame and characterological self-blame among Vietnamese patients with advanced cancer, and (2) investigating the associations of perceived stigma and self-blame (behavioural and characterological) with depression, emotional well-being and social well-being. Methods This cross-sectional study involved 200 Vietnamese patients with stage IV solid cancer. Depression was measured using the Center for Epidemiologic Studies Depression (CES-D) Scale. Emotional well-being and social well-being were measured with the relevant domains of the Functional Assessment of Cancer Therapy-General (FACT-G) scale. Perceived stigma was assessed using the sense of stigma subscale of Kissane’s Shame and Stigma Scale. Behavioural self-blame and characterological self-blame were measured by the patients’ answers to the questions on whether their cancer was due to patient’s behaviour or character. Multivariable linear regressions were used to investigate the associations while controlling for patient characteristics. Results Approximately three-fourths (79.0%, n = 158) of the participants reported perceived stigma with an average score of 20.5 ± 18.0 (out of 100). More than half of the participants reported behavioural self-blame (56.3%, n = 112) or characterological self-blame (62.3%, n = 124). Higher perceived stigma was associated with lower emotional well-being (ß = -0.0; p = 0.024). Behavioural self-blame was not significantly associated with depressive symptoms, emotional well-being or social well-being. Patients who reported characterological self-blame reported greater depressive symptoms (ß = 3.0; p = 0.020) and lower emotional well-being (ß = -1.6; p = 0.038). Conclusion Perceived stigma and self-blame were common amongst Vietnamese advanced cancer patients. Perceived stigma was associated with lower emotional well-being while characterological self-blame were associated with greater depressive symptoms and lower emotional well-being. Interventions should address perceived stigma and self-blame among this population. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00803-5.
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Tsai W, Zhang L, Park JS, Tan YL, Kwon SC. The importance of community and culture for the recruitment, engagement, and retention of Chinese American immigrants in health interventions. Transl Behav Med 2021; 11:1682-1690. [PMID: 33963414 PMCID: PMC8442562 DOI: 10.1093/tbm/ibab053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Chinese Americans experience cancer health disparities throughout the entire cancer continuum. Yet, they remain underrepresented in health research in part due to barriers in recruitment, engagement, and retention. This paper describes the strategies that we devised, by drawing upon our experiences with conducting two culturally sensitive cancer intervention studies, to help researchers improve their recruitment and retention rates of Chinese Americans in health research and address the gap in knowledge on intervention research with this population. The first study assessed the efficacy, adoption, and impact of an intervention, delivered by community health workers, to improve adherence to recommended stomach cancer prevention guidelines for at-risk Chinese Americans. The second study evaluated the feasibility and preliminary efficacy of a culturally adapted version of the Expressive Helping intervention for Chinese American cancer patients and survivors. Our main recruitment strategies revolved around building community relationships, developing culturally sensitive materials, and establishing good first impressions with participants. Our main engagement and retention strategies focused on attending to cultural sensitivity, fostering relationships, and using technology. Harnessing the community's inherent strengths and prioritizing cultural understanding is crucial for culturally sensitive health research with Chinese Americans.
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Affiliation(s)
- William Tsai
- Department of Applied Psychology, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA
| | - Liwei Zhang
- School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - James S Park
- Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Yi-Ling Tan
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Simona C Kwon
- Department of Population Health, NYU Langone Health, New York, NY, USA
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Tsai W, Nusrath S, Zhu R. Systematic review of depressive, anxiety and post-traumatic stress symptoms among Asian American breast cancer survivors. BMJ Open 2020; 10:e037078. [PMID: 32895276 PMCID: PMC7478010 DOI: 10.1136/bmjopen-2020-037078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES This paper aimed to review the experience of psychopathology symptoms (ie, depressive, anxiety and post-traumatic stress) and their social, cognitive and affective correlates among Asian American breast cancer survivors. Studies on psychosocial interventions for reducing psychopathology symptoms were also included in this review. DESIGN A systematic review was conducted. METHODS PubMed, PsycINFO and Web of Science were searched from database inception to November 2018. Empirical, peer-reviewed articles on adult women of Asian heritage residing in the USA with breast cancer diagnoses were included in this review. The methodological quality of the included articles was coded. RESULTS The search yielded 16 empirical articles, which were all deemed to be of high methodological quality. Eleven studies utilised a quantitative design, two studies utilised a qualitative design and three studies utilised a mixed-methods design. Thirteen were cross-sectional and three were longitudinal in design. Only two intervention studies were identified. Studies showed that Asian American breast cancer survivors endorsed moderate to high levels of depressive symptoms, anxiety and post-traumatic stress symptoms; those who are more acculturated demonstrated lower levels of depressive and anxiety symptoms. Asian American breast cancer survivors with social constraints were more likely to have intrusive thoughts and, in turn, have high levels of psychopathology symptoms. Intervention studies were limited, but the use of community-based participatory research approaches and cultural adaptations were noted strengths of the studies. DISCUSSION In addition to discussing clinical implications, we highlight limitations of the literature, including a lack of longitudinal studies and the limited use of standardised diagnostic instruments for assessing psychopathology symptoms among this population. Clarifying the prospective relationships between psychopathology symptoms and their social, cognitive and affective correlates will help inform the development of culturally sensitive psychosocial interventions among Asian American breast cancer survivors.
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Affiliation(s)
- William Tsai
- Applied Psychology, New York University, New York, New York, USA
| | - Sumaiya Nusrath
- Applied Psychology, New York University, New York, New York, USA
| | - Ruidi Zhu
- Applied Psychology, New York University, New York, New York, USA
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Neris RR, Nascimento LC, Leite ACAB, de Andrade Alvarenga W, Polita NB, Zago MMF. The experience of health-related quality of life in extended and permanent cancer survivors: A qualitative systematic review. Psychooncology 2020; 29:1474-1485. [PMID: 32658362 DOI: 10.1002/pon.5472] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/31/2020] [Accepted: 06/30/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This qualitative systematic review aims to synthesize qualitative evidence from primary studies on experiencing health-related quality of life (HRQoL) in extended and permanent cancer survivors. METHODS A systematic literature search was performed in PubMed, CINAHL, LILACS, PsycINFO, Scopus, and Web of Science. It followed guidelines from the statement in the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ). A quality appraisal of each study was undertaken using the Critical Appraisal Skills Programme. Data synthesis was conducted according to the thematic synthesis approach. Confidence in each review finding was assessed using the Confidence in the Evidence from Reviews of Qualitative research (Grade-CERQual). RESULTS Twenty-four studies from nine countries were selected for the final sample. Analysis of the studies' results allowed for the construction of nine descriptive themes that were interpreted into three analytical themes: "The body as a representation of HRQoL," "Living through and beyond cancer: the re-signification of HRQoL," and "Employing resources to improve HRQoL." According to the CERQual approach, moderate confidence estimations were achieved for the results. CONCLUSIONS The themes reflect that the HRQoL experience is re-signified by survivors from the privilege of being alive. This process happens with the support of social resources, family, hope, and spirituality. Based on the findings, it is suggested that health staff should be able to recognize the impact that cancer survival has on HRQoL and develop a care plan that addresses needs to sustain health in these survivors.
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Affiliation(s)
- Rhyquelle Rhibna Neris
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Willyane de Andrade Alvarenga
- Centro Universitário Santo Agostinho, Teresina, Piauí, Brazil.,Faculdade de Educação São Francisco, Pedreiras, Maranhã, Brazil
| | - Naiara Barros Polita
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil.,Universidade Estadual do Norte do Paraná, Bandeirantes, Paraná, Brazil
| | - Márcia Maria Fontão Zago
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
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Chu Q, Wu IHC, Tang M, Tsoh J, Lu Q. Temporal relationship of posttraumatic stress disorder symptom clusters during and after an expressive writing intervention for Chinese American breast cancer survivors. J Psychosom Res 2020; 135:110142. [PMID: 32485623 DOI: 10.1016/j.jpsychores.2020.110142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 05/07/2020] [Accepted: 05/13/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is a significant condition and frequently observed among breast cancer survivors. Extant literature has demonstrated the effectiveness of expressive writing interventions in reducing PTSD among breast cancer survivors. However, little is known about how different PTSD symptom clusters influence each other over time during and after the expressive writing intervention among breast cancer survivors. We investigated how the three PTSD symptom clusters (reexperiencing, avoidance and hyperarousal) influence each other during and after an expressive writing intervention among Chinese American breast cancer survivors. METHODS Chinese American breast cancer survivors (n = 136) completed an expressive writing intervention. Their PTSD symptoms were assessed at baseline, 1-, 3-, and 6-month follow-ups. RESULTS Using cross-lagged panel analysis, the model with hyperarousal symptoms at each assessment wave predicting the subsequent severity of avoidance and reexperiencing symptoms indicated the best fit, χ2(52) = 65.422, p = .100; CFI = 0.990, RMSEA = 0.044, 95% CI [0.000, 0.074]. CONCLUSION The results suggest that hyperarousal symptoms predict the subsequent severity of reexperiencing and avoidance symptoms over time during and after the expressive writing intervention. The findings highlight the importance of early diagnosis, monitoring and treatment of hyperarousal symptoms in enhancing the efficacy of PTSD interventions and reducing the chronicity in PTSD among Chinese American breast cancer survivors. Clinical Trial Registration atClinicalTrials.gov: NCT02946619.
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Affiliation(s)
- Qiao Chu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ivan Haw Chong Wu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Moni Tang
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Janice Tsoh
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA.
| | - Qian Lu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Psychology, University of Houston, Houston, TX, USA.
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Hsu BY, Chentsova Dutton Y, Adams IF, Gomez SL, Allen L, Huang E, Wang JHY. Talking about cancer: Explaining differences in social support among Chinese American and European American breast cancer survivors. J Health Psychol 2020; 25:1043-1056. [PMID: 29243524 PMCID: PMC9165535 DOI: 10.1177/1359105317745967] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Cultural models of emotional disclosure and its impact on seeking support are understudied in the context of cancer diagnosis. We argue that two different cultural norms must be considered: (1) the importance of emotional disclosure and (2) attitudes toward seeking support from loved ones. Our interviews with 37 foreign-born Chinese American and 23 European American breast cancer survivors revealed differences in disclosure of cancer diagnosis and perception of social support. Both Chinese American and European American survivors receive and provide emotional and social support with loved ones, but their manifestations of disclosure and help-seeking behaviors are culturally specific.
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Affiliation(s)
| | | | - Inez F. Adams
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Laura Allen
- Cancer Prevention Institute of California, Fremont, CA, USA
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Social Constraints and PTSD among Chinese American breast cancer survivors: not all kinds of social support provide relief. J Behav Med 2020; 44:29-37. [PMID: 32519299 DOI: 10.1007/s10865-020-00165-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
Research has demonstrated the association between social constraints and posttraumatic stress disorder (PTSD) symptoms among breast cancer survivors. Although perceived social support can buffer stress and improve emotional well-being, little is known about which type of social support is most effective in buffering the negative effects of social constraints among cancer survivors. We investigated the moderation of four types of social support (i.e., positive interaction, tangible support, emotional/informational support and affectionate support) on the association between social constraints and PTSD symptoms among Chinese American breast cancer survivors. One hundred and thirty-six Chinese American breast cancer survivors completed questionnaires that assessed social constraints, PTSD symptoms and perceived social support. Results of hierarchical regression analysis indicated that only support of positive interaction exerted a buffering effect, with social constraints associated with greater PTSD severity among survivors with low but not high levels of support of positive interaction. In contrast, high levels of tangible support potentiated the association between social constraints and PTSD symptoms. There were no moderating effects of emotional/informational support and affectionate support. These results demonstrated the roles of different types of social support in moderating the stress imposed by social constraints. Our findings highlight the importance of recognizing the potential cultural sensitivity of ethnic minorities in PTSD intervention and mental health services for cancer patients.
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Warmoth K, Wong CCY, Chen L, Ivy S, Lu Q. The role of acculturation in the relationship between self-stigma and psychological distress among Chinese American breast cancer survivors. PSYCHOL HEALTH MED 2020; 25:1278-1292. [DOI: 10.1080/13548506.2020.1734638] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Krystal Warmoth
- Krystal Warmoth, Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Celia C. Y. Wong
- Department of Psychology, The College at Brockport, State University of New York, Brockport, NY, USA
| | - Lingjun Chen
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shelby Ivy
- University of Texas at San Antonio, San Antonio, TX, USA
| | - Qian Lu
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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17
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Warmoth K, Yeung NCY, Xie J, Feng H, Loh A, Young L, Lu Q. Benefits of a Psychosocial Intervention on Positive Affect and Posttraumatic Growth for Chinese American Breast Cancer Survivors: A Pilot Study. Behav Med 2020; 46:34-42. [PMID: 30657442 PMCID: PMC6639149 DOI: 10.1080/08964289.2018.1541862] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 06/26/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022]
Abstract
Breast cancer survivors report persistent psychological and physical symptoms, which affect their quality of life and may challenge the recovery process. Due to social, cultural, and linguistic barriers, culturally sensitive care is largely unavailable for Chinese Americans, and their psychological needs are not often addressed. We aimed to investigate whether the Joy Luck Academy (JLA), a psychosocial intervention providing both information and peer support, was associated with positive adjustment among Chinese American breast cancer survivors. Thirty-nine Chinese American breast cancer survivors participated in a pilot psychosocial intervention. The educational materials and lectures were delivered in the participants' native language of Chinese. All of the educators and mentors shared the same linguistic and cultural background with the participants. The program utilized a community-based participatory research (CBPR) approach to further enhance the cultural sensitivity of the intervention. Participants' post-traumatic growth and positive affect were assessed before and after the intervention. The JLA showed an improvement in positive affect, and they had a greater appreciation for life. The intervention was found to be feasible, well-accepted, and beneficial for this population. Chinese American breast cancer survivors reported improved psychological health after attending the intervention. These findings encourage the development and implementation of psychosocial interventions for Chinese breast cancer survivors. Similar programs could be integrated into other ethnic or cultural communities.
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Affiliation(s)
- Krystal Warmoth
- University of Exeter Medical School, University of Exeter, Exeter, UK ()
| | - Nelson C. Y. Yeung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sino Building, Chung Chi Rd, Sha Tin, Hong Kong, China ()
| | - Jing Xie
- Culture & Health Research Center, University of Houston, Department of Psychology, Fred J. Heyne Building Rm 126, 3695 Cullen Boulevard, Houston, TX, USA 77204-5022 (; ; )
| | - Hannah Feng
- Culture & Health Research Center, University of Houston, Department of Psychology, Fred J. Heyne Building Rm 126, 3695 Cullen Boulevard, Houston, TX, USA 77204-5022 (; ; )
| | - Alice Loh
- Herald Cancer Association, Chinese Christian Herald Crusades, 715 E. Mission Road, San Gabriel, CA, USA 91776 (; )
| | - Lucy Young
- Herald Cancer Association, Chinese Christian Herald Crusades, 715 E. Mission Road, San Gabriel, CA, USA 91776 (; )
| | - Qian Lu
- Culture & Health Research Center, University of Houston, Department of Psychology, Fred J. Heyne Building Rm 126, 3695 Cullen Boulevard, Houston, TX, USA 77204-5022 (; ; )
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Texas ()
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18
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The associations of self-stigma, social constraints, and sleep among Chinese American breast cancer survivors. Support Care Cancer 2019; 28:3935-3944. [DOI: 10.1007/s00520-019-05233-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022]
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Zhang L, Lu Y, Qin Y, Xue J, Chen Y. Post-traumatic growth and related factors among 1221 Chinese cancer survivors. Psychooncology 2019; 29:413-422. [PMID: 31705578 DOI: 10.1002/pon.5279] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 10/21/2019] [Accepted: 10/28/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE There is an increasing number of studies on the post-traumatic growth (PTG) of cancer survivors worldwide. However, few Chinese studies have reported about PTG in cancer survivors because of the underdevelopment of community health services. This study aimed to evaluate the level of PTG in China and explore related factors among a large sample of survivors of more than 12 cancer types. METHODS We recruited 1236 survivors from 14 sites of the Beijing Cancer Rehabilitation Association. Survivors completed standardized questionnaires assessing PTG, social support, coping styles, demographic characteristics, and clinical conditions. Multivariate linear regression was used to evaluate potential predictive factors of PTG. RESULTS A total of 1221 (98.7%) subjects completed the questionnaires. The average PTG score was 61.15 ± 20.26. Seven variables were included in the final regression model: social support, coping style, time after treatment, exercise, BMI, work status, and economic income (P < .05). Survivors who had low levels of social support, had negative coping strategies, had a time after treatment of less than 5 years, exercised irregularly, had an abnormal BMI, were unemployed, or had low economic income had lower PTG levels. CONCLUSIONS PTG levels among Chinese cancer survivors are associated with social support, coping style, time after treatment, exercise, BMI, work status, and economic income. Strategies tailored to Chinese survivors should be developed to promote their PTG and improve their physical and psychological well-being.
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Affiliation(s)
- Liyan Zhang
- The Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Medical Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yuhan Lu
- Nursing Department, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yin Qin
- Beijing Cancer Rehabilitation Association, Beijing, China
| | - Jing Xue
- The Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Medical Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yang Chen
- The Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Medical Oncology, Peking University Cancer Hospital & Institute, Beijing, China
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20
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Treatment decision-making, family influences, and cultural influences of Chinese breast cancer survivors: a qualitative study using an expressive writing method. Support Care Cancer 2019; 28:3259-3266. [DOI: 10.1007/s00520-019-05161-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
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21
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Self-stigma predicts lower quality of life in Chinese American breast cancer survivors: exploring the mediating role of intrusive thoughts and posttraumatic growth. Qual Life Res 2019; 28:2753-2760. [DOI: 10.1007/s11136-019-02213-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2019] [Indexed: 12/20/2022]
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22
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Tsai W, Wu IHC, Lu Q. Acculturation and quality of life among Chinese American breast cancer survivors: The mediating role of self-stigma, ambivalence over emotion expression, and intrusive thoughts. Psychooncology 2019; 28:1063-1070. [PMID: 30838727 DOI: 10.1002/pon.5053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/22/2019] [Accepted: 02/28/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Highly acculturated Chinese American breast cancer survivors have greater access to health care providers, are English language proficient, and have more knowledge about the health care system. However, less is known about the potential psychosocial factors that may account for the health benefits of acculturation. As such, the current study seeks to understand how mainstream acculturation is associated with higher quality of life by investigating self-stigma, ambivalence over emotion expression (AEE), and intrusive thoughts, as serial mediators among Chinese breast cancer survivors. METHODS One hundred twelve Chinese American breast cancer survivors completed a self-reported questionnaire with these trait variables. RESULTS We found support for a serial multiple mediation hypothesis in which mainstream acculturation was indirectly associated with quality of life through self-stigma, AEE, and intrusive thoughts. Specifically, mainstream acculturation was associated with lower self-stigma, which, in turn, was associated with lower AEE and intrusive thoughts and subsequently resulted in lower quality of life among Chinese American breast cancer survivors. CONCLUSIONS The findings suggest that psychosocial factors are important mechanisms through which acculturation is associated with quality of life among Chinese American breast cancer survivors. As Chinese immigrants acculturate to mainstream American culture, they may benefit from the reduced public stigma toward breast cancer and incorporate new post-immigration knowledge about cancer that protects them from high levels of self-stigma. This, in turn, may lead Chinese American breast cancer survivors to experience lower AEE and intrusive thoughts and subsequently experience higher quality of life.
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Affiliation(s)
- William Tsai
- Department of Applied Psychology, New York University, New York, New York
| | - Ivan H C Wu
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Qian Lu
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, Texas
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Wu CS, Warmoth KM, Cheung B, Loh A, Young L, Lu Q. Successful Strategies for Engaging Chinese Breast Cancer Survivors in a Randomized Controlled Trial. TRANSLATIONAL ISSUES IN PSYCHOLOGICAL SCIENCE 2019; 5:51-61. [PMID: 30923730 DOI: 10.1037/tps0000171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chinese immigrant breast cancer survivors face various challenges due to cultural and socioecological factors. Research efforts to develop culturally sensitive interventions have been limited by lack of knowledge regarding successful recruitment and implementation practices among Chinese immigrant populations. This paper documents strategies utilized during the development and implementation of a randomized controlled trial of a culturally sensitive psychosocial intervention for Chinese immigrant breast cancer survivors. In partnership with a community agency, we developed culturally and linguistically appropriate research materials, recruited participants from community channels, and conducted longitudinal data collection. Key strategies include building equitable research partnerships with community agencies to engage participants; being responsive to the needs of community agencies and participants; considering within-group diversity of the research population; utilizing recruitment as an opportunity for relationship-building with participants; and developing key strategies to promote retention. Successful participant engagement in cancer intervention research is the result of collaboration among breast cancer survivors, community leaders and agencies, and academic researchers. The engagement process for this study is novel because we have emphasized cultural factors in the process and taken a relational approach to recruitment and retention.
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Affiliation(s)
- Christine S Wu
- Department of Psychology, University of Houston; Houston, Texas
| | | | - Bernice Cheung
- Department of Psychology, University of Houston; Houston, Texas
| | - Alice Loh
- Herald Cancer Association; San Gabriel, California
| | - Lucy Young
- Herald Cancer Association; San Gabriel, California
| | - Qian Lu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Psychology, University of Houston; Houston, Texas
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Health-Related Quality of Life among Women Breast Cancer Patients in Eastern China. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1452635. [PMID: 30065931 PMCID: PMC6051298 DOI: 10.1155/2018/1452635] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 05/29/2018] [Accepted: 06/05/2018] [Indexed: 11/18/2022]
Abstract
Objectives Breast cancer is one of the major cancers in Chinese women. European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ-C30 and QLQ-BR23) are now the most common and well developed instruments assessing the health-related quality of life (HRQOL) of breast cancer patients internationally, whereas there are relatively few Chinese studies. This study has two aims: to investigate the HRQOL and explore which dimensions of HRQOL play more important roles in breast cancer patients' overall quality of life in China and to explore the latent factor structure and the potential complementary relationship between these two EORTC questionnaires. Methods This cross-sectional and descriptive study was performed from October 2014 to February 2015 in Qingdao Municipal Hospital, China. A total of 621 women breast cancer patients were enrolled. EOTRC QLQ-C30 and QLQ-BR23 were used to evaluate the HRQOL of the participants. The nonparametric test, multiple linear regression, and exploratory factor analysis (EFA) were the main statistical methods we used. Results 608 participants completed the questionnaires with a response rate of 97.9%. The mean age of the participants was 48.0 years (SD=9.6). About 33% were illiterate or only finished primary school education. Almost half participants (47.4%) only adopted chemotherapy. HRQOL was significantly different with regard to patients' social-demographic and clinical characteristics. Age, residence, educational level, employment status, and TNM stage were five significant predictors for global health status. Pain, dyspnea, sexual enjoyment, and systemic therapy side-effect were main subscales which had a significant impact on the global health status for patients in different TNM stage. The EFA result suggested that QLQ-C30 and QLQ-BR23 were complementary questionnaires. Conclusions The EORTC QLQ-C30 and QLQ-BR23 questionnaires provide complementary information regarding breast cancer patients' HRQOL, and depending on the different cancer staging functional/symptom scales which significantly contributed to the overall HRQOL differed.
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Exploring the Social Needs and Challenges of Chinese American Immigrant Breast Cancer Survivors: a Qualitative Study Using an Expressive Writing Approach. Int J Behav Med 2018; 24:827-835. [PMID: 28585073 DOI: 10.1007/s12529-017-9661-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Little is known about the psychological well-being and social barriers among immigrant Chinese American breast cancer survivors. The aim of the present study was to explore the social needs and challenges of Chinese American immigrant breast cancer survivors. METHOD This study used the expressive writing approach to explore the experiences among 27 Chinese American breast cancer survivors. The participants were recruited through community-based organizations in Southern California, most of whom were diagnosed at stages I and II (33 and 48%, respectively). Participants, on average, had been living in the USA for 19 years. Participants were asked to write three 20-min essays related to their experience with breast cancer (in 3 weeks). Participants' writings were coded with line-by-line analysis, and categories and themes were generated. RESULTS Emotion suppression, self-stigma, and perceived stigma about being a breast cancer survivor were reflected in the writings. Interpersonally, participants indicated their reluctance to disclose cancer diagnosis to family and friends and concerns about fulfilling multiple roles. Some of them also mentioned barriers of communicating with their husbands. Related to life in the USA, participants felt unfamiliar with the healthcare system and encountered language barriers. CONCLUSION Counseling services addressing concerns about stigma and communication among family members may benefit patients' adjustments. Tailor-made information in Chinese about diagnosis and treatment for breast cancer and health insurance in the USA may also help patients go through the course of recovery.
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LeRoy AS, Shields A, Chen MA, Brown RL, Fagundes CP. Improving Breast Cancer Survivors' Psychological Outcomes and Quality of Life: Alternatives to Traditional Psychotherapy. CURRENT BREAST CANCER REPORTS 2018; 10:28-34. [PMID: 32153724 DOI: 10.1007/s12609-018-0266-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Purpose of Review Breast cancer survivors (BCS) often experience psychological problems and lowered quality of life (QOL). While helpful, psychotherapy is often costly and inaccessible. This review aims to provide practitioners with the latest information on empirically tested interventions among BCS that may be used in lieu of, or in addition to, traditional psychotherapy. Recent Findings Recent developments in cancer-related psychological interventions include a focus on facilitating emotional disclosure (e.g., expressive writing), enhancing close relationships (e.g., couples-based interventions), and increasing feasibility and accessibility via online and computer-based intervention programs. These alternatives to psychotherapy offer a number of benefits including cost-effectiveness, personalized adaptability, and ease of implementation. Summary Utilizing these interventions as alternatives or supplements to traditional psychotherapy may offer BCS an opportunity to increase their QOL, improve psychosocial outcomes, and find meaning in their cancer experience. Choosing the appropriate intervention requires understanding the unique circumstances for each survivor and their family.
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Affiliation(s)
- Angie S LeRoy
- Department of Psychology, The University of Houston, 3695 Cullen Blvd. Rm 126, Houston, TX 77204, USA
- Department of Psychology, Rice University, Bioscience Research Collaborative, Houston, TX, USA
| | - Allison Shields
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Michelle A Chen
- Department of Psychology, Rice University, Bioscience Research Collaborative, Houston, TX, USA
| | - Ryan L Brown
- Department of Psychology, Rice University, Bioscience Research Collaborative, Houston, TX, USA
| | - Christopher P Fagundes
- Department of Psychology, Rice University, Bioscience Research Collaborative, Houston, TX, USA
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
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Ye ZJ, Qiu HZ, Liang MZ, Liu ML, Li PF, Chen P, Sun Z, Yu YL, Wang SN, Zhang Z, Liao KL, Peng CF, Huang H, Hu GY, Zhu YF, Zeng Z, Hu Q, Zhao JJ. Effect of a mentor-based, supportive-expressive program, Be Resilient to Breast Cancer, on survival in metastatic breast cancer: a randomised, controlled intervention trial. Br J Cancer 2017; 117:1486-1494. [PMID: 28926525 PMCID: PMC5680471 DOI: 10.1038/bjc.2017.325] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 07/26/2017] [Accepted: 08/24/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Because of medical advances, metastatic breast cancer (MBC) is now viewed as a chronic disease, rather than an imminent death sentence. Helping women live with this disease requires more than a medical approach to symptoms. Thus, a mentor-based and supportive-expressive program 'Be Resilient to Breast Cancer' (BRBC) was designed to help Chinese women with MBC enhance their resilience levels, biopsychosocial functions, and potentially extend their life span. METHODS A total of 226 women with MBC were randomly assigned, in a 1 : 1 ratio, to an intervention group (IG) that participated in BRBC or to a control group (CG) that received no intervention. Be Resilient to Breast Cancer was conducted for 120 min once a week. Primary outcomes were cancer-specific survival and secondary outcomes were resilience, Allostatic Load Index (ALI), anxiety, depression, and quality of life (QoL). The Cox proportional-hazards model was used for survival analysis and growth mixture models were performed for secondary outcomes. RESULTS Be Resilient to Breast Cancer did not significantly prolong 3- or 5-year survival (median survival, 36.7 months in IG and 31.5 months in CG). The hazard ratio for death was 0.736 (95% CI, 0.525-1.133, P=0.076; univariate Cox model) and 0.837 (95% CI, 0.578-1.211, P=0.345; multivariate Cox analysis). The IG improved in anxiety (ES=0.85, P<0.001), depression (ES=0.95, P<0.001), QoL (ES=0.55, P<0.001), resilience (ES=0.67, P<0.001), and ALI (ES=0.90, P<0.001) compared to CG. CONCLUSIONS BRBC does not improve survival of women with MBC in this study, though longer follow up is warranted. It positively impacts resilience, QoL, ALI, and emotional distress.
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Affiliation(s)
- Zeng Jie Ye
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province 510006, China
| | - Hong Zhong Qiu
- College of Economics and Management, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province 510006, China
| | - Mu Zi Liang
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province 510006, China
| | - Mei Ling Liu
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province 510060, China
| | - Peng Fei Li
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province 510006, China
| | - Peng Chen
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province 510006, China
| | - Zhe Sun
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province 510405, China
| | - Yuan Liang Yu
- College of Economics and Management, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province 510006, China
| | - Shu Ni Wang
- College of Economics and Management, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province 510006, China
| | - Zhang Zhang
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province 510060, China
| | - Kun Lun Liao
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province 510060, China
| | - Cai Fen Peng
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province 510060, China
| | - Hui Huang
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province 510060, China
| | - Guang Yun Hu
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province 510405, China
| | - Yun Fei Zhu
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province 510405, China
| | - Zhen Zeng
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province 510405, China
| | - Qu Hu
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province 510405, China
| | - Jing Jing Zhao
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province 510120, China
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Ganesh S, Lye MS, Lau FN. Quality of Life among Breast Cancer Patients In Malaysia. Asian Pac J Cancer Prev 2017; 17:1677-84. [PMID: 27221837 DOI: 10.7314/apjcp.2016.17.4.1677] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Among the factors reported to determine the quality of life of breast cancer patients are socio- demographic background, clinical stage, type of treatment received, and the duration since diagnosis. OBJECTIVE The objective of this study was to determine the quality of life (QOL) scores among breast cancer patients at a Malaysian public hospital. MATERIALS AND METHODS This cross-sectional study of breast cancer patients was conducted between March to June 2013. QOL scores were determined using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its breast cancer supplementary measure (QLQ-BR23). Both the QLQ-C30 and QLQ-BR23 assess items from functional and symptom scales. The QLQ-C30 in addition also measures the Global Health Status (GHS). Systematic random sampling was used to recruit patients. RESULTS 223 breast cancer patients were recruited with a response rate of 92.1%. The mean age of the patients was 52.4 years (95% CI = 51.0, 53.7, SD=10.3). Majority of respondents are Malays (60.5%), followed by Chinese (19.3%), Indians (18.4%), and others (1.8%). More than 50% of respondents are at stage III and stage IV of malignancy. The mean Global Health Status was 65.7 (SD = 21.4). From the QLQ-C30, the mean score in the functioning scale was highest for 'cognitive functioning' (84.1, SD=18.0), while the mean score in the symptom scale was highest for 'financial difficulties' (40.1, SD=31.6). From the QLQ-BR23, the mean score for functioning scale was highest for 'body image' (80.0, SD=24.6) while the mean score in the symptom scale was highest for 'upset by hair loss' (36.2, SD=29.4). Two significant predictors for Global Health Status were age and employment. The predictors explained 10.6% of the variation of global health status (R2=0.106). CONCLUSIONS Age and employment were found to be significant predictors for Global Health Status (GHS). The Quality of Life among breast cancer patients reflected by the GHS improves as age and employment increases.
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Affiliation(s)
- Sri Ganesh
- Department of Community Health, University Putra Malaysia, Kuala Lumpur, Malaysia E-mail :
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Li ST, Yuen J, Zhou K, Binte Ishak ND, Chen Y, Met-Domestici M, Chan SH, Tan YP, Allen JC, Lim ST, Soo KC, Ngeow J. Impact of subsidies on cancer genetic testing uptake in Singapore. J Med Genet 2016; 54:254-259. [DOI: 10.1136/jmedgenet-2016-104302] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 09/30/2016] [Accepted: 10/03/2016] [Indexed: 11/04/2022]
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Effect of a multidiscipline mentor-based program, Be Resilient to Breast Cancer (BRBC), on female breast cancer survivors in mainland China-A randomized, controlled, theoretically-derived intervention trial. Breast Cancer Res Treat 2016; 158:509-22. [PMID: 27400910 DOI: 10.1007/s10549-016-3881-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/20/2016] [Indexed: 10/21/2022]
Abstract
To reduce the risk of adjustment problems for breast cancer patients in mainland China, we examined the efficacy of a multidiscipline mentor-based program, Be Resilient to Breast Cancer (BRBC), delivered after breast surgery to (a) increase protective factors of social support, hope for the future, etc.; (b) decrease risk factors of Physical and Emotional Distress; and (c) increase outcomes of Resilience, Transcendence and Quality of Life (QOL). A multisite randomized controlled trial was conducted at 6 specialist cancer hospitals. 101 and 103 breast cancer patients were allocated to intervention group (IG) and control group (CG), respectively, and 112 general females (without breast cancer) were allocated to the norm group (NG). Participants completed measures that were related to latent variables derived from the Resilience Model for Breast Cancer (RM-BC) at baseline (T1), 2 months (T2), 6 months (T3), and 12 months (T4) after intervention. At T2, the IG reported significantly lower Depression (ES = 0.65,P = 0.0019) and Illness Uncertainty (ES = 0.57, P = 0.004), better Hope (ES = 0.81, P < 0.001) and QOL (ES = 0.60, P = 0.002) than did the CG. At T3, the IG reported significantly lower Anxiety (ES = 0.74, P < 0.001), better Social Support (ES = 0.51,P = 0.009), Transcendence (ES = 0.87, P < 0.001), and Resilience (ES = 0.83, P < 0.001) compared with the CG. At T4, the IG reported better Resilience though not significant (P = 0.085) and better Transcendence (P = 0.0243) than did the NG. The BRBC intervention improves the positive health outcomes and decreases the risk factors of illness-related distress of breast cancer patients during the high-risk cancer treatment.
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Kim Y, Shin HY, Moon W, Cho SH. Use of complementary and alternative medicine by lung cancer patients in Korea: A qualitative study. Eur J Integr Med 2016. [DOI: 10.1016/j.eujim.2015.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lebel S, Payne AYM, Mah K, Irish J, Rodin G, Devins GM. Do stigma and its psychosocial impact differ between Asian-born Chinese immigrants and Western-born Caucasians with head and neck cancer? PSYCHOL HEALTH MED 2016; 21:583-92. [PMID: 26850943 DOI: 10.1080/13548506.2016.1139138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Stigma appears to influence emotional distress and well-being in cancer survivors, but cross-cultural differences have been ignored. Previous studies suggest that stigma may be especially relevant for survivors of Asian origin. However, their study designs (e.g. focused on female cancers, qualitative designs, and an absence of comparison groups) limit the strength of this conclusion. We hypothesized that (1) Asian-born Chinese immigrants (AI) would report more perceived cancer-related stigma than Western-born Caucasians (WBC); and (2) the impact of stigma on emotional distress and well-being would be greater in AI as compared to WBC. Head and neck cancer survivors (n = 118 AI and n = 404 WBC) completed measures of well-being, emotional distress, and a three-item indicator of stigma in structured interviews. The majority of respondents (59%) reported one or more indicators of stigma. Stigma correlated significantly with emotional distress (r = .13, p = .004) and well-being (r = -.09, p = .032). Contrary to our hypotheses, WBCs and AIs did not differ in reported stigma nor did we detect differences in its psychosocial impact. Stigma exerts a deleterious psychosocial impact on head and neck cancer survivors. It did not differ significantly between AI and WBC survivors.
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Affiliation(s)
- Sophie Lebel
- a School of Psychology , University of Ottawa , Ottawa , ON , Canada
| | - Ada Y M Payne
- b Cardiac eHealth & Behavioural Cardiology , Peter Munk Cardiac Centre , Toronto , ON , Canada.,c Department of Psychiatry , University of Toronto , Toronto , ON , Canada
| | - Kenneth Mah
- d Behavioural Sciences and Health Research Division , Toronto General Hospital , Toronto , ON , Canada
| | - Jonathan Irish
- e Cancer Clinical Research Unit (CCRU) , Princess Margaret Cancer Centre , Toronto , ON , Canada
| | - Gary Rodin
- c Department of Psychiatry , University of Toronto , Toronto , ON , Canada.,f Psychosocial Oncology and Palliative Care , Princess Margaret Hospital , Toronto , ON , Canada.,g Department of Supportive Care , Ontario Cancer Institute , Toronto , ON , Canada
| | - Gerald M Devins
- c Department of Psychiatry , University of Toronto , Toronto , ON , Canada.,d Behavioural Sciences and Health Research Division , Toronto General Hospital , Toronto , ON , Canada.,f Psychosocial Oncology and Palliative Care , Princess Margaret Hospital , Toronto , ON , Canada.,g Department of Supportive Care , Ontario Cancer Institute , Toronto , ON , Canada
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Lu Q, You J, Man J, Loh A, Young L. Evaluating a culturally tailored peer-mentoring and education pilot intervention among Chinese breast cancer survivors using a mixed-methods approach. Oncol Nurs Forum 2015; 41:629-37. [PMID: 25355018 DOI: 10.1188/14.onf.629-637] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To evaluate a social support intervention that was culturally tailored for Chinese Americans who face many challenges because of cultural and linguistic barriers. DESIGN Intervention with a one-group pre- or post-test design, mixed methods, and a community-based participatory research (CBPR) approach. SETTING Southern California. SAMPLE 14 Chinese American breast cancer survivors post-treatment and eight breast cancer peer mentors. METHODS The intervention was a 10-week program to provide emotional and informational support through peer mentoring and education. Health outcomes were assessed before and after the intervention. Eight weekly process evaluations and two focus group interviews also were conducted. MAIN RESEARCH VARIABLES Depressive and anxiety symptoms. FINDINGS The program was associated with a decrease in depressive symptoms. Participants valued the program highly. Inductive analysis suggested possible mechanisms for effectiveness, such as reducing stigma, empowerment, and increased sense of belonging. CONCLUSIONS The peer-mentoring and education program has the potential to serve as a model intervention for ethnic minorities. Mixed methods and CBPR are valuable in evaluating pilot interventions with minorities. Focusing on relationships may be fruitful for designing novel interventions for cancer survivors from collectivistic cultures. IMPLICATIONS FOR NURSING Peer-mentoring and education programs can be integrated into communities and clinics to improve care for underserved minority cancer survivors and to reduce health disparities.
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Affiliation(s)
- Qian Lu
- Department of Psychology, University of Houston in Texas
| | - Jin You
- Department of Psychology, Wuhan University in China
| | - Jenny Man
- Department of Psychology, University of Houston
| | - Alice Loh
- Herald Cancer Association, San Gabriel, CA
| | - Lucy Young
- Herald Cancer Association, San Gabriel, CA
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Jassim GA, Whitford DL. Understanding the experiences and quality of life issues of Bahraini women with breast cancer. Soc Sci Med 2014; 107:189-95. [DOI: 10.1016/j.socscimed.2014.01.031] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 01/13/2014] [Accepted: 01/20/2014] [Indexed: 10/25/2022]
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Wang JHY, Sheppard VB, Liang W, Ma GX, Maxwell AE. Recruiting Chinese Americans into cancer screening intervention trials: strategies and outcomes. Clin Trials 2014; 11:167-77. [PMID: 24567288 DOI: 10.1177/1740774513518849] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cancer is the leading cause of death among Asian Americans. While Asian Americans are the fastest growing minority population in the United States, they are underrepresented in cancer research and report poor adherence to cancer screening guidelines. PURPOSE This study utilized data from two large randomized intervention trials to evaluate strategies to recruit first-generation Chinese American immigrants from community settings and Chinese American physician practices. Findings will inform effective strategies for promoting Asian American participation in cancer control research. METHODS Chinese Americans who were non-adherent to annual mammography screening guidelines (Study 1 with 664 immigrant women > 40 years of age) and to colorectal cancer screening guidelines (Study 2 with 455 immigrants > 50 years of age) were enrolled from the greater Washington DC, New York City (NYC), and Philadelphia (PA) areas. Both studies trained bilingual staff to enroll Chinese-speaking participants with the aid of linguistically appropriate fliers and brochures to obtain consent. Study 1 adopted community approaches and worked with community organizations to enroll participants. Study 2 randomly selected potential participants through 24 Chinese American primary-care physician offices, and mailed letters from physicians to enroll patients, followed by telephone calls from research staff. The success of recruitment approaches was assessed by yield rates based on number of participants approached, ineligible, and consented. RESULTS Most participants (70%) of Study 1 were enrolled through in-person community approaches (e.g., Chinese schools, stores, health fairs, and personal networks). The final yield of specific venues differed widely (6% to 100%) due to various proportions of ineligible subjects (2%-64%) and refusals (0%-92%). The Study 2 recruitment approach (physician letter followed by telephone calls) had different outcomes in two geographic areas, partially due to differences in demographic characteristics in the DC and NYC/PA areas. The community approaches enrolled more recent immigrants and uninsured Chinese Americans than the physician and telephone call approach (p < .001). Enrollment cost is provided to inform future research studies. LIMITATIONS Our recruitment outcomes might not be generalizable to all Chinese Americans or other Asian American populations because they may vary by study protocols (e.g., length of trials), target populations (i.e., eligibility criteria), and available resources. CONCLUSIONS Use of multiple culturally relevant strategies (e.g., building trusting relationships through face-to-face enrollment, use of bilingual and bicultural staff, use of a physician letter, and employing linguistically appropriate materials) was crucial for successfully recruiting a large number of Chinese Americans in community and clinical settings. Our data demonstrate that substantial effort is required for recruitment; studies need to budget for this effort to ensure the inclusion of Asian Americans in health research.
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Affiliation(s)
- Judy Huei-yu Wang
- aDepartment of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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Lee-Lin F, Menon U, Leo MC, Pedhiwala N. Feasibility of a targeted breast health education intervention for Chinese American immigrant women. Oncol Nurs Forum 2014; 40:361-72. [PMID: 23803269 DOI: 10.1188/13.onf.361-372] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To assess the feasibility and acceptability of a targeted educational intervention to increase mammography screening among Chinese American women. DESIGN One-group pre- and post-test quasiexperimental design. SETTING Metropolitan areas of Portland, OR. SAMPLE 44 foreign-born Chinese American women aged 40 years and older. METHODS Participants who had not had a mammogram within the past 12 months were recruited and enrolled to a targeted breast health educational program. Before starting the group session, participants completed a baseline survey, which was administered again 12 weeks postintervention. MAIN RESEARCH VARIABLES Completion of mammography screening test, movement in stage of readiness, mammography and breast cancer knowledge, perceived susceptibility, perceived benefits, and perceived common and cultural barriers. FINDINGS The study response rate was high (71%). Of the 42 women who completed the study, 21 (50%) had a mammogram postintervention. The top three reasons for not completing a mammogram at the end of the study were no need or no symptom, busy, and reliance on family for assistance. Mean breast cancer susceptibility scores increased significantly at post-test as theorized (t[40] = -2.88, p < 0.01). Participants were more likely to obtain a mammogram when they had been in the United States for 3-15 years. CONCLUSIONS A targeted program that aims to increase breast health knowledge, improve access, and remove barriers may promote mammography screening among Chinese American immigrant women. IMPLICATIONS FOR NURSING This promising intervention now being tested under a randomized, controlled design can be adapted to other Asian subgroups. KNOWLEDGE TRANSLATION Targeted breast health intervention is feasible for improving mammography screening among Chinese immigrant women. Educating these women about early detection is important, as the first sign of breast cancer usually shows on a woman's mammogram before it can be felt or any other symptoms are present. Immigrant women may be too busy to dedicate proper time to self-care behaviors; therefore, making it easier and faster for them to obtain a mammogram may improve the screening rate.
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Affiliation(s)
- Frances Lee-Lin
- School of Nursing, Oregon Health and Science University, Portland, USA.
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Wang JHY, Adams IF, Tucker-Seeley R, Gomez SL, Allen L, Huang E, Wang Y, Pasick RJ. A mixed method exploration of survivorship among Chinese American and non-Hispanic White breast cancer survivors: the role of socioeconomic well-being. Qual Life Res 2013; 22:2709-20. [PMID: 23591710 PMCID: PMC3855903 DOI: 10.1007/s11136-013-0374-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2013] [Indexed: 01/07/2023]
Abstract
PURPOSE Cancer-related stress is heavily influenced by culture. This study explored similarities and differences in survivorship care concerns among Chinese American and non-Hispanic White (NHW) breast cancer survivors. METHODS A sequential, mixed-method design (inductive/qualitative research-phase I and deductive/quantitative research-phase II) was employed. Eligible women identified from the Greater Bay Area Cancer Registry were age ≥21, diagnosed with stage 0-IIa breast cancer between 2006 and 2011, and had no recurrence or other cancers. In phase I, we conducted 4 Chinese (n = 19) and 4 NHW (n = 22) focus groups, and 31 individual telephone interviews (18 Chinese immigrants, 7 Chinese US-born, and 6 NHW). Content analysis was conducted to examine qualitative data. In phase II, another 296 survivors (148 NHW age-matched to 148 Chinese cases) completed a cross-sectional survey. Descriptive statistics and linear regression analysis were conducted to examine quantitative data. RESULTS Qualitative data revealed "socioeconomic well-being" (SWB) as a dominant survivorship concern, which was operationalized as a cancer survivor's perceived economic and social resources available to access care. Quantitative data showed that low-acculturated Chinese immigrants reported the poorest SWB, controlling for covariates. Highly acculturated Chinese immigrants and the US-born Chinese/NHW group reported similar SWB. Women who had low-income levels or chemotherapy had poorer SWB. CONCLUSIONS SWB emerged as an important aspect of breast cancer survivorship. Immigration stress, cancer care costs, and cultural values all contributed to immigrants' socioeconomic distress. Immigrant and US-born breast cancer survivors experienced different socioeconomic circumstances and well-being following treatment. Our findings warrant further investigation of socioeconomic distress and survivorship outcomes.
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Affiliation(s)
- Judy Huei-yu Wang
- Cancer Prevention and Control Program, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW., Suite 4100, Washington, DC, 20007, USA,
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Breast cancer experience and survivorship among Asian Americans: a systematic review. J Cancer Surviv 2013; 8:94-107. [PMID: 24214498 DOI: 10.1007/s11764-013-0320-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 10/11/2013] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Breast cancer is the most common cancer in Asian American women, and the number of Asian American breast cancer survivors is rapidly increasing. Although Asian Americans are one of the fastest growing and most heterogeneous ethnic groups in the United States, limited data exist in regard to their breast cancer experience and survivorship. METHODS A systematic review of the breast cancer experience literature was conducted and included studies of Asian Americans or their subgroups as a major category of study participants. Of the 125 studies reviewed, 10 qualitative studies, 10 quantitative studies, 5 studies that used a mixed-method approach, and 1 intervention study met the criteria for inclusion. RESULTS Qualitatively, Asian Americans reported unmet physical and emotional needs and challenges during survivorship. Quantitative studies consistently found that socioeconomic status, cultural health beliefs, immigration stress, acculturation level, English proficiency, social support, and spirituality associated with Asian American breast cancer patients' health behaviors and health-related quality of life (HRQOL). Studies also revealed significant variation in breast cancer reaction and HRQOL within Asian American subgroups. CONCLUSIONS Although research on Asian American breast cancer experience and survivorship is sparse, we concluded that Asian Americans experience disrupted HRQOL following breast cancer diagnosis and treatment, interwoven with their cultural and socio-ecological system, and that programs focused on improving cancer survivorship outcomes among this ethnic minority group are limited. Most studies have concentrated on the West coast population, and there is significant underrepresentation of longitudinal and intervention studies. Implications for study design, measurement, and future research areas are also included. IMPLICATIONS FOR CANCER SURVIVORS The results highlight a need to understand ethnic differences and to take into account social, cultural, and linguistic factors in breast cancer survivorship experiences among Asian American subgroups as a means to develop culturally relevant and linguistically appropriate interventions designed to improve HRQOL.
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Cao WJ, Chen CS, Hua Y, Li YM, Xu YY, Hua QZ. Factor analysis of a health-promoting lifestyle profile (HPLP): application to older adults in Mainland China. Arch Gerontol Geriatr 2012; 55:632-8. [PMID: 22854282 DOI: 10.1016/j.archger.2012.07.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 07/09/2012] [Accepted: 07/11/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED This research reports preliminary psychometric properties, especially the factor structure, of a Chinese version of a health-promoting lifestyles profile designed for older adults; and examines the distribution of the health-promoting behavioral patterns - both for the purpose of developing culturally sensitive health advancement strategies for Chinese seniors. Responses to this questionnaire were used to measure health-promoting behaviors in a random sample of 1012 elderly Chinese from thirty communities in Xi'an Shaanixi-Province. DESIGN Factor analysis relied on polychoric correlations with ordinal categorical data were used to evaluate reliability and validity of a revised Chinese version of the health-promoting lifestyles profile (HPLP-C). Because this revised version was used to assess elderly adults, we termed it the HPLP-CE. This factor analysis supported a six-factor model of the original HPLP-C scale. Confirmatory factor analysis indicated a good fit, with factors explaining 88.1% of the common variance of the HPLP-CE scores. Cronbach's α coefficients were 0.91 for the revised instrument, and ranged from 0.67 to 0.88 for six dimensions. The split-half reliability was 0.92, while the test-retest reliability was 0.68. Relationships between HPLP-CE, perceived health status, SF-36 scale scores, and associations with selected demographic variables were significantly positive. CONCLUSIONS We concluded that this revised scale, based on the 40-item HPLP-C, was considered suitable for measuring health-promoting lifestyles of older adults in China. Mental and inner self-reflection planes were the most salient factors for assessing health-promoting behaviors of seniors. Such factors need to be considered if preventive programs are to be designed to promote seniors' health.
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Affiliation(s)
- Wen-Jun Cao
- Department of Preventive Medicine and Health Statistics, Fourth Military Medical University, No. 169 Changle West Road, Xi'an, Shaanxi 710032, China
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Lee-Lin F, Menon U, Nail L, Lutz KF. Findings from focus groups indicating what Chinese American immigrant women think about breast cancer and breast cancer screening. J Obstet Gynecol Neonatal Nurs 2012; 41:627-37. [PMID: 22537294 DOI: 10.1111/j.1552-6909.2012.01348.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To explore beliefs of Chinese American, immigrant women related to breast cancer and mammography. DESIGN Qualitative description with semistructured focus groups. SETTING Metropolitan Portland, Oregon. PARTICIPANTS Thirty eight foreign-born Chinese women, age 40 and older, in five focus groups. METHODS Focus group discussions in Chinese were audiotaped, transcribed, and translated into English. Using a process of directed content analysis, group transcripts were coded for themes based on the discussion guide. RESULTS Three main themes emerged from the analysis: knowledge and beliefs; support, communication, and educational needs; and access to care. Subthemes included beliefs such as barriers and facilitators to screening and perceptions about personal breast cancer risk. Several women were profoundly affected by the negative breast cancer-related experiences of relatives and friends. Some common myths remain about causes and treatment of breast cancer. CONCLUSIONS Although Chinese American immigrant women share beliefs with other minority women in the United States, some culturally related barriers such as alienation due to cultural reasons for not sharing diagnosis with anyone and beliefs about the efficacy of Eastern versus Western medicine may affect adherence to screening and treatment. Facilitators included being told to get the test and getting screened for the sake of the family, whereas erroneous information about the cause of breast cancer such as diet and stress remained. Primary care providers such as advanced practice nurses should take into account culturally driven motivations and barriers to mammography adherence among Chinese American immigrant women. Provider/client interactions should involve more discussion about women's breast cancer risks and screening harms and benefits. Such awareness could open a dialogue around breast cancer that is culturally sensitive and nonthreatening to the patient. Information may need to be tailored to women individually or targeted to subethnic groups rather than using generic messages for all Asian immigrant women.
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Chieng WS, Lee SC. Discrepancy between initial high expression of interest in clinical cancer genetic testing and actual low uptake in an Asian population. Genet Test Mol Biomarkers 2012; 16:785-93. [PMID: 22536849 DOI: 10.1089/gtmb.2011.0268] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
AIMS Little is known about the acceptance of clinical cancer genetic testing in Asians. We surveyed the attitudes and perceived motivators and barriers to genetic testing immediately after genetic counseling in at-risk patients for hereditary cancer in a cancer genetics clinic in Singapore, and compared the responses of actual test acceptors and decliners. RESULTS Three hundred seventeen patients participated, including 199 cancer-affected and 118 cancer-free probands or family members. Overall, 70% of patients expressed an initial willingness to be tested, and most did not perceive major barriers. However, only 69/199 (35%) of cancer-affected probands were actually tested. There was no significant difference in age, education, marital status, or initial expression of negative feelings toward genetic information between the test acceptors and decliners, although the decliners were more likely to have indicated a wish not to be tested (22% vs. 4%, p<0.001) and cited cost as a barrier (32% vs. 12%, p=0.002). The most common actual reasons against testing were cost (60%), not wanting to bear the emotional burden of genetic information (16%), and the perception that the medical management will not change (16%). CONCLUSION A significant discrepancy exists between an initial high interest in testing and actual low uptake. Health programs that address cost issues and education to correct misperceptions may improve genetic information utilization.
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Affiliation(s)
- Wei-Shieng Chieng
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
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Wang JHY, Adams I, Huang E, Ashing-Giwa K, Gomez SL, Allen L. Physical distress and cancer care experiences among Chinese-American and non-Hispanic White breast cancer survivors. Gynecol Oncol 2012; 124:383-8. [PMID: 22115854 PMCID: PMC3298543 DOI: 10.1016/j.ygyno.2011.11.029] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 11/14/2011] [Accepted: 11/14/2011] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The number of Chinese-American breast cancer survivors (BCS) is increasing as a result of increasing incidence rates. There has been little research on Chinese BCS' follow-up cancer care. This qualitative study aims to understand how Chinese-American BCS experience and cope with physical distress relative to non-Hispanic White (NHW) survivors. METHODS Seventy-one BCS (37 Chinese immigrant, 7 US-born Chinese, 27 NHW) were recruited from the Greater Bay Area Cancer Registry to participate in focus group discussions or one-on-one interviews about their survivorship experiences. All BCS were diagnosed with breast cancer at stage 0-IIA between 2006 and 2009, and had survived for 1-4 years without recurrence. Interviews were conducted in Cantonese, Mandarin, or English. Data analyses followed established qualitative methods of content analysis. RESULTS BCS experienced pain and side effects from radiation, surgery, and hormonal therapy. Physical distress subsequently caused emotional concerns about recurrence or metastasis. Most BCS consulted physicians about their physical distress. Chinese immigrant BCS were less likely to have their issues resolved compared to NHW and US-born Chinese who were more likely to question physicians, ask for referrals, and make repeat attempts if their problems were not resolved. Some Chinese immigrant BCS turned to Traditional Chinese Medicine for relief or accepted the idea that physical distress was part of survivorship. CONCLUSION Chinese immigrant BCS may be at risk for greater distress compared with US-born Chinese and NHW BCS because of cultural norms that make them less inclined to express their needs to physicians or challenge physicians when their needs are not met. Furthermore, they may express symptoms in culturally unique ways (e.g., hot-cold imbalances). Further research is needed to determine how to best improve survivorship care experiences in this understudied population, with the goal of decreasing BCS' physical distress and improving quality of life.
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Affiliation(s)
- Judy Huei-yu Wang
- Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW., Suite 4100, Washington DC, 20007, USA.
| | - Inez Adams
- Department of Anthropology, Michigan State University, 355 Baker Hall, East Lansing, MI 48864, USA
| | - Ellen Huang
- Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW., Suite 4100, Washington DC, 20007, USA.
| | - Kimlin Ashing-Giwa
- Center of Community Alliance for Research & Education, Department of Population Sciences, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA.
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA94538, USA ; (Scarlett Lin Gomez) and (Laura Allen)
| | - Laura Allen
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA94538, USA ; (Scarlett Lin Gomez) and (Laura Allen)
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Lu Q, Zheng D, Young L, Kagawa-Singer M, Loh A. A pilot study of expressive writing intervention among Chinese-speaking breast cancer survivors. Health Psychol 2012; 31:548-51. [PMID: 22229930 DOI: 10.1037/a0026834] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Little attention has been focused on Asian American breast cancer survivor's psychological needs. No outcome-based psychosocial interventions have been reported to target at this population. Expressive writing interventions have been previously shown to improve health outcomes among non-Hispanic White breast cancer populations. This pilot study aimed to test the cultural sensitivity, feasibility, and potential health benefits of an expressive writing intervention among Chinese-speaking breast cancer survivors. METHODS Participants (N = 19) were asked to write about their deepest thoughts and feelings, their coping efforts, and positive thoughts and feelings regarding their experience with breast cancer each week for 3 weeks. Health outcomes were assessed at baseline, 3, and 6 months after the intervention. A Community-Based Participatory Research Approach (CBPR) is used. RESULTS Expressive writing was associated with medium and large effect sizes (η(p)² = 0.066∼0.208) in improving multiple health outcomes (quality of life, fatigue, posttraumatic stress, intrusive thoughts, and positive affect) at follow-ups. Participants perceived the study to be valuable. The study yielded high compliance and completion rates. CONCLUSION Expressive writing is associated with long-term improvement of health outcomes among Chinese breast cancer survivors and has the potential to be utilized as a support strategy for minority cancer survivors. In addition, CBPR is valuable in improving feasibility and cultural sensitivity of the intervention in understudied populations. Future studies employing randomized, controlled trial designs are warranted.
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Affiliation(s)
- Qian Lu
- Department of Psychology, University of Houston, Houston, TX 77204-5022, USA.
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Yi JK, Swartz MD, Reyes-Gibby CC. English proficiency, symptoms, and quality of life in Vietnamese- and Chinese-American breast cancer survivors. J Pain Symptom Manage 2011; 42:83-92. [PMID: 21227634 DOI: 10.1016/j.jpainsymman.2010.09.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 09/17/2010] [Accepted: 09/25/2010] [Indexed: 01/12/2023]
Abstract
CONTEXT In the United States, limited English proficiency has been shown to have a negative influence on effective functioning in the health care environment. Minority immigrant populations, therefore, may be especially vulnerable to poorer symptom management and quality of life (QOL) during and after cancer treatment, given their limited language skills. Breast cancer is the most prevalent cancer in Asian-American women but little is known about its adverse consequences in this population. OBJECTIVES We examined the extent to which English proficiency was associated with symptoms and QOL in Chinese- (n = 72) and Vietnamese-American (n = 25) breast cancer survivors in Houston, Texas. METHODS Data were collected through face-to-face interviews. Symptoms and QOL were assessed using the Edmonton Symptom Assessment Scale and the Quality of Life Instrument-Breast Cancer Patient Version (QOL-BC), respectively. RESULTS The most commonly reported severe symptoms (≥ 7 on a 0-10 scale) were lack of well-being (38%), fatigue (26%), pain (18%), lack of appetite (14%), anxiety (14%), and feeling depressed (14%). For the QOL-BC, the physical (mean = 6.78; standard deviation [SD] = 1.28) and spiritual subscales (mean = 6.01; SD = 2.18) had the highest and lowest mean scores, respectively. Of the whole sample, 33% reported having the ability to understand, read, speak, and write in English very well. English proficiency was significantly associated with symptom distress (coefficient = -0.257; P = 0.011) and QOL (coefficient = -0.390; P = 0.002). CONCLUSION English proficiency has a significant impact on symptom distress and QOL. These findings may help the development of services to meet the unique needs of Vietnamese- and Chinese-American breast cancer survivors.
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Affiliation(s)
- Jenny K Yi
- Department of Educational Psychology, University of Houston, Houston, Texas, USA
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"A struggle between vanity and life": the experience of receiving breast reconstruction in women of Taiwan. Cancer Nurs 2011; 33:E1-11. [PMID: 20467306 DOI: 10.1097/ncc.0b013e3181d1c853] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Understanding the role of sociocultural factors on women's experiences of breast reconstruction is needed to provide better care and avoid erroneous assumptions of these women's needs. OBJECTIVE The purpose of this study was to understand the lived experiences of Taiwanese women with breast cancer who receive breast reconstruction following mastectomy in Taiwan. METHODS A qualitative research design, guided by the philosophy of hermeneutic phenomenology, was selected to guide the study. In-depth interviews were conducted 1 to 2 times with each participant and explored the women's experiences related to making decisions about, undergoing, and recovering from breast reconstruction. RESULTS Seven women who received either autologous breast reconstruction or saline implants were recruited in southern Taiwan. Five themes were identified, including "dream of a wonderful future," "unexpected reality," "struggling to accept," "balancing vanity with life priorities," and "coming to terms: no regret." CONCLUSION Taiwanese women felt ambivalent about their new breasts, which failed to meet their expectations. This ambivalence, combined with a culture that values selflessness and the placement of family first, resulted in many women feeling guilty, vain, and superficial for requesting breast reconstruction. IMPLICATIONS FOR PRACTICE Clinical implications include the importance of regular and authentic patient-health care provider communication throughout the process of breast reconstruction, including recovery, and better acknowledgement of Taiwanese women's body image concerns associated with breast reconstruction.
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So WKW, Choi KC, Chan CWH, Chair SY. Age-related differences in the quality of life of Chinese women undergoing adjuvant therapy for breast cancer. Res Gerontol Nurs 2010; 4:19-26. [PMID: 21210577 DOI: 10.3928/19404921-20101201-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 10/27/2010] [Indexed: 11/20/2022]
Abstract
A cross-sectional descriptive design was used in this study to compare the quality of life of younger (<60) and older (≥60) Chinese women undergoing adjuvant therapy for breast cancer. A total of 261 patients completed a self-report survey on their demographic and clinical characteristics, as well as the Functional Assessment of Cancer Therapy for Breast Cancer and the Medical Outcomes Study Social Support Survey-Chinese version. Stepwise regression was used for secondary analysis. Significant differences between the two groups were established in the total score (p = 0.049), and the physical well-being (p = 0.048), emotional well-being (p = 0.014), and breast cancer (p < 0.001) subscales after adjustment for potential confounding variables. The older group had better overall quality of life, physical and emotional well-being, and higher breast cancer subscale scores than the younger group. However, health care professionals need to be aware of the confounding factors identified and of certain cultural values, which may also influence the quality of life of these older patients.
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Affiliation(s)
- Winnie Kwok-Wei So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China.
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Health-Related Quality of Life in Iranian Breast Cancer Survivors: A Qualitative Study. APPLIED RESEARCH IN QUALITY OF LIFE 2010. [DOI: 10.1007/s11482-010-9097-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Galván N, Buki LP, Garcés DM. Suddenly, a carriage appears: social support needs of Latina breast cancer survivors. J Psychosoc Oncol 2009; 27:361-82. [PMID: 19544182 DOI: 10.1080/07347330902979283] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Through focus groups and individual interviews, data were gathered on the emotional, informational, and instrumental support needs of 22 immigrant Latina women. A thematic analysis revealed that participants who perceived to receive social support reported less psychological distress and better adjustment to breast cancer than those who did not perceive this support. Types and sources of support varied across survivorship stages. Many needs were related to financial, linguistic, and cultural barriers participants encountered in the course of the disease. Based on the findings, we conclude with several clinical recommendations to improve the quality of life in this medically underserved population.
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Affiliation(s)
- Nallely Galván
- University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Yoo GJ, Aviv C, Levine EG, Ewing C, Au A. Emotion work: disclosing cancer. Support Care Cancer 2009; 18:205-15. [PMID: 19434430 DOI: 10.1007/s00520-009-0646-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Accepted: 03/19/2009] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Breast cancer remains one of the leading causes of morbidity and mortality for all women in the US. Current research has focused on the psychological relationship and not the sociological relationship between emotions and the experience of breast cancer survivors. This paper focuses on the emotion work involved in self-disclosing a breast cancer diagnosis in a racially or ethnically diverse population. METHODS The participants (n = 176) selected for this study were African American, Asian American, Latina, and Caucasian women who had been diagnosed with stages 0, I, or II breast cancer within the past 4 years. They completed an in-depth qualitative interview on self-disclosure and social support. FINDINGS The results indicate self-disclosing was done at a time when important decisions about treatment needed to be made. Different strategies for disclosure were used, all of which entailed emotion work. Respondents talked about the various elements of emotion work in the disclosure process including: managing others' worry, protecting and soothing others, and educating and instructing others. For many respondents, disclosure without calculating emotional management meant opening up to others which meant support and an increase in emotional resources. CONCLUSIONS The findings in this paper have implications for women with breast cancer and demonstrate the need for women to be involved in honest disclosure and less emotional management of others' feelings. There is also a need for education about the nature of the cancer experience among people who are not well educated about the treatment and consequences of cancer. This need may be even stronger among racial and ethnic minorities.
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Affiliation(s)
- Grace J Yoo
- Cancer Disparities Research Group, San Francisco State University, 1600 Holloway, EP 103, San Francisco, CA 94132, USA.
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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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