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Kataria I, Sethuraman L, Nayak P, Oswal K, Purushotham A. Measurement of cancer stigma in India: challenges and opportunities. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 24:100408. [PMID: 38659627 PMCID: PMC11041012 DOI: 10.1016/j.lansea.2024.100408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/17/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, India
| | | | - Prakash Nayak
- Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Sawhney R, Nathani P, Patil P, Bhandarkar P, Veetil DK, Venghateri JB, Roy N, Gadgil A. Recognising socio-cultural barriers while seeking early detection services for breast cancer: a study from a Universal Health Coverage setting in India. BMC Cancer 2023; 23:881. [PMID: 37726732 PMCID: PMC10507865 DOI: 10.1186/s12885-023-11359-3] [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: 01/30/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Breast cancer is the commonest cancer among women in India, yet the uptake of early detection programs is poor. This leads to late presentation, advanced stage at the time of diagnosis, and high mortality. Poor accessibility and affordability are the most commonly cited barriers to screening: we analyse socio-cultural factors influencing the uptake of early detection programmes in a Universal Health Coverage (UHC) setting in India, where geographical and financial barriers were mitigated. METHODS Two hundred seventy-two women engaging in an awareness-based early detection program were recruited by randomization as the participant (P) group. A further 272 women who did not participate in the early detection programme were recruited as non-participants (NP). None of the groups were previously screened for breast cancer. Interviews were conducted using a 19-point questionnaire, consisting of closed-ended questions regarding demographics and social, cultural, spiritual and trust-related barriers. RESULTS The overall awareness about breast cancer was high among both groups. None of the groups reported accessibility-related barriers. Participants were more educated (58.09% vs 47.43%, p = 0.02) and belonged to nuclear families (83.59% vs 76.75%, p = 0.05). Although they reported more fear of isolation due to stigma (25% vs 14%, p = 0.001), they had greater knowledge about breast cancer and trust in the health system compared to non-participants. CONCLUSIONS The major socio-cultural barriers identified were joint family setups, lower education and awareness, and lack of trust in healthcare professionals. As more countries progress towards UHC, recognising socio-cultural barriers to seeking breast health services is essential in order to formulate context-specific solutions to increase the uptake of early detection and screening services.
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Affiliation(s)
- Riya Sawhney
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low and Middle-Income Countries, Mumbai, India
| | - Priyansh Nathani
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low and Middle-Income Countries, Mumbai, India
| | - Priti Patil
- Department of Statistics, Bhabha Atomic Research Centre (BARC) Hospital, Mumbai, India
| | - Prashant Bhandarkar
- Department of Statistics, Bhabha Atomic Research Centre (BARC) Hospital, Mumbai, India
| | - Deepa Kizhakke Veetil
- Department of Minimal Access, General, Gastrointestinal and Bariatric Surgery, Manipal Hospitals, Delhi, India
| | - Jubina Balan Venghateri
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low and Middle-Income Countries, Mumbai, India
| | - Nobhojit Roy
- Department of Global Public Health, Karolinska Institute, 17177, Stockholm, Sweden.
| | - Anita Gadgil
- The George Institute of Global Health, Delhi, India
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Aggarwal A, Rama R, Dhillon PK, Deepa M, Kondal D, Kaushik N, Bumb D, Mehrotra R, Kohler BA, Mohan V, Gillespie TW, Patel AV, Rajaraman S, Prabhakaran D, Ward KC, Goodman M. Linking population-based cohorts with cancer registries in LMIC: a case study and lessons learnt in India. BMJ Open 2023; 13:e068644. [PMID: 36878651 PMCID: PMC9990691 DOI: 10.1136/bmjopen-2022-068644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVES In resource-constrained settings, cancer epidemiology research typically relies on self-reported diagnoses. To test a more systematic alternative approach, we assessed the feasibility of linking a cohort with a cancer registry. SETTING Data linkage was performed between a population-based cohort in Chennai, India, with a local population-based cancer registry. PARTICIPANTS Data set of Centre for Cardiometabolic Risk Reduction in South-Asia (CARRS) cohort participants (N=11 772) from Chennai was linked with the cancer registry data set for the period 1982-2015 (N=140 986). METHODS AND OUTCOME MEASURES Match*Pro, a probabilistic record linkage software, was used for computerised linkages followed by manual review of high scoring records. The variables used for linkage included participant name, gender, age, address, Postal Index Number and father's and spouse's name. Registry records between 2010 and 2015 and between 1982 and 2015, respectively, represented incident and all (both incident and prevalent) cases. The extent of agreement between self-reports and registry-based ascertainment was expressed as the proportion of cases found in both data sets among cases identified independently in each source. RESULTS There were 52 self-reported cancer cases among 11 772 cohort participants, but 5 cases were misreported. Of the remaining 47 eligible self-reported cases (incident and prevalent), 37 (79%) were confirmed by registry linkage. Among 29 self-reported incident cancers, 25 (86%) were found in the registry. Registry linkage also identified 24 previously not reported cancers; 12 of those were incident cases. The likelihood of linkage was higher in more recent years (2014-2015). CONCLUSIONS Although linkage variables in this study had limited discriminatory power in the absence of a unique identifier, an appreciable proportion of self-reported cases were confirmed in the registry via linkages. More importantly, the linkages also identified many previously unreported cases. These findings offer new insights that can inform future cancer surveillance and research in low-income and middle-income countries.
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Affiliation(s)
- Aastha Aggarwal
- The Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, Haryana, India
- Centre for Chronic Disease Control, Dwarka, Delhi, India
| | | | - Preet K Dhillon
- The Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, Haryana, India
- Centre for Chronic Disease Control, Dwarka, Delhi, India
- Genentech Inc, South San Francisco, California, USA
| | - Mohan Deepa
- Madras Diabetes Research Foundation (ICMR Center for Advanced Research on Diabetes), Chennai, Tamil Nadu, India
| | - Dimple Kondal
- Centre for Chronic Disease Control, Dwarka, Delhi, India
| | - Naveen Kaushik
- Centre for Chronic Disease Control, Dwarka, Delhi, India
| | - Dipika Bumb
- Ramaiah International Centre for Public Health Innovations, Bengaluru, Karnataka, India
| | - Ravi Mehrotra
- Centre for Health, Innovation and Policy, Noida, Uttar Pradesh, India
- Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Betsy A Kohler
- North American Association of Central Cancer Registries, Springfield, Illinois, USA
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation (ICMR Center for Advanced Research on Diabetes), Chennai, Tamil Nadu, India
- Dr. Mohan's Diabetes Specialities Centre (IDF Centre of Excellence in Diabetes Care), Gopalapuram, Chennai, Tamil Nadu, India
| | - Theresa W Gillespie
- Department of Hematology & Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory University Winship Cancer Institute, Atlanta, Georgia, USA
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Atlanta, Georgia, USA
| | | | - Dorairaj Prabhakaran
- The Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, Haryana, India
- Centre for Chronic Disease Control, Dwarka, Delhi, India
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia, USA
- Emory University Winship Cancer Institute, Atlanta, Georgia, USA
- Centre for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia, USA
- Emory University Winship Cancer Institute, Atlanta, Georgia, USA
- Centre for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Paneru B, Karmacharya A, Bharati A, Makaju S, Adhikari B, Kafle D, Shakya S, Spiegelman D, Seth S, Stangl A, Shrestha AD, Shrestha A. Association between cancer stigma and cervical cancer screening uptake among women of Dhulikhel and Banepa, Nepal. PLoS One 2023; 18:e0285771. [PMID: 37200234 DOI: 10.1371/journal.pone.0285771] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/29/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Cervical cancer ranks as the most common cancer among Nepalese women with a high incidence and mortality. Despite evidence that effective screening programs reduce disease burden, screening services are under-utilized. Cancer stigma can be a major barrier to cervical cancer screening uptake among Nepalese women. OBJECTIVES This study assessed the association between cancer stigma and cervical cancer screening uptake among women residing in semi-urban areas of Kavrepalanchok district (Dhulikhel and Banepa), Nepal. METHODS We conducted a cross-sectional study among 426 women aged 30-60 years using telephone interview method from 15th June to 15th October 2021. A validated Cancer Stigma Scale (CASS) was used to measure cancer stigma and categorized women as presence of cancer stigma if the mean total score was greater than three. We obtained information on cervical cancer screening uptake through self-reported responses. Univariable and multivariable logistic regression were performed to assess the association between cancer stigma and cervical cancer screening uptake. We adjusted socio-demographic: age, ethnicity, occupation, religion and education, and reproductive health variables: parity, family planning user, age of menarche and age at first sexual intercourse during multivariable logistic regression. RESULTS Twenty-three percent of women had cancer stigma and 27 percent reported that they had ever been screened for cervical cancer. The odds of being screened was 0.23 times lower among women who had stigma compared to those who had no stigma (95% CI: 0.11-0.49) after adjusting for confounders: age, ethnicity, occupation, religion, education, parity, contraceptive use, age of menarche and age at first sexual intercourse. CONCLUSION Women residing in semi-urban areas of Nepal and had cancer stigma were less likely to have been screened for cervical cancer. De-stigmatizing interventions may alleviate cancer stigma and contribute to higher uptake of cervical cancer screening.
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Affiliation(s)
- Bandana Paneru
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Institute for Implementation Science and Health, Kathmandu, Nepal
| | - Aerona Karmacharya
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Alina Bharati
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Soniya Makaju
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Bikram Adhikari
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Dikshya Kafle
- Canadian Red Cross, Country Office Nepal, Kathmandu, Nepal
| | - Sunila Shakya
- Department of Obstetrics and Gynecology, Dhulikhel Hospital/Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Donna Spiegelman
- Center of Methods for Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, United States of America
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States of America
| | - Sangini Seth
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States of America
| | - Anne Stangl
- International Center for Research on Women, Washington, DC, United States of America
| | - Aamod Dhoj Shrestha
- Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
- COBIN, Nepal Development Society, Bharatpur, Nepal
| | - Archana Shrestha
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Institute for Implementation Science and Health, Kathmandu, Nepal
- Center of Methods for Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, United States of America
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Fereydooni S, Lorenz KA, Ganesh A, Satija A, Spruijt O, Bhatnagar S, Gamboa RC, Singh N, Giannitrapani KF. Empowering families to take on a palliative caregiver role for patients with cancer in India: Persistent challenges and promising strategies. PLoS One 2022; 17:e0274770. [PMID: 36112593 PMCID: PMC9481001 DOI: 10.1371/journal.pone.0274770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 09/04/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The population of patients with cancer requiring palliative care (PC) is on the rise in India. Family caregivers will be essential members of the care team in the provision of PC. OBJECTIVE We aimed to characterize provider perspectives of the challenges that Indian families face in taking on a palliative caregiving role. METHOD Data for this analysis came from an evaluation of the PC-PAICE project, a series of quality improvement interventions for PC in India. We conducted 44 in-depth semi-structured interviews with organizational leaders and clinical team members at seven geographically and structurally diverse settings. Through thematic content analysis, themes relating to the caregivers' role were identified using a combination of deductive and inductive approaches. RESULT Contextual challenges to taking up the PC caregiving role included family members' limited knowledge about PC and cancer, the necessity of training for caregiving responsibilities, and cultural preferences for pursuing curative treatments over palliative ones. Some logistical challenges include financial, time, and mental health limitations that family caregivers may encounter when navigating the expectations of taking on the caregiving role. Strategies to facilitate family buy-in for PC provision include adopting a family care model, connecting them to services provided by Non-Governmental Organizations, leveraging volunteers and social workers to foster PC awareness and training, and responding specifically to family's requests. CONCLUSION Understanding and addressing the various challenges that families face in adopting the caregiver role are essential steps in the provision and expansion of PC in India. Locally initiated quality improvement projects can be a way to address these challenges based on the context.
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Affiliation(s)
- Soraya Fereydooni
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, United States of America
- Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Karl A. Lorenz
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, United States of America
- Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Archana Ganesh
- All India Institute of Medical Science (AIIMS), New Delhi, India
| | - Anchal Satija
- All India Institute of Medical Science (AIIMS), New Delhi, India
| | - Odette Spruijt
- Peter MacCallum Cancer Center, Melbourne, Victoria, Australia
| | - Sushma Bhatnagar
- All India Institute of Medical Science (AIIMS), New Delhi, India
| | - Raziel C. Gamboa
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, United States of America
| | - Nainwant Singh
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, United States of America
| | - Karleen F. Giannitrapani
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, United States of America
- Stanford University School of Medicine, Palo Alto, California, United States of America
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Yadav K, Babu R, Hariprasad R, Gupta R, Kumari M, Mehrotra R, Kumar S, Naik N, Gupta S, Singh S. Perspectives of Healthcare Providers and the General Population on a Cancer Awareness Portal: a Qualitative Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:561-567. [PMID: 32740859 DOI: 10.1007/s13187-020-01846-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study was aimed at a qualitative assessment of a cancer informational website, "India Against Cancer," developed by the ICMR-National Institute of Cancer Prevention and Research with the dual purpose of promoting cancer awareness among the general population and providing comprehensive information to healthcare providers. We used the narrative qualitative approach (data collection using in-depth interviews (IDIs) and focused group discussions (FGDs)) and content analysis. Purposive sampling was undertaken for both IDIs and FGDs. Thematic analysis was done on four themes: general cancer awareness, ease of comprehension of the Web portal, the relevance of the website content, and general comments and suggestions. Readability assessment of content of the website was conducted using Flesch-Kincaid Readability methodology. The general cancer awareness was enhanced among the participants after visiting the website. Ease of comprehension of the Web portal content was reported to fare well. The sections on "risk factors," "warning signs," and "diet and cancer" were mentioned as most relevant by the general population, whereas "myths and facts" and "screening guidelines" were most relevant for the healthcare workers. Similarly, references and epidemiology sections were most useful for healthcare researchers/professionals. Readability scores of content in English were appropriate for high school pass audience. The content on "India Against Cancer" website was found to serve its intended purpose of promoting cancer awareness among the general population and providing authentic cancer-related information to the healthcare providers. The suggestions received would enable us to enhance the utility of our website by tailoring it to the needs of the target audience.
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Affiliation(s)
- Kavita Yadav
- ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Roshani Babu
- ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Roopa Hariprasad
- ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Ruchika Gupta
- ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Malasha Kumari
- ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Ravi Mehrotra
- Department of Health Research, Indian Cancer Research Consortium, New Delhi, India
| | - Sanjeev Kumar
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Navami Naik
- Indo-American Cancer Association, Atlanta, GA, USA
| | - Sanjay Gupta
- ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India.
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, I-7, Sector-39, Noida, 201301, India.
| | - Shalini Singh
- ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
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Akin-Odanye EO, Husman AJ. Impact of stigma and stigma-focused interventions on screening and treatment outcomes in cancer patients. Ecancermedicalscience 2021; 15:1308. [PMID: 34824631 PMCID: PMC8580722 DOI: 10.3332/ecancer.2021.1308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Indexed: 12/11/2022] Open
Abstract
Background Stigma is known to negatively influence cancer patients’ psychosocial behaviour and treatment outcomes. The aim of this study was to systematically review the current data on cancer-related stigma across different populations and identify effective interventions used to address it. Methodology The protocol, search, appraisal, synthesis, analysis and reporting framework was used for conducting this systematic literature review. CINAHL, PubMed, PsycINFO and Google Scholar databases were searched using the different combination of keywords that include ‘cancer stigma’. Articles publication period was set for 2010–2020. A total of 54 articles (31 quantitative, 19 qualitative, 2 mixed methods and 2 scoping reviews) that met inclusion criteria were reviewed out of the 958 articles initially identified. Quality assessment of included studies revealed the studies had varying levels of methodological quality. Extracted data were organised and narratively analysed. Results Cancer stigma was expressed across different segments of the society including amongst the elites and healthcare providers. Developing countries had higher rates of stigma reported and experience of stigma varied by cancer type. Cancer was consistently associated with imminent death in all studies reviewed. Cancer patients experiencing stigma were more inclined to conceal their diagnosis and to seek medical help later. Whilst cancer stigma majorly resulted in negative psychosocial outcomes in patients, there were also instances of posttraumatic growth emanating from the stigma experienced. Literature on cancer-related stigma interventions was scant. Conclusion Cancer related stigma remains high in both clinical settings and amongst the general public. There is need for more interventions to combat cancer stigma and its effect in both patient and non-patient population. Anti-cancer public enlightenment campaigns should be sensitively designed to not further fuel stigma against patients with certain types of cancers.
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Affiliation(s)
- Elizabeth O Akin-Odanye
- Department of Clinical Psychology, University College Hospital, Queen Elizabeth Road, Oritamefa, Ibadan, Oyo State, 200212, Nigeria
| | - Anisah J Husman
- College of Health Professions and Sciences, University of Central Florida, 4000 Central Florida Blvd, Orlando, FL 32816, USA
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Yıldız K, Koç Z. Stigmatization, discrimination and illness perception among oncology patients: A cross-sectional and correlational study. Eur J Oncol Nurs 2021; 54:102000. [PMID: 34492525 DOI: 10.1016/j.ejon.2021.102000] [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: 01/06/2021] [Revised: 06/07/2021] [Accepted: 07/07/2021] [Indexed: 11/12/2022]
Abstract
PURPOSE Many individuals who get cancer may be exposed to stigmatization from their close relatives and their entourage. This cross-sectional and correlational study was conducted in order to determine stigmatization, discrimination and perception of illness among oncology patients in Northern Turkey. METHOD The sample of the study consisted of 367 inpatients who were hospitalized in the oncology and hematology clinics of a University Hospital in northern Turkey between 31.01.2019 and 30.07.2019. Data were collected using the demographics form, Cataldo Lung Cancer Stigma Scale and Illness Perception Questionnaire. RESULTS The mean total score of the patients according to Cataldo Lung Cancer Stigma Scale is 30.4 ± 8.8. In this study, no statistically significant relationship was determined between Cataldo Lung Cancer Stigma Scale total score and Illness Perception Questionnaire sub-dimension scores (p > .05). It can be said that the oncology patients were exposed to stigmatization and discrimination, and that certain socio demographic and clinical characteristics such as sex, marital status, education level, employment status, diagnosis, and the clinical phase of the disease are significant predictors of Cataldo Lung Cancer Stigma Scale scores. CONCLUSIONS In order to help them express their feelings in oncology patients, reduce their anxiety, increase their adaptation to their illness and treatment, help them cope with the multi-faceted crisis caused by the disease and improve their quality of life, cancer stigmatization should be evaluated objectively.
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Affiliation(s)
- Kübra Yıldız
- Ondokuz Mayıs University Health Application and Research Hospital, Turkey.
| | - Zeliha Koç
- Ondokuz Mayıs University, Health Science Faculty, Turkey.
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Mondal S. Truth-Telling to Terminal Stage Cancer Patients in India: A Study of the General Denial to Disclosure. OMEGA-JOURNAL OF DEATH AND DYING 2021:302228211032732. [PMID: 34275387 DOI: 10.1177/00302228211032732] [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: 11/16/2022]
Abstract
Telling the truth to the terminal-stage cancer patients differs socio-culturally based on the priorities assigned to patients' autonomy and the principles of beneficence and non-maleficence. After conducting in-depth interviews with 108 terminal-stage adult cancer patients, 306 family members, and 25 physicians, in private and public hospitals in both rural and urban areas, in the state of West Bengal, India it has been found that even though 85.60% of the patients prefer full disclosure, only 22.03% are actually informed. Though demographic characteristics, like age, gender, education etc., have marginal influences over the pattern of truth-telling, the main factor behind non-disclosure is the family members' preference for principles of beneficence and non-maleficence over patient autonomy. Hence, only 9.32% of those 118 patients' family members have agreed to full disclosure. Physicians comply with this culture of non-disclosure as family, in India, is the centre of decision-making and acts as the primary unit of care.
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Affiliation(s)
- Souvik Mondal
- Department of Sociology, Presidency University, Kolkata, India
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The psychometric properties of the Persian version of the body image after breast Cancer questionnaire: A second- order confirmatory factor analysis. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01741-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Torode J, Kithaka B, Chowdhury R, Simelela N, Cruz JL, Tsu VD. National action towards a world free of cervical cancer for all women. Prev Med 2021; 144:106313. [PMID: 33678227 PMCID: PMC8201602 DOI: 10.1016/j.ypmed.2020.106313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Julie Torode
- Union for International Cancer Control, Avenue Giuseppe Motta 31-33, 1202 Geneva, Switzerland.
| | - Benda Kithaka
- Women 4 Cancer, Biblica House, Dennis Pritt Road, P.O. Box 13263-00100, Nairobi, Kenya
| | - Raveena Chowdhury
- Marie Stopes International, 1 Conway Street, Fitzroy Square, London W1T 6LP, UK
| | - Nothemba Simelela
- World Health Organization, 20 Avenue Appia 1211, Geneva 27, Switzerland
| | - Jennifer L Cruz
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Vivien D Tsu
- Department of Global Health, University of Washington, Harris Hydraulics Laboratory, 1510 San Juan Rd NE, Box 357965, Seattle, WA 98195-7965, USA
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Kaul P, Kumar R, Singh MP, Garg PK. Social taboos: a formidable challenge in cancer care. BMJ Case Rep 2021; 14:14/1/e236095. [PMID: 33431441 PMCID: PMC7802719 DOI: 10.1136/bcr-2020-236095] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Taboo surrounding cancer has continued to be a stubborn and refractory public health issue especially in South Asian countries. Disparities in cancer care remain ubiquitous. Differences in the manner in which cancer is perceived, addressed, and treated might partly be a result of varying cultural influences. This case report highlights the clinical course of a female patient with neurofibromatosis who later developed a large facial malignant peripheral nerve sheath tumour. The case particularly addresses the catastrophic impact of the 'cancer-related social taboos' on various dimensions of cancer care ranging from primary and secondary prevention to definitive management. The financial issues in low-income to medium-income groups as potential deterrents to optimum treatment have also been highlighted. Approach to the common challenges faced by an oncologist practising in a society plagued by misconceptions about health and disease and potential remedial measures to debunk these myths have also been discussed.
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Affiliation(s)
- Pallvi Kaul
- Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rahul Kumar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mahendra Pal Singh
- Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Pankaj Kumar Garg
- Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Faruqui N, Bernays S, Martiniuk A, Abimbola S, Arora R, Lowe J, Denburg A, Joshi R. Access to care for childhood cancers in India: perspectives of health care providers and the implications for universal health coverage. BMC Public Health 2020; 20:1641. [PMID: 33143668 PMCID: PMC7607709 DOI: 10.1186/s12889-020-09758-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 10/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are multiple barriers impeding access to childhood cancer care in the Indian health system. Understanding what the barriers are, how various stakeholders perceive these barriers and what influences their perceptions are essential in improving access to care, thereby contributing towards achieving Universal Health Coverage (UHC). This study aims to explore the challenges for accessing childhood cancer care through health care provider perspectives in India. METHODS This study was conducted in 7 tertiary cancer hospitals (3 public, 3 private and 1 charitable trust hospital) across Delhi and Hyderabad. We recruited 27 healthcare providers involved in childhood cancer care. Semi-structured interviews were audio recorded after obtaining informed consent. A thematic and inductive approach to content analysis was conducted and organised using NVivo 11 software. RESULTS Participants described a constellation of interconnected barriers to accessing care such as insufficient infrastructure and supportive care, patient knowledge and awareness, sociocultural beliefs, and weak referral pathways. However, these barriers were reflected upon differently based on participant perception through three key influences: 1) the type of hospital setting: public hospitals constituted more barriers such as patient navigation issues and inadequate health workforce, whereas charitable trust and private hospitals were better equipped to provide services. 2) the participant's cadre: the nature of the participant's role meant a different degree of exposure to the challenges families faced, where for example, social workers provided more in-depth accounts of barriers from their day-to-day interactions with families, compared to oncologists. 3) individual perceptions within cadres: regardless of the hospital setting or cadre, participants expressed individual varied opinions of barriers such as acceptance of delay and recognition of stakeholder accountabilities, where governance was a major issue. These influences alluded to not only tangible and structural barriers but also intangible barriers which are part of service provision and stakeholder relationships. CONCLUSION Although participants acknowledged that accessing childhood cancer care in India is limited by several barriers, perceptions of these barriers varied. Our findings illustrate that health care provider perceptions are shaped by their experiences, interests and standpoints, which are useful towards informing policy for childhood cancers within UHC.
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Affiliation(s)
- Neha Faruqui
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
| | - Sarah Bernays
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,London School of Hygiene and Tropical Medicine, London, UK
| | - Alexandra Martiniuk
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Seye Abimbola
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia
| | - Ramandeep Arora
- Cankids … Kidscan, New Delhi, India.,Max Super Speciality Hospital, New Delhi, India
| | | | - Avram Denburg
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Rohina Joshi
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,George Institute for Global Health, New Delhi, India
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Thirthahalli C, Shetty P. Impact of COVID-19 on cancer screening by Non-Government Organizations and the way forward. Indian J Cancer 2020; 57:485-486. [PMID: 33078759 DOI: 10.4103/ijc.ijc_465_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Chethana Thirthahalli
- Department of Community Oncology, Indian Cancer Society, Bengaluru, Karnataka, India
| | - Punith Shetty
- Department of Community Oncology, Indian Cancer Society, Bengaluru, Karnataka, India
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Non-Communicable Diseases-Related Stigma: A Mixed-Methods Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186657. [PMID: 32932667 PMCID: PMC7559120 DOI: 10.3390/ijerph17186657] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 12/23/2022]
Abstract
This systematic review examines and consolidates existing evidence on stigma associated with the top four non-communicable diseases (NCDs)—cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes—and its impact on the lives of people affected. We conducted a systematic literature search in PubMed, PsycINFO, JSTOR, Science Direct, and Web of Science for original research in English that explored health-related stigma among people living with either of the four NCDs. A three-step integrative synthesis of data was conducted. Twenty-six articles (qualitative = 15; quantitative = 11) were selected, with most (n = 15) related to cancers, followed by diabetes (n = 7), chronic respiratory diseases (n = 3), and cardiovascular diseases (n = 1). Blame, shame, and fear were the main causes of stigma, the origin and nature of which differed according to the disease-specific features. The manifestations (enacted and felt stigma) and consequences (social, behavioral, psychological, and medical) of stigma across NCDs were similar. Inconsistencies existed in the conceptualization of stigma processes. To fill this gap, we developed an NCD-related stigma framework. People living with NCDs can experience stigma, which can negatively impact their health, management of their disease, and quality of life. The new framework can help in improving the understanding of the processes and experiences of stigma related to NCDs.
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Epton T, Chittem M, Tanikella R, Rajappa S, Sinha S, Harris PR. Indian patient use of cancer euphemisms: Association with psychological outcomes and health behaviours. Psychooncology 2020; 29:1193-1200. [PMID: 32390299 DOI: 10.1002/pon.5408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Euphemisms may be used to reduce the threat associated with the word "cancer." Cancer may be particularly threatening in Indian culture due to the myths surrounding its cause and prognosis. This study explored the prevalence of euphemism use by Indian patients and the relationship among euphemism use and illness cognitions, affect, health behaviour, and spontaneous self-affirmation (a behaviour associated with dealing with threat). METHODS In total, 350 cancer patients in India were recruited to take part in a study exploring patients' experiences of, and thoughts about, having an illness. They responded to a questionnaire measuring illness perceptions, coping strategies, anxiety, depression, health behaviours, and spontaneous self-affirmation. Patients were asked what words they used to describe their illness; euphemism users were those who used a euphemism (ie, non-medical term) as a first word. RESULTS About 51% of patients used a euphemism as a first word. Those with less education, unskilled employment, a lower income, and more children were more likely to be euphemism users. Euphemism users reported (a) weaker illness perceptions (less personal control, greater reporting of symptoms, and less understanding of their condition), (b) less use of 3 of 14 coping strategies, (c) less likelihood of spontaneously self-affirming, and (d) fewer healthy eating days. CONCLUSIONS Euphemism use in patients was not related to distress but was related to negative illness perceptions and use of fewer coping strategies, suggesting that we need further study about the extent to which euphemisms signal issues in psychological adaptation to cancer diagnosis.
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Affiliation(s)
- Tracy Epton
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology, Hyderabad, India
| | - Ravali Tanikella
- Department of Liberal Arts, Indian Institute of Technology, Hyderabad, India
| | - Senthil Rajappa
- Department of Medical Oncology, Basavatakaram Indo-American Cancer Hospital and Research Centre, Hyderabad, India
| | - Sudha Sinha
- Department of Paediatric Oncology, MNJ Institute of Oncology, Hyderabad, India
| | - Peter R Harris
- School of Psychology, University of Sussex, Brighton, UK
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Faruqui N, Joshi R, Martiniuk A, Lowe J, Arora R, Anis H, Kalra M, Bakhshi S, Mishra A, Santa A, Sinha S, Siddaiahgari S, Seth R, Bernays S. A health care labyrinth: perspectives of caregivers on the journey to accessing timely cancer diagnosis and treatment for children in India. BMC Public Health 2019; 19:1613. [PMID: 31791308 PMCID: PMC6889559 DOI: 10.1186/s12889-019-7911-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/07/2019] [Indexed: 11/17/2022] Open
Abstract
Background Cure rates for children with cancer in India lag behind that of high-income countries. Various disease, treatment and socio-economic related factors contribute to this gap including barriers in timely access of diagnostic and therapeutic care. This study investigated barriers to accessing care from symptom onset to beginning of treatment, from perspectives of caregivers of children with cancer in India. Methods Semi-structured in-depth interviews were conducted with caregivers of children (< 18 years) diagnosed with cancer in seven tertiary care hospitals across New Delhi and Hyderabad. Purposive sampling to saturation was used to ensure adequate representation of the child’s gender, age, cancer type, geographical location and socioeconomic status. Interviews were audio recorded after obtaining informed consent. Thematic content analysis was conducted and organised using NVivo 11. Results Thirty-nine caregivers were interviewed, where three key themes emerged from the narratives: time intervals to definitive diagnosis and treatment, the importance of social supportive care and the overall accumulative impacts of the journey. There were two phases encapsulating the experiences of the family: referral pathways taken to reach the hospital and after reaching the hospital. Most caregivers, especially those from distant geographical areas had variable and inconsistent referral pathways partly due to poor availability of specialist doctors and diagnostic facilities outside major cities, influence from family or friends, and long travel times. Upon reaching the hospital, families mostly from public hospitals faced challenges navigating the hospital facilities, finding accommodation, and comprehending the diagnosis and treatment pathway. Throughout both phases, financial constraint was a recurring issue amongst low-income families. The caregiver’s knowledge and awareness of the disease and health system, religious and social factors were also common barriers. Conclusion This qualitative study highlights and explores some of the barriers to childhood cancer care in India. Our findings show that referral pathways are intrinsically linked to the treatment experience and there should be better recognition of the financial and emotional challenges faced by the family that occur prior to definitive diagnosis and treatment. This information would help inform various stakeholders and contribute to improved interventions addressing these barriers.
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Affiliation(s)
- Neha Faruqui
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia. .,George Institute for Global Health, Sydney, NSW, Australia.
| | - Rohina Joshi
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Alexandra Martiniuk
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Ramandeep Arora
- Cankids…Kidscan, New Delhi, India.,Max Super Speciality Hospital, New Delhi, India
| | | | - Manas Kalra
- Indraprastha Apollo Hospital, New Delhi, India
| | | | | | - Ayyagari Santa
- Basavatarakam Indo American Cancer Hospital, Hyderabad, India
| | | | | | | | - Sarah Bernays
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,London School of Hygiene and Tropical Medicine, London, UK
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van der Scheun FC, Nagelkerke MCM, Kilaru A, Shridhar V, Prasad R, van der Werf TS. Stigma among healthcare workers towards hepatitis B infection in Bangalore, India: a qualitative study. BMC Health Serv Res 2019; 19:736. [PMID: 31640692 PMCID: PMC6805630 DOI: 10.1186/s12913-019-4606-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 10/02/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND With about 50 million people infected with hepatitis B (HBV) in India the burden of disease is high. Stigma has been identified to have a major negative impact on screening, diagnosis and treatment of hepatitis B patients. The aim of this study was to assess the stigma in nurses and physicians in Bangalore, India; studies on stigma in HBV have only been published outside of India. METHODS Semi-structured in-depth-interviews were conducted in the period of March 20th and April 16th 2018 to study stigma and other problems in the care of hepatitis B patients. Stigma was pragmatically defined as a mark of disgrace associated with having a hepatitis B infection. Thirty physicians and nurses in different clinics and hospitals across the city of Bangalore were selected by purposeful sampling and snowball effect until theoretical saturation was reached. RESULTS The following themes were identified during the interviews: feelings when treating a patient; pregnancy and marriage; confidentiality; morality; improvement in care and the difference with HIV. The most stigma was discovered in the theme morality. The majority of our participants mentioned lack of awareness as biggest obstacle in health care of hepatitis B patients. CONCLUSIONS This is the first qualitative study in India exploring hepatitis B stigma among health care workers. Stigma was found in certain themes, such as morality. Though, no unwillingness to treat was found. There was a general lack of awareness amongst patients according to our participants and could jeopardize proper treatment. These results will further help in developing strategies to tackle hepatitis B in India.
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Affiliation(s)
- F C van der Scheun
- University of Groningen, Faculty of Medical Sciences, Antonius Deusinglaan 1, 9713, AV, Groningen, the Netherlands.
| | - M C M Nagelkerke
- University of Groningen, Faculty of Medical Sciences, Antonius Deusinglaan 1, 9713, AV, Groningen, the Netherlands
| | - A Kilaru
- PCMH Restore Health Center, Bangalore, India
| | - V Shridhar
- PCMH Restore Health Center, Bangalore, India
| | - R Prasad
- PCMH Restore Health Center, Bangalore, India.,Academy of Family Physicians of India (AFPI), Karnataka, India
| | - T S van der Werf
- University of Groningen, Faculty of Medical Sciences, Antonius Deusinglaan 1, 9713, AV, Groningen, the Netherlands
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20
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Ghose S, Radhakrishnan V, Bhattacharya S. Ethics of cancer care: beyond biology and medicine. Ecancermedicalscience 2019; 13:911. [PMID: 31123494 PMCID: PMC6467456 DOI: 10.3332/ecancer.2019.911] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Indexed: 11/23/2022] Open
Abstract
Treatable cancers are on the rise due to improved early diagnosis and more innovative treatments, and preventative strategies against cancer are becoming a global concern. With the rapidly increasing complexity of cancer treatment, a clear definition of what constitutes ethical cancer care has become a matter of great debate. This situation is more complex in a developing country where healthcare resources are limited. Doctors, nurses and public health professionals engaged in the prevention, screening, diagnosis, treatment and research of cancers are often posed with ethical dilemmas while making complex choices. With a special focus on low- and middle-income countries, this paper is intended to highlight these real-world ethical concerns facing those involved in the management of cancer patients. While taking a neutral view, this paper has adopted a theme-wise approach to discuss barriers in cancer care.
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Affiliation(s)
- Soumita Ghose
- Administration and Policy, Tata Medical Centre, Kolkata 700156, India
| | - Vivek Radhakrishnan
- Department of Clinical Haematology and Hematopoietic Cell Therapy, Tata Medical Centre, Kolkata 700156, India
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21
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Datta SS, Saha T, Ojha A, Das A, Daruvala R, Reghu KS, Achari R. What do you need to learn in paediatric psycho-oncology? Ecancermedicalscience 2019; 13:916. [PMID: 31123499 PMCID: PMC6467458 DOI: 10.3332/ecancer.2019.916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Indexed: 11/29/2022] Open
Abstract
Paediatric psycho-oncology is an evolving speciality and is increasingly being recognised as an essential component in children's cancer care. Modern paediatric oncology services aspire to integrate physical care with psycho-social care and build capacity within clinical teams to address the emotional needs of parents and children side by side with other aspects of medical care. This article discusses the unique challenges of paediatric psycho-oncology and common situations where psychological assessment and management of children and young people with cancer become especially important. The authors propose a tiered structure of training. Providing empathic evidence-based psycho-social care is 'everyone's business' in paediatric oncology and not merely that of mental health professionals. However, there are times when a more specialist intervention by a paediatric liaison psychiatrist and/or a clinical psychologist is needed for optimum outcome. Learning interviewing techniques suitable for children and adolescents should be a core part of the training in paediatric psycho-oncology. Professionals should be encouraged to reflect on their own emotional wellbeing, which in turn will provide a stable foundation of emotionally matured care to children, young people and their families.
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Affiliation(s)
- Soumitra Shankar Datta
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata 700160, India
- EGA UCL Institute for Women’s Health, University College London, London WC1E 6BT, UK
| | - Tania Saha
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata 700160, India
| | - Aparupa Ojha
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata 700160, India
| | - Anirban Das
- Department of Paediatric Oncology, Tata Medical Centre, Kolkata 700160,, India
| | - Rhea Daruvala
- Department of Paediatric Haematology, Oncology and Bone Marrow Transplant, Mazumdar Shaw Cancer Centre, Narayana Health City, Bangalore 560099, India
| | | | - Rimpa Achari
- Department of Radiation Oncology, Tata Medical Centre, Kolkata 700160, India
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Abstract
INTRODUCTION Palliative care coverage and opioid consumption in India are relatively low compared with global data. The literature suggests commonplace concealment and collusion in withholding information, but these hypotheses lack evidence. OBJECTIVES This study aimed to develop an explanatory evidence-based model of stigma, communication and access to cancer palliative care in India that can be used to develop, test and implement future interventions. DESIGN This cross-sectional qualitative study sampled advanced cancer patients (n=10), their family caregivers (n=10) and oncologists (n=10). Grounded theory procedures were utilised to analyse transcripts, and a theoretical model generated. SETTING A tertiary teaching hospital in South India. RESULTS The model explains how stigma associated with communicating a diagnosis of advanced cancer is enacted by treating oncologists, family members and community. This leads to patient expectations of cure and futile treatment uptake. Patients commonly only present needs with respect to pain, not within psychological, social or spiritual domains, likely due to the lack of patients' insight into their diagnosis and prognosis. As a result of oncologists' and families' unwillingness to disclose the prognosis, and patient focus on pain due to their lack of insight, palliative care clinicians view their services as under-utilised, and patients perceive palliative care as a pain management service that is not 'different' from other clinical services. Advanced care needs and purchase of futile treatments lead to lost employment among families, increased family debt and high care costs, which are rarely disclosed due to their unwillingness to discuss their needs. CONCLUSION Our novel theoretical model is an essential first step to ensure that complex interventions are plausible, with mechanisms of action that address the needs of relevant stakeholders. A family-centred approach with an oncology workforce skilled in communication and an enabled patient population could increase access to palliative care, and improved outcomes may be attainable.
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Affiliation(s)
- Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Department of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Department of Pain and Palliative Medicine, St John's Medical College Hospital, Bangalore, Karnataka, India
| | - Shoba Nair
- Department of Pain and Palliative Medicine, St John's Medical College Hospital, Bangalore, Karnataka, India
| | - Maria Ekstrand
- Division of Prevention Science- Department of Medicine, University of California San Francisco, San Franscisco, California, USA
- St John's Research Institute, Bangalore, Karnataka, India
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Banerjee J, Satapathy S, Upadhyay AD, Dwivedi SN, Chatterjee P, Kumar L, Rath GK, Dey AB. A short geriatric assessment tool for the older person with cancer in India-Development and psychometric validation. J Geriatr Oncol 2019; 10:222-228. [DOI: 10.1016/j.jgo.2018.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 06/07/2018] [Accepted: 09/04/2018] [Indexed: 12/27/2022]
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Tadakamadla J, Kumar S, Lalloo R, Gandhi Babu DB, Johnson NW. Impact of oral potentially malignant disorders on quality of life. J Oral Pathol Med 2017; 47:60-65. [PMID: 28766765 DOI: 10.1111/jop.12620] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Oral potentially malignant disorders (OPMDs) could have a significant psychological impact on patients, principally because of the unknown risk of malignant transformation, while the physical and functional impairments could differ. This study aimed to assess the impact of three different OPMDs and their disease stages on the quality of life (QoL) of affected patients. METHODS Oral leukoplakia (OL), oral lichen planus (OLP) and oral submucous fibrosis (OSF) patients who were undergoing treatment at an oral medicine clinic of a dental teaching hospital in India were the study population. All subjects completed the recently developed OPMDQoL questionnaire and a short form 12 item (version 2) health survey questionnaire (SF-12v2). OPMDQoL questionnaire consists of 20 items over four dimensions. A higher score denotes poor OHRQoL. SF-12v2 has two components, a Physical Component Summary (PCS) and Mental Component Summary (MCS). RESULTS A total of 150 subjects (50 each of OL, OLP and OSF) participated. OL patients (37.7 ± 7.9) reported significantly better OPMDQoL scores than OLP (47.3 ± 5.8) and OSF (45.4 ± 9.2) patients. OLP patients reported significant problems in obtaining a clear diagnosis for their condition, more so than the other OPMDs. OL patients reported fewer problems for the dimension, "physical impairment and functional limitations" than the OLP and OSF patients. A significant trend was observed with the overall OPMDQoL and MCS, deteriorating as the disease stage increased. CONCLUSIONS OLP and OSF have a significant impact on the QoL of affected individuals: OL less so. Increasing stage of the disease is associated with worsening QoL.
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Affiliation(s)
- Jyothi Tadakamadla
- Menzies Health Institute Queensland and School of Dentistry and Oral Health, Griffith University, Qld, Australia
| | - Santhosh Kumar
- Menzies Health Institute Queensland and School of Dentistry and Oral Health, Griffith University, Qld, Australia
| | - Ratilal Lalloo
- School of Dentistry, The University of Queensland, St Lucia, Qld, Australia
| | - Dara Balaji Gandhi Babu
- Department of Oral Medicine and Radiology, Panineeya Institute of Dental Sciences & Research Centre, Hyderabad, Telangana, India
| | - Newell W Johnson
- Menzies Health Institute Queensland and School of Dentistry and Oral Health, Griffith University, Qld, Australia
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Mohammad S. International quality of life, similar but different. Pediatr Transplant 2017; 21. [PMID: 28752675 DOI: 10.1111/petr.13026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Saeed Mohammad
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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A qualitative exploration of cervical and breast cancer stigma in Karnataka, India. BMC WOMENS HEALTH 2017; 17:58. [PMID: 28768506 PMCID: PMC5541646 DOI: 10.1186/s12905-017-0407-x] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 07/19/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Breast and cervical cancer are two of the most common cancers among women worldwide and were the two leading causes of cancer related death for women in India in 2013. While it is recognized that psychosocial and cultural factors influence access to education, prevention, screening and treatment, the role of stigma related to these two cancers has received limited attention. METHODS Two qualitative exploratory studies. One focusing on cervical cancer, the other on breast cancer, were conducted in Karnataka, India using in-depth interviews and focus group discussions. In the breast cancer study, 59 in-depth interviews were conducted with patients, primary caregivers and healthcare providers. In the cervical cancer study, 147 respondents were interviewed including older and younger women, husbands, healthcare providers and community leaders. While stigma was not the focus of either study, themes relating to stigma emerged and are the focus of this analysis. RESULTS Cancer stigma emerged as a general theme across both data sets. It appeared throughout the transcripts as descriptions of how women with breast or cervical cancer would be treated and talked about by husbands, family and the community (manifestations of stigma) and the reasons for this behavior. Stigma as a theme also arose through discussions around managing disclosure of a cancer diagnosis. Stigma was juxtaposed with a narrative of support for women with cancer. Three major themes emerged as driving the manifestations of cancer stigma: fear of casual transmission of cancer; personal responsibility for having caused cancer, and; belief in and fear of the inevitability of disability and death with a cancer diagnosis. Manifestations of cancer stigma were described in terms of experienced (enacted) stigma, including isolation or verbal stigma, and anticipated (fear of) stigma, should a cancer diagnosis be disclosed. CONCLUSIONS The presence in these communities of cancer stigma and its many forms emerged across both the cervical and breast cancer data sets. Stigma was a feared outcome of a cancer diagnosis and described as a barrier to screening, early diagnosis and treatment seeking for women with symptoms. While further research on cancer stigma is needed, this exploration of some of the driving factors provides insight for future programmatic efforts to reduce cancer stigma and improve access to information, screening and treatment.
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