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Goyal AK, Bakshi J, Panda NK, Kapoor R, Vir D, Kumar K, Aneja P. Shame and Stigma Over Long-Term Survival in Postoperative Cases of Head and Neck Cancer. J Maxillofac Oral Surg 2024; 23:1057-1062. [PMID: 39376758 PMCID: PMC11456006 DOI: 10.1007/s12663-023-01931-6] [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] [Received: 07/19/2021] [Accepted: 04/29/2023] [Indexed: 10/09/2024] Open
Abstract
Background Surgical excision of the tumor remains the primary choice for the treatment of head and neck cancer patients, but it often leads to facial disfigurement, which further causes mutilation in the patients. Mutilation causes shame and stigma, which imparts significant psychological strain on patients, and tends to impair their quality of life. Objective The present study aimed to assess the shame and stigma over long-term postoperative survival duration in head and neck cancer patients. Methodology Total 100 postoperative patients of head and neck cancer were recruited from the outpatient department of the host institute, and shame and stigma was assessed using the Hindi version of the shame and stigma scale. Results The global shame and stigma score was 22.67 ± 16.22, with the highest perceived stigma due to changes in appearance (11.94 ± 8.805), followed by impaired speech (4.490 ± 3.243), feeling of regret (3.950 ± 3.313), and feeling of stigma (4.490 ± 3.243). The shame and stigma was found to be significantly higher in maxillary cancer patients (33.22 ± 16.60), followed by larynx cancer patients (22.06 ± 13.41) and oral cancer patients (21.53 ± 16.49). Patients with stage III and stage IV of cancer were found to perceive higher shame and stigma (35.91 ± 22.23 and 27.36 ± 14.71, respectively) compared to the patients having stage I and stage II cancer (9.583 ± 9.709 and 16.44 ± 11.82, respectively). A significantly declining linear trend was found between shame and stigma and postoperative survival duration. Conclusion We concluded that shame and stigma act as important determinants of quality of life over long-term survival in head and neck cancer patients, and should be considered while designing psychological interventions and surgical reconstruction protocols. The present study will help clinicians to assess the mutilation among head and neck cancer patients in a better way and will help in devising new psychological strategies to manage psychological aspects associated with mutilation, which will ultimately enhance the quality of life of patients.
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Affiliation(s)
- Atul Kumar Goyal
- Department of Otolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Jaimanti Bakshi
- Department of Otolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Naresh K. Panda
- Department of Otolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Rakesh Kapoor
- Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Dharam Vir
- Department of Otolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Krishan Kumar
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Aneja
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Peng HL, Chen YH, Lee HY, Tsai WY, Chang YL, Lai YH, Chen SC. Factors associated with shame and stigma among head and neck cancer patients: a cross-sectional study. Support Care Cancer 2024; 32:357. [PMID: 38750287 DOI: 10.1007/s00520-024-08568-2] [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: 12/25/2023] [Accepted: 05/10/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE Head and neck cancer (HNC) patients often suffer from shame and stigma due to treatment limitations or due to societal factors. The purpose of this study was to assess perceived body image, depression, physical and psychosocial function, and self-stigma, as well as to identify factors that predicted shame and stigma in patients with HNC. METHODS This cross-sectional study recruited 178 HNC patients from the outpatient radiation department of a medical center in Northern Taiwan. Patients were assessed for patient reported outcomes using the Body Image Scale (BIS), the Hospital Anxiety and Depression Scale-Depression Subscale (HADS-Depression Subscale), the University of Washington Quality of Life Scale (UW-QOL) version 4.0, and the Shame and Stigma Scale (SSS). Data were analyzed by descriptive analysis, Pearson's product-moment correlation, and multiple regression. RESULTS The two top-ranked subscales of shame and stigma were: "speech and social concerns" and "regret". Shame and stigma were positively correlated with a longer time since completion of treatment, more body image concerns, and higher levels of depression. They were negatively correlated with being male and having lower physical function. Multiple regression analysis showed that female gender, a longer time since completing treatment, higher levels of body image concern, greater depression, and less physical function predicted greater shame and stigma. These factors explained 74.7% of the variance in shame and stigma. CONCLUSION Patients' body image concerns, depression, time since completing treatment, and physical function are associated with shame and stigma. Oncology nurses should assess and record psychological status, provide available resources, and refer appropriate HNC patients to counselling.
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Affiliation(s)
- Hsi-Ling Peng
- Department of Nursing, Asia Eastern University of Science and Technology, Taipei, Taiwan
| | - Yen-Hui Chen
- Department of Nursing, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Han-Yen Lee
- Department of Nursing, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Ying Tsai
- Department of Nursing, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ya-Lan Chang
- Department of Nursing, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Nursing, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Yeur-Hur Lai
- School of Nursing, College of Medicine, National Taiwan University, 1 Jen-Ai Rd., Sec. 1, Taipei, 100, Taiwan.
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Nursing, National Taiwan University Cancer Center, Taipei, Taiwan.
| | - Shu-Ching Chen
- School of Nursing and Geriatric and Long-Term Care Research Center, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
- Department of Radiation Oncology and Proton and Radiation Therapy Center, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- School of Nursing, College of Nursing, Chang Gung University of Science and Technology, 261, Wen-Hua 1 Road, Guishan, Taoyuan, 333, Taiwan.
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Chou PC, Lee Y, Chang YY, Hung CF, Chen YF, Lin TK, Shih FY, Chen WF, Lin PY, Chong MY, Wang LJ. The Interrelationship of Benefit Finding, Demoralization, and Stigma among Patients with Parkinson's Disease and Their Caregivers. Healthcare (Basel) 2024; 12:878. [PMID: 38727435 PMCID: PMC11083473 DOI: 10.3390/healthcare12090878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 05/13/2024] Open
Abstract
Parkinson's disease (PD) is a debilitating neurodegenerative disease with a relentlessly progressive course of illness. This study aimed to assess the dyadic dynamics of benefit finding (BF), demoralization, and stigma on the depression severity of PD patients and their caregivers. This study used a cross-sectional design with purposive sampling. In total, 120 PD patients and 120 caregivers were recruited from the neurological ward or neurological outpatient clinic of a medical center in Taiwan from October 2021 to September 2022. PD patients and their caregivers were enrolled and assessed using the Mini International Neuropsychiatric Interview, the Benefit Finding scale, Demoralization Scale, Stigma Subscale of the Explanatory Model Interview Catalogue, and Taiwanese Depression Questionnaire. Among the 120 patients and 120 caregivers that successfully completed the study, 41.7% (N = 50) and 60% (N = 72) were female, respectively. The most common psychiatric diagnoses of both the PD patients (17.5%) and their caregivers (13.3%) were depressive disorders. Using structural equation modeling, we found that the stigma, BF, and demoralization of PD patients might contribute to their depression severity. Demoralization and stigma of PD patients' caregivers might also contribute to the depression severity of PD patients. Caregivers' BF and demoralization were significantly linked with their depression severity. PD patients' BF degree and their caregivers' BF degree had significant interactive effects. Both patients' and their caregivers' stigma levels had significant interactive effects. Clinicians should be aware of and manage these contributing factors between PD patients and their caregivers in order to prevent them from exacerbating each other's depression.
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Affiliation(s)
- Pei-Chien Chou
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-C.C.); (Y.L.); (C.-F.H.); (P.-Y.L.)
| | - Yu Lee
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-C.C.); (Y.L.); (C.-F.H.); (P.-Y.L.)
| | - Yung-Yee Chang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-Y.C.); (Y.-F.C.); (T.-K.L.)
| | - Chi-Fa Hung
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-C.C.); (Y.L.); (C.-F.H.); (P.-Y.L.)
| | - Ying-Fa Chen
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-Y.C.); (Y.-F.C.); (T.-K.L.)
| | - Tsu-Kung Lin
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-Y.C.); (Y.-F.C.); (T.-K.L.)
| | - Fu-Yuan Shih
- Center for Parkinson’s Disease, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (F.-Y.S.); (W.-F.C.)
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Wu-Fu Chen
- Center for Parkinson’s Disease, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (F.-Y.S.); (W.-F.C.)
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-C.C.); (Y.L.); (C.-F.H.); (P.-Y.L.)
| | - Mian-Yoon Chong
- Health Management International, Singapore 218108, Singapore;
- Regency Specialist Hospital, Johor 81750, Malaysia
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
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Goyal AK, Bakshi J, Panda NK, Kapoor R, Vir D, Kumar K, Aneja P. Assessment of Shame and Stigma in Head and Neck Cancer: A Meta-Analysis. J Maxillofac Oral Surg 2024; 23:16-22. [PMID: 38312965 PMCID: PMC10830929 DOI: 10.1007/s12663-021-01658-2] [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] [Received: 04/14/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022] Open
Abstract
Background Head and neck cancer is the most common cancer around the globe, following lung cancer and breast cancer. Treatment at advanced stages of head and neck cancer is usually followed intense surgical procedures, which leads to mutilation among patients. Mutilation imparts a sense of disgrace and causes a feeling of shame and stigma in the patient. The feeling of shame and stigma persists over time and affects the overall long-term survival of patients by deteriorating their quality of life. Objectives Since shame and stigma is an important psychological domain of head and neck cancer, the present article aims toward evaluating the studies published so far for the assessment of shame and stigma in head and neck cancer and highlighting the lacunae in the existing research designs. The present study also aims to design a checklist that could be followed while developing, translating, or validating a psychometric instrument that aims to measure shame and stigma in head and neck cancer. Methods In the present metanalysis, all articles published in the past years on shame and stigma in head and neck cancer was compiled using a predefined data extraction matrix. The available literature was compiled for major objectives of the study, the sample size used, major findings, and critical lacunae that need to be addressed. Results Shame and stigma is a very important domain of psychological well-being in head and neck cancer patients, which yet not appropriately addressed and further need to be researched. Conclusion Future studies could be based on the lacunae highlighted in the existing literature, and the prescribed methodology checklist could be taken into consideration while conducting further studies involving developing, translating, or validating a psychometric instrument related to shame and stigma in the head and neck cancer.
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Affiliation(s)
- Atul Kumar Goyal
- Department of Otolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaimanti Bakshi
- Department of Otolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh K. Panda
- Department of Otolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kapoor
- Homi Bhabha Cancer Hospital and Research Center, Ferozpur Bangar, Punjab India
| | - Dharam Vir
- Department of Otolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Krishan Kumar
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Aneja
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Wang S, Deng Y, Zhang Y, Guo VY, Zhang B, Cheng X, Xin M, Hao Y, Hou F, Li J. The role of illness-related cognition in the relationships between resilience and depression/anxiety in nasopharyngeal cancer patients. Cancer Med 2023; 12:21408-21418. [PMID: 37991167 PMCID: PMC10726906 DOI: 10.1002/cam4.6688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/05/2023] [Accepted: 10/26/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE Resilience has been reported as an important predictor of better mental health and prognoses in cancer patients, while its mechanisms were not clearly elucidated. In this study, we surveyed a large sample of nasopharyngeal carcinoma patients to investigate the mediating role of illness-related cognition (illness perception, stigma and meaning in life) on the associations between resilience and symptoms of anxiety and depression. METHODS This cross-sectional study involved 773 participants diagnosed with nasopharyngeal carcinoma. Participants completed a self-reported structured questionnaire to assess their illness perception, stigma and meaning in life, resilience and symptoms of anxiety and depression. Structural equation models (SEM) were employed to explore the relationship between resilience and symptoms of anxiety and depression in the entire sample, as well as in two subgroups: Subgroup I (0-1 year since diagnosis), and Subgroup II (over 1 year since diagnosis). RESULTS In the entire sample, after adjusting for potential confounders, illness perception, stigma and meaning in life were found to mediate the protective effect of resilience on symptoms of depression (mediating effect proportion: 65.25%) and anxiety (mediating effect proportion: 67.63%). In Subgroup I, direct effects were dominant in the associations between resilience and symptoms of anxiety (mediating effect proportion: 37.95%) and depression (mediating effect proportion: 29.13%). However, in Subgroup II, the associations between resilience and symptoms of anxiety (mediating effect proportion: 98.92%) and depression (mediating effect proportion: 81.04%) were completely mediated. CONCLUSIONS Our study suggests that direct and indirect effects of resilience on depression and anxiety dominate in early periods (0-1 year) and long-term periods (over 1 year) following the cancer diagnosis, respectively. The findings indicate that comprehensive intervention considering both the direct effect of resilience in early stages (e.g., health education prescription and social support groups) and the indirect effects of illness cognition in long-term periods (e.g., cognitive behavioral therapies) are likely to yield the most favorable outcomes for cancer patients.
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Affiliation(s)
- Shenghao Wang
- Department of Medical Statistics, School of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Yang Deng
- Department of Medical Statistics, School of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Yuan Zhang
- Sun Yat‐sen Global Health InstituteSun Yat‐sen UniversityGuangzhouChina
- Department of Radiation OncologySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and TherapyGuangzhouChina
| | - Vivian Yawei Guo
- Department of Medical Statistics, School of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Bo Zhang
- Department of Medical Statistics, School of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Xi Cheng
- Department of Medical Statistics, School of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Meiqi Xin
- Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityHong KongChina
| | - Yuantao Hao
- Peking University Center for Public Health and Epidemic Preparedness & Response Peking UniversityBeijingChina
- Key Laboratory of Epidemiology of Major Diseases (Peking University)Ministry of EducationBeijingChina
| | - Fengsu Hou
- Sun Yat‐sen Global Health InstituteSun Yat‐sen UniversityGuangzhouChina
- Department of Public HealthShenzhen Kangning HospitalShenzhenChina
| | - Jinghua Li
- Department of Medical Statistics, School of Public HealthSun Yat‐sen UniversityGuangzhouChina
- Sun Yat‐sen Global Health InstituteSun Yat‐sen UniversityGuangzhouChina
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Bobevski I, Kissane DW, Desroches J, De Simone A, Henry M. Validation of the Canadian Version of the Shame and Stigma Scale for Head and Neck Cancer Patients. Curr Oncol 2023; 30:7553-7565. [PMID: 37623029 PMCID: PMC10453664 DOI: 10.3390/curroncol30080548] [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: 07/13/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
Cancers of the head and neck and their treatment can cause disfigurement and loss of functioning, with a profound negative impact on the person's self-image and psychosocial wellbeing. This can lead to experiences of shame and stigma, which are important targets for psychosocial interventions. Accurate measurement and identification of these problems enables clinicians to offer appropriate interventions and monitor patients' progress. This study aimed to validate the Canadian version of the Shame and Stigma Scale (SSS) among French- and English-speaking head and neck cancer patients. Data from 254 patients from two major Canadian hospitals were analysed. The existing four-factor structure of the SSS was supported, with the following subscales: Shame with Appearance, Sense of Stigma, Regret, and Social/Speech Concerns. The Canadian SSS showed adequate convergent and divergent validity and test-retest reliability. Rasch analysis suggested scale improvement by removing two misfitting items and two items with differential functioning between French- and English-speaking patients. The final 16-item scale version was an adequate fit with the Rasch model. The SSS provides more accurate measures for people with high levels of shame and stigma, and thus has utility in identifying patients with more severe symptoms who may be in need of psychosocial interventions.
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Affiliation(s)
- Irene Bobevski
- School of Medicine, University of Notre Dame Australia, Darlinghurst, NSW 2010, Australia;
- Department of Psychiatry, School of Clinical Sciences, Monash Health and Monash University, Clayton, VIC 3168, Australia
| | - David W. Kissane
- School of Medicine, University of Notre Dame Australia, Darlinghurst, NSW 2010, Australia;
- Department of Psychiatry, School of Clinical Sciences, Monash Health and Monash University, Clayton, VIC 3168, Australia
| | - Justin Desroches
- Faculty of Medicine, McGill University, Montreal, QC H3A 0G4, Canada; (J.D.)
| | - Avina De Simone
- Faculty of Medicine, McGill University, Montreal, QC H3A 0G4, Canada; (J.D.)
| | - Melissa Henry
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada
- Lady-Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
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Liu ZJ, Feng LS, Li F, Yang LR, Wang WQ, He Y, Meng ZT, Wang YF. Development and validation of the thyroid cancer self-perceived discrimination scale to identify patients at high risk for psychological problems. Front Oncol 2023; 13:1182821. [PMID: 37534245 PMCID: PMC10391158 DOI: 10.3389/fonc.2023.1182821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023] Open
Abstract
Objective To develop a Thyroid Cancer Self-Perceived Discrimination Scale (TCSPDS) to identify patients at high risk for psychological problems and to test its reliability, validity and acceptability. Methods Using classical test theory, a total of 176 thyroid cancer patients from November 2021 to October 2022 were recruited to develop the TCSPDS. Item analysis was used to improve the preliminary TCSPDS. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and structural equation model (SEM) were used to test the construct validity of the final TCSPDS. Pearson correlation coefficient was used to analyze the validity coefficient between TCSPDS and EORTC QLQ-C30 to test the criterion-related validity (CRV) of the final TCSPDS. The internal consistency coefficient (Cronbach's alpha coefficient), split half reliability (Spearman-Brown coefficient) and test-retest reliability were used to verify the reliability of the final TCSPDS. The questionnaire completion time and effective response rate were used to validate the acceptability of the final TCSPDS. Results The TCSPDS consisted of 20 items and was divided into 3 subscales: 8 items for stigma, 6 items for self-deprecation, and 6 items for social avoidance. The TCSPDS had good validity (χ2/df=1.971, RMSEA=0.074, GFI=0.921, CFI= 0.930, IFI=0.932, TLI=0.901, Validity coefficient=0.767), reliability (Cronbach's alpha=0.867, Spearman-Brown coefficient=0.828, test-retest reliability coefficient=0.981) and acceptability [average completion time (15.01 ± 1.348 minutes) and an effective response rate of 95.14%]. Patients with higher TCSPDS scores reported a lower quality of life (P<0.05). Conclusion The TCSPDS could be used for early identification and assessment of the level of self-perceived discrimination in patients with thyroid cancer, which may provide a scientific basis for health education, social support and psychosocial oncology services in the future, especially in Southwest China.
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Affiliation(s)
- Zhi-jin Liu
- Department of Geriatric Oncology, The Third Affiliated Hospital of Kunming Medical University - Yunnan Cancer Hospital, Kunming, China
| | - Lin-sen Feng
- Department of Hematology, The Sixth Affiliated Hospital of Kunming Medical University-Yuxi People’s Hospital, Yuxi, China
- Department of Hematology, General Medical College of Kunming Medical University, Kunming, China
| | - Feng Li
- Department of Geriatric Oncology, The Third Affiliated Hospital of Kunming Medical University - Yunnan Cancer Hospital, Kunming, China
| | - Li-rong Yang
- Department of Geriatric Oncology, The Third Affiliated Hospital of Kunming Medical University - Yunnan Cancer Hospital, Kunming, China
| | - Wan-qi Wang
- Department of Geriatric Oncology, The Third Affiliated Hospital of Kunming Medical University - Yunnan Cancer Hospital, Kunming, China
| | - Yuan He
- Department of Geriatric Oncology, The Third Affiliated Hospital of Kunming Medical University - Yunnan Cancer Hospital, Kunming, China
| | - Zong-ting Meng
- Department of Geriatric Oncology, The Third Affiliated Hospital of Kunming Medical University - Yunnan Cancer Hospital, Kunming, China
| | - Yu-feng Wang
- Department of Geriatric Oncology, The Third Affiliated Hospital of Kunming Medical University - Yunnan Cancer Hospital, Kunming, China
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Goyal AK, Bakshi J, Panda NK, Kapoor R, Vir D, Kumar K, Aneja P. Accuracy of a self-reported Measure in Psychological Assessment when the Instrument is self-administered by the Patient or when Administrated by the Clinician. Indian J Otolaryngol Head Neck Surg 2023; 75:1266-1270. [PMID: 37274986 PMCID: PMC10235333 DOI: 10.1007/s12070-022-03379-5] [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] [Received: 10/10/2021] [Accepted: 12/07/2022] [Indexed: 06/07/2023] Open
Abstract
Background Self-reported measures are the questionnaire-based instrument that are routinely used in the clinical scenario to assess psychological health. Technically, the self-reported measure should be administrated by the patients themselves but due to the complexity of tools and illiteracy among patients, clinicians often tend to interview the patients. Objective Present article aims to compare the accuracy of a self-reported measure in the assessment of the psychological health of a patient when the instrument is self-administrated by the patient and when administrated by the clinician or researcher. Methods We have recruited 43 patients of oral cancer in the study who have a tumor in the buccal mucosa region. The Hindi version of the shame and stigma scale was used to analyse the shame and stigma in patients. The questionnaire was first provided to the patient for the self-administration and after that clinician administrated the questionnaire to the patient by keeping the clinician blinded to the patient self-administrated responses. Results There was no significant difference in the global mean score and mean score of various subdomains of shame and stigma scale in the self-administered and clinician-administered mode of interview. However, the clinician-administered mode could provide more accurate measures as it helps the patient towards a better understanding of questions. Conclusion It is recommended that the newly developed or translated self-reported measure should be tested for both patient administrated and clinician administrated compatibility. Questionnaires could be administrated by the clinician in the case when the patient is illiterate or in the case when the patient does not understand the language of the instrument.
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Affiliation(s)
- Atul Kumar Goyal
- Department of Otolaryngology and Head & Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaimanti Bakshi
- Department of Otolaryngology and Head & Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh K Panda
- Department of Otolaryngology and Head & Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kapoor
- Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Dharam Vir
- Department of Otolaryngology and Head & Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Krishan Kumar
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Aneja
- Department of Hindi, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Goyal AK, Bakshi J, Panda NK, Kapoor R, Vir D, Kumar K, Aneja P. Media Commercials Conveying Awareness Regarding Prevention of Head and Neck Cancer by Focusing on Stigmatized Perspective of Disease: Right or Wrong? Indian J Otolaryngol Head Neck Surg 2022; 74:5990-5993. [PMID: 36742652 PMCID: PMC9895729 DOI: 10.1007/s12070-021-02656-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/17/2021] [Indexed: 02/07/2023] Open
Abstract
Cancer in the head and neck region is among the most common cancer around the world, the incidence of which keep increasing in past years. Treatment of disease is usually done by the surgical excision which often leads to some degree of facial disfigurements which cause mutilation in patients. Mutilation imparts the feeling of stigma in patients, and patients usually tend to hide facial disfigurements using additional clothing. As a prevention strategy, awareness regarding the disease conveys to the mass population via media commercials. Media commercials which highlight the adverse outcomes of cancer are found to target the stigmatized perspective of disease. On the brighter side, more stigmatized is the patient image in the commercials, more motivation it will create in masses to avoid risk factors like tobacco, smoking and alcohol. But on the darker side, stigmatized commercials create a social environment in which people tend to maintain social distance to cancer patients, and patients have to bear social disapproval by society for their whole life. It reduces the self-esteem and quality of life of patients which affects their overall survival. In the present article, we review the status of stigma in head and neck cancer patients, tools that are available for assessment of stigma, and effects of the stigmatized media commercials on the patient's self-esteem. The present article represents the accurate picture of the problem and highlights the policies which could be employed to balance the paradox of stigmatized media commercials and a healthy social environment for cancer patients.
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Affiliation(s)
- Atul Kumar Goyal
- Department of Otolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaimanti Bakshi
- Department of Otolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh Kumar
Panda
- Department of Otolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kapoor
- Homi Bhabha Cancer Hospital and Research Center, Punjab, India
| | - Dharam Vir
- Department of Otolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Krishan Kumar
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Aneja
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Zhang Z, Azman N, Eyu HT, Nik Jaafar NR, Mohd Salleh Sahimi H, Mohamad Yunus MR, Mohd Shariff N, Hami R, Mansor NS, Lu P, Leong Bin Abdullah MFI. Validation of the Malay Version of the Shame and Stigma Scale among Cancer Patients in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14266. [PMID: 36361144 PMCID: PMC9656140 DOI: 10.3390/ijerph192114266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 06/16/2023]
Abstract
The assessment of stigma among cancer patients is of the utmost importance as stigma may lead to various psychological sequelae and a lower quality of life. This study aimed to translate the English version of the Shame and Stigma Scale (SSS) into Malay and validate the Malay version of the SSS (SSS-M) to assess the degree of stigma among cancer patients in Malaysia. Initially, the concurrent translation and back translation of the SSS-M were performed, and the face and content validity were assessed. Subsequently, the SSS-M was administered to a total of 234 patients with mixed types of cancer to assess its reliability (internal consistency and test-retest reliability), construct validity (convergent and discriminant validity), and conduct an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA). The SSS-M total score registered a good internal consistency (a Cronbach's α of 0.881) and test-retest reliability (an intraclass correlation coefficient of 0.876, p < 0.001). The EFA and CFA confirmed that the SSS-M consisted of 16 items in 3 domains. Its convergent and discriminant validity were achieved. Hence, the SSS-M demonstrated good psychometric properties and is available for use to assess stigma among cancer patients in Malaysia.
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Affiliation(s)
- Zheng Zhang
- Department of Oncology, 1st Affiliated Hospital, Xinxiang Medical University, Xinxiang 453100, China
- Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas 13200, Malaysia
| | - Nizuwan Azman
- Division of Research and Networking, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas 13200, Malaysia
| | - Hui Ting Eyu
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia
| | - Nik Ruzyanei Nik Jaafar
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia
| | - Hajar Mohd Salleh Sahimi
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia
| | - Mohd Razif Mohamad Yunus
- Department of Otorhinolaryngology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia
| | - Noorsuzana Mohd Shariff
- Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas 13200, Malaysia
| | - Rohayu Hami
- Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas 13200, Malaysia
| | - Nor Shuhada Mansor
- Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas 13200, Malaysia
| | - Ping Lu
- Department of Oncology, 1st Affiliated Hospital, Xinxiang Medical University, Xinxiang 453100, China
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Tseng WT, Lee Y, Hung CF, Lin PY, Chien CY, Chuang HC, Fang FM, Li SH, Huang TL, Chong MY, Wang LJ. Stigma, depression, and anxiety among patients with head and neck cancer. Support Care Cancer 2021; 30:1529-1537. [PMID: 34533631 DOI: 10.1007/s00520-021-06550-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/07/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Patients with head and neck cancer (HNC) are vulnerable to psychiatric comorbidities, particularly anxiety and depression, and also suffer from cancer stigma. This study aimed to comprehensively compare HNC patients' stigma, depression, and anxiety, and elucidate the underlying relationships among them. METHODS This cross-sectional study recruited inpatients with HNC from a medical center. Measurements included a psychiatric diagnostic interview, the Shame and Stigma Scale (SSS), the Hamilton Anxiety Rating Scale (HAM-A), the Hamilton Depression Rating Scale (HAM-D), the Explanatory Model Interview Catalogue (EMIC), and stressors of HNC patients. Structural equation modeling was used to establish models of potential mechanisms. RESULTS Those patients having stressors of worry about health (t = 5.21, p < 0.001), worry about job (t = 2.73, p = 0.007), worry about family (t = 2.25, p = 0.026), or worry about economic problems (t = 2.09, p = 0.038) showed significantly higher SSS score than those having no such stressor. The SSS total score was significantly correlated with HAM-A (r = 0.509, p < 0.001), HAM-D (r = 0.521, p < 0.001), and EMIC (r = 0.532, p < 0.001) scores. Structural equation modeling was used to propose the possible effect of stigma on anxiety (β = 0.51, p < 0.001), and then the possible effect of anxiety on depression (β = 0.90, p < 0.001). CONCLUSION Stigma is significantly correlated with anxiety and depression and might in HNC patients. Proper identification of comorbidities and a reduction of stigma should be advised in mental health efforts among patients with HNC.
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Affiliation(s)
- Wei-Ting Tseng
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Road, Niaosung District, Kaohsiung City, Taiwan
| | - Yu Lee
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Road, Niaosung District, Kaohsiung City, Taiwan.
| | - Chi-Fa Hung
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Road, Niaosung District, Kaohsiung City, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Road, Niaosung District, Kaohsiung City, Taiwan
| | - Chih-Yen Chien
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Hui-Ching Chuang
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Fu-Min Fang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Shau-Hsuan Li
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Tai-Lin Huang
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Mian-Yoon Chong
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Road, Niaosung District, Kaohsiung City, Taiwan
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Road, Niaosung District, Kaohsiung City, Taiwan.
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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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Goyal AK, Bakshi J, Panda NK, Kapoor R, Vir D, Kumar K, Aneja P, Singh B, Gupta M, Walia SS. Translation and Validation of Shame and Stigma Scale for Head and Neck Cancer into the Hindi Language. J Maxillofac Oral Surg 2021. [DOI: 10.1007/s12663-021-01588-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Reynolds LM, Harris L. Stigma in the face of cancer disfigurement: A systematic review and research agenda. Eur J Cancer Care (Engl) 2020; 30:e13327. [PMID: 32896036 DOI: 10.1111/ecc.13327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/01/2020] [Accepted: 08/07/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION An emerging body of work has reported on the psychological impact of disfigurement on cancer patients; however, the extent of research focusing on stigmatisation in this context is unclear. This review aimed to evaluate how stigma associated with disfigurement impacts on cancer patients. METHODS A systematic review of literature was conducted using SCOPUS, Web of Science, MEDLINE and PubMed databases. Articles were included if they described a qualitative or quantitative study that investigated the impact of stigma and disfigurement on individuals with cancer and/or their families. Included studies were appraised for methodology and narratively synthesised. RESULTS Of the 16 studies which met the inclusion criteria, ten were qualitative and six were quantitative. Publication dates ranged from 1994 to 2020. Results highlighted the varying impact of felt and enacted stigma in people with cancer disfigurement. While individuals cope with stigma in different ways and outcomes can sometimes be positive, most articles documented a negative impact to well-being including emotions such as disgust and shame. CONCLUSION This review identified negative and (sometimes) positive consequences of disfigurement and stigma on cancer patients; however, the main finding is that relevant research is in its infancy. Several areas of future research are warranted.
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Affiliation(s)
- Lisa M Reynolds
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Lauren Harris
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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