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Chawak S, Chittem M, Dhillon H, Huligol N, Butow P. Development of a question prompt list for Indian cancer patients receiving radiation therapy treatment and their primary family caregivers. Psychooncology 2024; 33:e6295. [PMID: 38282221 DOI: 10.1002/pon.6295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/08/2023] [Accepted: 01/07/2024] [Indexed: 01/30/2024]
Abstract
AIM We aimed to develop two question prompt lists (QPLs), one for Indian cancer patients undergoing radiation therapy and the second for their primary family caregivers. METHODS The study comprised three phases: (1) qualitative interviews with patients (n = 65) and PFCs (n = 39) to identify their information needs, queries and concerns regarding RT; (2) development of draft QPLs using conventional content analysis and translation into Hindi and Marathi using European Organisation Research and Treatment of Cancer guidelines; and, (3) A readability analysis, and acceptability study with patients (n = 22), PFCs (n = 26) and Radiation Oncology (RO) staff (n = 20) exploring barriers to QPL implementation. RESULTS AND DISCUSSION Analysis in Phase I identified questions patients and PFCs asked or wanted to ask their physician. A list of 125 and 136 questions were generated for patients and PFCs, respectively. After five iterations, the draft QPLs were finalised, translated, and back-translated from English into Hindi and Marathi (Phase II). In Phase III, most patients and PFCs reported the QPLs were easy to read, they did not find it difficult to ask the questions, and the questions were not emotionally upsetting. Conversely, RO staff reported concerns that patients may find it difficult to discuss the questions with their physician. CONCLUSION The study highlights the need to empower patients and PFCs to ask questions and for staff to feel comfortable answering them. Implementing physician-endorsed QPLs could achieve these aims.
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Affiliation(s)
- Shweta Chawak
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, India
- Jindal School of Psychology and Counselling, O P Jindal Global University, Haryana, India
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, India
| | - Haryana Dhillon
- Centre for Medical Psychology & Evidence-based, Decision-making, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Nagraj Huligol
- Department of Radiation Oncology, Dr Balabhai Nanavati Hospital, Mumbai, India
| | - Phyllis Butow
- Centre for Medical Psychology & Evidence-based, Decision-making, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
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Maya S, Chittem M, Chawak S, Parker PA, Banerjee SC. Experiences of prognosis disclosure versus nondisclosure among family caregivers of persons with advanced cancer. Death Stud 2023:1-11. [PMID: 38117258 DOI: 10.1080/07481187.2023.2293711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Caregiving in the South Asian context is often assumed by family automatically for the person with cancer (PWC). In this paper, we applied the disclosure decision-making model (DD-MM) to understand the motives behind cancer prognosis disclosure (or not) by caregivers to the PWC. Fifty caregivers participated in semi-structured interviews; and data were analyzed using Framework Approach. For the disclosing caregivers, some of the themes that emerged were consistent with the DD-MM framework while others were not. In particular, the theme "recipient assessment" was part of the DD-MM framework, while others such as unmet communication needs, caregiver self-reflection, and family support were outside of the framework. In contrast, for the non-disclosing caregivers, the reasons for nondisclosure fit very concisely into the DD-MM framework, particularly with information assessment, recipient assessment, and (non) disclosure efficacy. This study has significant implications for development of communication skills trainings around holding family meetings in India.
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Affiliation(s)
- Sravannthi Maya
- Department of Liberal Arts, Indian Institute of technology Hyderabad, Hyderabad, India
- The Raft, Psycho-Social and Counseling Support Center, Hyderabad, India
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of technology Hyderabad, Hyderabad, India
| | - Shweta Chawak
- Jindal School of Psychology and Counselling, O.P. Jindal Global University, Haryana, India
| | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Lathia T, Chittem M, Chawak S, Katdare P, Jayaram S, Selvan C. Experiences and expectations of physician communication: A focus group discussion with Indian patients with type 2 diabetes mellitus. Chronic Illn 2023:17423953231200683. [PMID: 37710965 DOI: 10.1177/17423953231200683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
OBJECTIVES This pilot study aimed to: (a) understand the experiences of Indian patients with type 2 diabetes mellitus and their expectations of their physicians during a medical consultation, (b) serve as a preliminary study to inform the development of a larger project exploring and improving patients' communication experiences, and (c) assess whether the pilot study findings indicate the viability of using the Relationship: Establishment, Development, and Engagement model of communication as the conceptual framework for the larger project. METHODS Using convenience sampling, 11 patients participated in a focus group discussion. Conventional content analysis was used. RESULTS Two themes were generated: (a) A plethora of negative feelings: experiences of the physician's verbal and nonverbal communication styles, and (b) 'I know what I want': Expectations of communication by patients from their physician. CONCLUSIONS The medical encounter with the physician elicited a range of negative experiences and clear expectations from the patients with type 2 diabetes mellitus. This pilot points to the need for (a) a mixed methods approach to comprehensively examine the communication needs of patients with type 2 diabetes mellitus from their physician, (b) understand physicians' communication practices, and (c) using these findings, culturally adapt and test the Relationship: Establishment, Development, and Engagement to improve physicians' communication skills in India.
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Affiliation(s)
- Tejal Lathia
- Apollo Hospitals, Navi Mumbai, Maharashtra, India
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | - Shweta Chawak
- Jindal School of Psychology and Counselling, O.P. Jindal Global University, Haryana, India
| | - Praneeta Katdare
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | | | - Chitra Selvan
- Department of Endocrinology, Ramaiah Medical College, Bengaluru, Karnataka, India
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Chittem M, Pongener M, Maya S, Chawak S. An Interpretative Phenomenological Analysis. Health Psychol 2022. [DOI: 10.4324/9781003360858-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Lathia T, Selvan C, Namjoshi S, Chawak S, Kelada L, Chittem M. Indian physicians' attitudes and practice regarding menopause and its management: a focus group discussion. Menopause 2022; 29:1323-1328. [PMID: 36194849 DOI: 10.1097/gme.0000000000002059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To explore Indian physicians' attitudes and practice toward menopause and its management. To contribute to the larger project aimed at developing communication skills and decision aids for Indian physicians and women. METHODS Using a cross-sectional design, purposive sampling, and a qualitative methodology, 10 Indian physicians (female, 6; male, 4; mean age, 51.5 years) who were practicing either endocrinology or gynecology were recruited to participate in a virtual focus group discussion. Questions explored physicians' attitudes toward menopause and their approach toward addressing menopause and related concerns with their patients. The focus group was analyzed using qualitative content analysis. RESULTS Three main themes emerged: (1) "The only way to get over it is to accept it": Attitudes toward menopause, (2) "More than menopausal hormone therapy, it is empathy that's required": Physiological and psychological symptom management and (3) Matching the empathic intent with skills: A need for training in the management of menopause. CONCLUSIONS The study findings underscore the need to introduce Indian physicians to empathic communication skills training, involve, and educate physicians about the international and national clinical guidelines regarding menopausal hormone therapy and alternative therapies, and techniques for distress screening and early referrals. VIDEO SUMMARY http://links.lww.com/MENO/B17.
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Affiliation(s)
- Tejal Lathia
- From the Department of Endocrinology, Apollo Hospitals, Navi Mumbai, India
| | - Chitra Selvan
- Department of Endocrinology, Ramaiah Medical College, Bangalore, India
| | - Shraddha Namjoshi
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, India
| | - Shweta Chawak
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, India
| | | | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, India
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Chawak S, Chittem M, Dhillon H, Huilgol N, Butow P. Treatment-related communication experiences and expectations among Indian cancer patients receiving radiation therapy and their family members: A qualitative study. Patient Educ Couns 2022; 105:2913-2922. [PMID: 35597700 DOI: 10.1016/j.pec.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/08/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To explore Indian cancer patients' and their primary family caregivers' (PFC) experiences and expectations of treatment-related communication with their physician while undergoing radiation therapy. METHODS Participants, comprising patient-PFC dyads (n = 32), patients only (n = 33) and PFC only (n = 7), were recruited from one hospital in Mumbai, India. Semi-structured interviews explored participants' perceived role in cancer-related decision-making, diagnosis and prognosis communication experiences with the physician, communication expectations of their treating physician, and information needs. Interviews were audio-recorded, transcribed verbatim, and analysed using the framework approach. RESULTS Main themes included: (i) patients' passive role in treatment communication, (ii) family as an integral part of the medical consultation, and (iii) dyads' expectations and beliefs about the role of the physician. CONCLUSION Indian cancer patients played a passive role in treatment decision-making while physicians were seen as primary medical decision-makers. Further, PFCs provided the final consent for the treatment plan and acted as a mediator/moderator between the patient-physician. PRACTICE IMPLICATIONS These findings suggest the need for (i) interventions such as question prompt lists that may improve patient activation and caregiver preparedness, and (ii) triadic communication training interventions for optimal communication between the three stakeholders (i.e., patient, physician and PFC).
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Affiliation(s)
- Shweta Chawak
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, India.
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, India
| | - Haryana Dhillon
- Centre for Medical Psychology & Evidence based, Decision-making, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Nagraj Huilgol
- Chief Radiation Oncologist, Department of Radiation Oncology, Dr Balabhai Nanavati Hospital, Mumbai, India
| | - Phyllis Butow
- Centre for Medical Psychology & Evidence based, Decision-making, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
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Chittem M, Sridharan SG, Pongener M, Maya S, Epton T. Experiences of barriers to self-monitoring and medication-management among Indian patients with type 2 diabetes, their primary family-members and physicians. Chronic Illn 2022; 18:677-690. [PMID: 34259058 DOI: 10.1177/17423953211032251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study explored the subjective accounts of the main barriers to self-monitoring of blood-glucose (SMBG) and medication-management among Indian patients with type 2 diabetes (T2DM), their primary family-members (PFMs) and physicians. METHODS Using convenience sampling, patients with T2DM, their PFMs, and physicians, residing in a South Indian capital city, were recruited for semi-structured, audio-recorded interviews. Thematic analysis was used to analyze the data. RESULTS Fifty patients (female = 14; mean age = 42.5 years) and their PFMs (female = 38; mean age = 39 years), and 25 physicians (female = 4; mean age = 49.8 years) were recruited. Three superordinate themes were identified: (i) complex medication-regimen: confusion, forgetting and reduced motivation, (ii) family recommendations of alternative therapies due to the social pressures of avoiding stigma, intrusiveness and being misrepresented for injecting insulin, and (iii) an expensive illness: choosing to spend money on only medication. DISCUSSION Implications of the findings highlight the need to (i) train physicians in communication and empathy skills, (ii) empower patients to communicate their barriers to physicians through triadic communication models and question-prompt lists, (iii) educate communities on the benefits of insulin for managing T2DM to reduce stigma, and (iv) equip communities with information about health insurance to address the financial toll of T2DM management.
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Affiliation(s)
- Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Kandi, India
| | | | | | - Sravannthi Maya
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Kandi, India
| | - Tracy Epton
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, University of Manchester, Manchester, UK
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Shunmugasundaram C, Dhillon HM, Butow PN, Sundaresan P, Chittem M, Akula N, Veeraiah S, Huilgol N, Rutherford C. Body Image Scale: Evaluation of the Psychometric Properties in Three Indian Head and Neck Cancer Language Groups. Front Psychol 2022; 13:779850. [PMID: 35645858 PMCID: PMC9135105 DOI: 10.3389/fpsyg.2022.779850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/08/2022] [Indexed: 12/24/2022] Open
Abstract
Background Body image is a subjective concept encompassing a person's views and emotions about their body. Head and neck cancer (HNC) diagnosis and treatment affects several psychosocial concepts including body image. Large numbers of HNC patients are diagnosed each year in India but there are no suitable measures in regional languages to assess their body image. This study assessed the psychometric properties of the Body Image Scale (BIS), a measure suitable for clinical and research use in HNC populations, translated into Tamil, Telugu and Hindi and compared body image distress between language groups. Methods Translated versions of BIS were completed by HNC patients recruited from three cancer centers across India one time only. Psychometric evaluation was conducted including factor analysis using principal component analysis and internal consistency reliability using Cronbach's alpha. Patients completed the EORTC Quality of Life Questionnaire (QLQ) C-30 and EORTC QLQ HN-35 measures to enable exploration of convergent and discriminant validity. ANOVA was used to calculate difference in mean values for body image. Results Our sample included 621 HNC patients (Tamil = 205, Telugu = 216, Hindi = 200). Factor analysis revealed a one-factor solution and Cronbach's alpha coefficients ranged between 0.891 and 0.969 indicating good reliability. Hypothesized correlations between similar and different constructs were as expected, supporting construct validity. On the BIS, we found a statistically significant difference (F = 11.0954, P < 0.05) between means of Tamil, Telugu, and Hindi groups, with higher body image scores in Telugu (M = 12.86; SD = 7.65) and Hindi groups (M = 12.52; SD = 7.36) indicating more symptoms/body image distress, when compared to Tamil population (M = 9.28; SD = 10.04). Conclusion The reliability and validity of the three translated Indian versions of the BIS were maintained, providing a method for assessing body image of HNC population worldwide speaking Tamil, Telugu, and Hindi across the illness trajectory.
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Affiliation(s)
- Chindhu Shunmugasundaram
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Haryana M. Dhillon
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Phyllis N. Butow
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Puma Sundaresan
- Radiation Oncology Network, Western Sydney Local Health District, Sydney, NSW, Australia
- Sydney Medical School, Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Sangareddy, India
| | - Niveditha Akula
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Sangareddy, India
| | | | - Nagraj Huilgol
- Division of Radiation Oncology, Nanavati Super Speciality Hospital, Mumbai, India
| | - Claudia Rutherford
- Quality of Life Office, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
- Susan Wakil School of Nursing and Midwifery, Cancer Nursing Research Unit, The University of Sydney, Sydney, NSW, Australia
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George PN, Ganesh M, Chawak S, Chittem M. Factors Associated with Choosing the Kerala Model of Palliative Care versus Standard Care among Indian Cancer Patients. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1742613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractPatients who opt for the Kerala Model of Palliative Care (KMPC) report favorable psychological outcomes. Still, not all patients in Kerala prefer this treatment's approach. Hence, this study is aimed to examine the demographical, medical, pain, and psychological factors associated with cancer patients who choose the KMPC versus standard care (SC). Using a cross-sectional design and purposive sampling, 87 patients (SC = 40; KMPC = 47) residing in Kerala, India, responded to questionnaires on pain, anxiety, and depression, and quality of life (QoL). Data analysis was conducted using chi-squared and independent sample t-tests. Findings revealed that KMPC (vs. SC) patients had lower levels of education, were self-employed or homemakers, belonged to a middle or low socioeconomic status, received government aid or were financially self-supported, and were diagnosed for less than 1 year or less than 5 years. KMPC patients reported higher levels of pain, lower levels of anxiety and depression, better overall total QoL, physical health, social health, functionality capacity, and emotional health. These findings suggest the need for community awareness programs regarding the benefits of opting for the KMPC. Patients who chose KMPC reported higher levels of pain than SC patients, highlighting the need for the KMPC to improve its approach to pain management.
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Affiliation(s)
- Prema N. George
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | - M.P. Ganesh
- Department of Entrepreneurship and Management, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | - Shweta Chawak
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
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Selvan C, Lathia TB, Chawak S, Katdare P, Nayak R, Chittem M. Response from Authors to Letter to Editor 'In Search of Unity in Diversity'. Indian J Endocrinol Metab 2022; 26:192-193. [PMID: 35873933 PMCID: PMC9302418 DOI: 10.4103/ijem.ijem_107_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/16/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Chitra Selvan
- Department of Endocrinology, Ramaiah Medical College, Bangalore, Karnataka, India
| | - Tejal B. Lathia
- Apollo and Fortis Hospitals, Navi Mumbai, Maharashtra, India
| | - Shweta Chawak
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | - Praneeta Katdare
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | - Reshma Nayak
- Founder, CustEQ Solutions, Navi Mumbai, Maharashtra, India
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
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Chittem M, Kelada L, Muppavaram N, Lingappa L, Wakefield CE. Unmet and under-met needs among Indian parents of children with neurological disorders. J Pediatr Nurs 2022; 63:e1-e9. [PMID: 34848111 DOI: 10.1016/j.pedn.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Parents of children with neurological disorders commonly report having unmet needs related to their child's care. Mixed methods research is needed with parents of children with neurological disorders in India in order to: 1) quantify which needs are unmet and under-met, and 2) qualitatively explore how parents perceive their unmet and under-met needs. METHODS This concurrent mixed-methods study used a convergence model of triangulation design. Parents of children with neurological disorders receiving treatment in a children's hospital in Hyderabad, India completed questionnaires (n = 205) on unmet/under-met needs. Twenty-five of these parents then completed in-depth interviews exploring experiential aspects of unmet needs. RESULTS Quantitative analysis suggested that education about the child's illness and medical needs were the most frequent unmet needs. Parents needed their child's condition explained to them (91.7%) and greater continuity of their child's care (85.4%). Qualitative analysis suggested that parents reported struggling to find a specialist who was knowledgeable about their child's condition. Though parents living in rural areas quantitatively reported fewer unmet needs (child's medical care, care coordination, and communication) than parents living in the city (B = 0.92 [95%CI = 0.64,1.20] for medical care needs), the qualitative data showed this may be due to lower expectations from the health system. CONCLUSION Parents of children with neurological disorders in India frequently report unmet and under-met needs. PRACTICE IMPLICATIONS Community-based interventions coupled with training nurses on information provision could help bridge the gap between what is offered by hospital systems, and what is needed by parents, in terms of information and support.
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Affiliation(s)
- Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, India.
| | - Lauren Kelada
- School of Women's and Children's Health, Faculty of Medicine and Health, UNSW Sydney, Kensington, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, Australia
| | - Nagesh Muppavaram
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, India
| | - Lokesh Lingappa
- Department of Neurology, Rainbow Children's Hospital, Hyderabad, India
| | - Claire Elizabeth Wakefield
- School of Women's and Children's Health, Faculty of Medicine and Health, UNSW Sydney, Kensington, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, Australia
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Maya S, Banerjee SC, Chawak S, Parker PA, Kandikattu S, Chittem M. Oncologists' experience with discussing cancer prognosis with patients and families: perspectives from India. Transl Behav Med 2021; 11:1896-1904. [PMID: 34170321 PMCID: PMC8686106 DOI: 10.1093/tbm/ibab070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Nondisclosure of prognosis of advanced cancer is commonly practiced in some Asian cultures including India; but research is limited. To describe experiences of Indian oncologists in discussing cancer prognosis with people with cancer and their caregivers, with a focus on barriers and facilitators of prognostic discussions. Thirty oncologists practicing in South India, Hyderabad participated in semi-structured interviews; and analyzed using Interpretative Phenomenological Analysis. Barriers included system-level, patient-level, and physician-level challenges as obstructions to open and honest interactions around cancer prognosis. Most of the barriers focused on communication-related challenges. Lack of communication skills training for providers coupled with over-reliance on use of euphemisms, hesitation in communicating with "weak" patient, and struggles to establish healthcare proxy described communication-related barriers. The study also described factors including family involvement in cancer care and empathic communication as facilitators of honest and open communication about prognosis. In particular, rapport building and getting to know the patient, use of empathic communication, engaging in gradual and individualized disclosure, and balancing hope with honesty were communication-related facilitators that aid open communication with patients with cancer and their caregivers about prognosis and plan of care. Results provide implications for development of communication skills trainings for oncology physicians in India. Adapting, delivering, and evaluating existing communication skills training programs, particularly around discussions of prognosis and goals of care is a requisite step for providing patient-centered and supportive care to patients with cancer and their caregiving families.
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Affiliation(s)
- Sravannthi Maya
- Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | | | - Shweta Chawak
- Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | | | | | - Mahati Chittem
- Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
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Selvan C, Lathia T, Chawak S, Katdare P, Nayak R, Chittem M. The Weight of Words: Indian Physicians' Perspectives on Patient Communication to Promote Diabetes Adherence. Indian J Endocrinol Metab 2021; 25:395-401. [PMID: 35300439 PMCID: PMC8923319 DOI: 10.4103/ijem.ijem_313_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/11/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Effective communication by physicians can lead to improved patient adherence, resulting in better patient outcomes and increased patient satisfaction. This study: (i) examined communication with patients when they were non-adherent, (ii) examined attitudes toward common communication cues, and (iii) explored communication approaches to encourage diabetes adherence used by Indian physicians. METHODS Using a concurrent mixed methods approach, Indian physicians, specialized in diabetes and/or endocrinology were recruited, to complete a survey containing quantitative (n = 834) and qualitative (n = 648) questions. The questions included (i) whether physicians expressed disappointment and used scare tactics for non-adherent patients, (ii) to rate the importance of common communication cues when promoting adherence, and (iii) nested, qualitative questions to understand their communication approach to promote adherence. The data were analyzed using descriptive statistics and qualitative content analysis, respectively. RESULTS The quantitative study reported that the majority of the physicians sometimes showed their disappointment in their patient's progress (44.4%), sometimes used scare tactics to convey disease severity due to non-adherence (34.3%), and rated all communication cues as most important. The qualitative findings revealed that physicians used paternalistic (authoritative, educational, authoritarian) or collaborative (multistakeholder, patient-centered) approaches and the language cues of fear, blame, and threats to promote patient adherence. CONCLUSION These findings highlight the need for communication skill training programs for Indian physicians focused on empathic, non-verbal, supportive, and inclusive techniques so as to promote patient adherence. Further, these trainings need to use role-playing, video recording, and peer feedback methods to show physicians how to implement these skills during patient interactions.
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Affiliation(s)
- Chitra Selvan
- Department of Endocrinology, Ramaiah Medical College, Bangalore, Karnataka, India
| | - Tejal Lathia
- Department of Endocrinology, Apollo and Fortis Hospitals, Navi Mumbai, Maharashtra, India
| | - Shweta Chawak
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | - Praneeta Katdare
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | - Reshma Nayak
- Founder, CustEQ Solutions, Navi Mumbai, Maharashtra, India
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
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Shunmugasundaram C, Dhillon HM, Butow PN, Sundaresan P, Chittem M, Akula N, Veeraiah S, Rutherford C. Patient-reported anxiety and depression measures for use in Indian head and neck cancer populations: a psychometric evaluation. J Patient Rep Outcomes 2021; 5:44. [PMID: 34097161 PMCID: PMC8184912 DOI: 10.1186/s41687-021-00316-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 05/06/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Head and neck cancers (HNC) are one of the most traumatic forms of cancer because they affect essential aspects of life such as speech, swallowing, eating and disfigurement. HNCs are common in India, with over 100,000 cases being registered each year. HNC and treatment are both associated with considerable anxiety and depression. With increasing multinational research, no suitable measures in Indian languages are available to assess anxiety and depression in Indian HNC patients. This study evaluated the psychometric properties of cross-culturally adapted versions of Zung's self-rating Anxiety Scale (SAS) and the Patient health questionnaire - 9 (PHQ-9) in Tamil, Telugu and Hindi speaking Indian HNC populations. METHODS HNC patients were recruited from three tertiary cancer centres in India. Patients completed the cross-culturally adapted versions of SAS and PHQ-9. We assessed targeting, scaling assumptions, construct validity (exploratory and confirmatory factor analyses), convergent validity, and internal consistency reliability. RESULTS The study sample included 205 Tamil, 216 Telugu and 200 Hindi speaking HNC patients. Exploratory and confirmatory factor analyses indicated a two-factor solution for PHQ-9 and four-factor solution for SAS in all three languages. Cronbach's alpha coefficients ranged between 0.717 and 0.890 for PHQ-9 and between 0.803 and 0.868 for SAS, indicating good reliability. Correlations between hypothesized scales were as expected providing evidence towards convergent validity. CONCLUSIONS This first psychometric evaluation of the measurement properties of Tamil, Telugu and Hindi versions of the SAS and PHQ-9 in large, Indian HNC populations supported their use as severity and outcome measures across the disease and treatment continuum.
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Affiliation(s)
- Chindhu Shunmugasundaram
- Faculty of Science, School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making, The University of Sydney, Sydney, New South Wales, Australia.
- Faculty of Science, School of Psychology, Psycho-Oncology Cooperative Research Group, The University of Sydney, Sydney, New South Wales, Australia.
| | - Haryana M Dhillon
- Faculty of Science, School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Science, School of Psychology, Psycho-Oncology Cooperative Research Group, The University of Sydney, Sydney, New South Wales, Australia
| | - Phyllis N Butow
- Faculty of Science, School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Science, School of Psychology, Psycho-Oncology Cooperative Research Group, The University of Sydney, Sydney, New South Wales, Australia
| | - Puma Sundaresan
- Radiation Oncology Network, Western Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Health & Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Sangareddy District, India
| | - Niveditha Akula
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Sangareddy District, India
| | | | - Claudia Rutherford
- Faculty of Science, School of Psychology, Quality of Life Office, The University of Sydney, Sydney, New South Wales, Australia
- Susan Wakil School of Nursing and Midwifery, Cancer Nursing Research Unit, The University of Sydney, Sydney, Australia
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Chawak S, Chittem M, Maya S, Dhillon HM, Butow PN. The Question-prompt list (QPL): Why it is needed in the Indian oncology setting? Cancer Rep (Hoboken) 2021; 4:e1316. [PMID: 33295152 PMCID: PMC8451377 DOI: 10.1002/cnr2.1316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND In India, caregivers are an integral part of the illness experience, especially in cancer, to the extent that they can become proxy decision-makers for the patient. Further, owing to acute resource constraints in the Indian healthcare system, it may be difficult for oncologists to assess and elicit questions from each patient/caregiver. Consequently, there is a need to address these unique aspects of oncology care in India to improve patient outcomes and understanding of their illness and treatment. This can be achieved through a Question Prompt List (QPL), a checklist used by care recipients during medical consultations. RECENT FINDINGS This narrative review will first introduce research on the development and effectiveness of the QPL, and then it will highlight current gaps in oncology care in India and explore how the QPL may aid in closing these gaps. A literature search of the empirical research focused on the development, feasibility and acceptability of the QPL in oncology settings was conducted. The final review included 40 articles pertaining to QPL research. Additionally, psycho-oncology research in India centered on information needs and experiences was reviewed. Current Indian psycho-oncology research reports patients' want to be actively involved in their cancer care and a need for more illness information. However, a high demand on physicians' resources and the family caregivers' interference can be barriers to meeting patients' information/communication needs. International research demonstrates that a QPL helps structure and decrease consultation time, improves patient satisfaction with care, and improves the quality of communication during medical encounters. CONCLUSION QPLs for Indian patients and caregivers may focus on the scope of medical consultations to address patient needs while influencing the course and content of the patient-caregiver-physician interactions. Further, it can address the resource constraints in Indian oncology care settings, thus reducing the physician's burden.
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Affiliation(s)
- Shweta Chawak
- Department of Liberal ArtsIndian Institute of Technology HyderabadHyderabadIndia
| | - Mahati Chittem
- Department of Liberal ArtsIndian Institute of Technology HyderabadHyderabadIndia
| | - Sravannthi Maya
- Department of Liberal ArtsIndian Institute of Technology HyderabadHyderabadIndia
| | - Haryana M. Dhillon
- Centre for Medical Psychology & Evidence‐based Decision‐making, School of PsychologyThe University of SydneySydneyNew South WalesAustralia
| | - Phyllis N. Butow
- Centre for Medical Psychology & Evidence‐based Decision‐making, School of PsychologyThe University of SydneySydneyNew South WalesAustralia
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Kelada L, Wakefield CE, Muppavaram N, Lingappa L, Chittem M. Psychological outcomes, coping and illness perceptions among parents of children with neurological disorders. Psychol Health 2020; 36:1480-1496. [DOI: 10.1080/08870446.2020.1859113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Lauren Kelada
- School of Women’s and Children’s Health, UNSW Sydney, Kensington, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - Claire E. Wakefield
- School of Women’s and Children’s Health, UNSW Sydney, Kensington, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - Nagesh Muppavaram
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, India
| | - Lokesh Lingappa
- Department of Neurology, Rainbow Children’s Hospital, Hyderabad, India
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, India
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Broom J, Broom A, Kenny K, Chittem M. Antimicrobial overuse in India: A symptom of broader societal issues including resource limitations and financial pressures. Glob Public Health 2020; 16:1079-1087. [PMID: 33161832 DOI: 10.1080/17441692.2020.1839930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
India and the global community are facing a critical crisis of antimicrobial resistance (AMR), significantly contributed to by on-going and increasing antimicrobial misuse. Information as to what drives misuse of antimicrobials within India is essential to inform strategies to address the crisis. This papers aims to identify perceived influences on antimicrobial use in Hyderabad, India. We conducted semi-structured qualitative interviews conducted with thirty participants (15 doctors, 15 pharmacists) around their experiences of antimicrobials in Hyderabad, India. Thematic analysis was performed and four themes identified around (1) Perceptions of the problem of resistance and antimicrobial use; (2) Social pressures to prescribe/dispense; (3) Financial pressures driving antimicrobial over-use; and (4) Lack of regulation around training and qualifications. We conclude that antimicrobial use within India is embedded with, and occurs as a result of, complex social and economic factors including issues of resource limitation, structural/governance limitations and social relationships. Strategies to address misuse without acknowledging and addressing the critical driving forces of use will be unlikely to induce significant change.
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Affiliation(s)
- Jennifer Broom
- Sunshine Coast Health Institute, Birtinya, Australia.,University of Queensland, Brisbane, Australia
| | - Alex Broom
- School of Social and Political Sciences, The University of Sydney, Sydney, Australia
| | - Katherine Kenny
- School of Social and Political Sciences, The University of Sydney, Sydney, Australia
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology (IIT), Hyderabad, India
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Affiliation(s)
- Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Kandi, Sangareddy District, Telangana, India
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Chittem M, Lathia T, Sridharan SG. Addressing gendered responses to dietary modifications among patients with type 2 diabetes mellitus. Diabetes Metab Syndr 2020; 14:1069. [PMID: 32645650 DOI: 10.1016/j.dsx.2020.06.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Sangareddy District, Telangana, 502205, India.
| | - Tejal Lathia
- Consultant Endocrinologist, Department of Endocrinology, Apollo and Fortis Hospitals, Navi Mumbai, 400703, Maharashtra, India
| | - Subha Gomathy Sridharan
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Sangareddy District, Telangana, 502205, India
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Chawak S, Chittem M, S A, Varghese D, Epton T. Predictors of health behaviours among Indian college students: an exploratory study. HE 2020. [DOI: 10.1108/he-11-2019-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this study is to understand the association between health behaviours of diet, physical activity, smoking cigarettes, alcohol consumption, safe sex and sleep quality with demographic (e.g. age, gender) and psychological (i.e. stress, self-esteem and sense of coherence) factors in Indian residential college students.Design/methodology/approachStudents studying for Bachelor of Technology at residential colleges in India were invited to complete an online questionnaire regarding their health behaviours, demographics and psychological variables. Each health behaviour was regressed onto demographic and psychological factors to determine which of them were associated with performing each behaviour.FindingsThere was no clear pattern of predictors for the health behaviours overall. Self-esteem was related to healthy diet, being single was related to adequate sleep, higher parental income was related to safer sex and being older was related to more alcohol use and safer sex.Research limitations/implicationsThis study revealed that health education efforts may need to be designed for specific behaviours and correlates among Indian college students. Interventions regarding (1) healthy eating should target students with lower self-esteem, (2) sleep should target students in a relationship and (3) safer sex should target younger students and those from less affluent backgrounds.Originality/valueThis research is one of the first attempts to study the predictors of health behaviours among Indian college students. The study highlighted that psychological factors (e.g. self-esteem) and demographic factors (e.g. relationship status, parental income, age) affect different health behaviours. These findings can help health educators to design tailored interventions and aid in health education and promotion among Indian college students.
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Chawak S, Chittem M, Butow P, Huilgol N. Indian Cancer Patients' Needs, Perceptions of, and Expectations from their Support Network: a Qualitative Study. J Cancer Educ 2020; 35:462-469. [PMID: 30715673 DOI: 10.1007/s13187-019-1483-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Psycho-oncology research in India reveals that family caregivers and oncologists are primary medical decision-makers frequently acting on behalf of the patient. Thus, patients are rarely asked about their wants and needs. This study aimed to understand Indian cancer patients' needs and expectations from their support network. Twenty-six cancer patients participated in semi-structured interviews exploring patients' needs, perceptions of their support network and the type of support they would prefer, and their experiences of receiving this support. The interviews were analyzed using Interpretive Phenomenological Analysis. Emergent themes included: (i) role of the oncologist: being the primary medical decision-maker, communicating in a style consistent with patient preferences; (ii) role of the immediate family: being emotionally available, helping with navigating the hospital system, aiding in medical adherence; (iii) role of relatives and friends: giving advice and providing tangible aid and services; and (iv) role of other cancer patients: helping with coping with the illness. The study highlights Indian patients' ability to define their supportive network and assign specific roles to them. The study implies the need to develop communication training programs and peer-to-peer support groups to address patients' unmet communication needs and aid in coping.
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Affiliation(s)
- Shweta Chawak
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Sangareddy District, Kandi, Telangana, 502285, India
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Sangareddy District, Kandi, Telangana, 502285, India.
| | - Phyllis Butow
- School of Psychology, University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Nagraj Huilgol
- Division of Radiation Oncology, Nanavati Super Specialty Hospital, Mumbai, Maharasthra, 400056, India
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22
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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24
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Chittem M, Chawak S, Sridharan SG, Sahay R. The relationship between diabetes-related emotional distress and illness perceptions among Indian patients with Type II diabetes. Diabetes Metab Syndr 2019; 13:965-967. [PMID: 31336552 DOI: 10.1016/j.dsx.2018.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 12/26/2018] [Indexed: 10/27/2022]
Abstract
AIMS To examine the relationship between diabetes-related emotional distress (DED) and illness perceptions among Indian patients with Type II diabetes (T2D). MATERIAL AND METHODS 92 patients with T2D completed questionnaires on their demographic and medical details, DED and illness perceptions. Multiple regression analysis was conducted to examine the association between demographic, medical and illness perceptions variables and DED. RESULTS Increased number of children, personal control and illness-related concern were associated with increased levels of DED. CONCLUSIONS Additional support is needed for Indian patients with T2D who have more children, greater sense of personal control and higher levels of diabetes-related worry.
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Affiliation(s)
- Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, 502285, India.
| | - Shweta Chawak
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, 502285, India.
| | - Subha Gomathy Sridharan
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, 502285, India.
| | - Rakesh Sahay
- Department of Endocrinology, Osmania General Hospital, Afzalgunj Rd, Afzal Gunj, Hyderabad, Telangana, 500012, India.
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Abstract
AbstractThe theory of salutogenesis focusses on how individuals move in the direction of health rather than illness. Within this is the concept of sense of coherence (SOC) that refers to a stable disposition which creates coping resources and a sense of health preservation. With the help of a widely validated SOC scale, a range of studies evidenced that a strong SOC was associated with psychological well-being, healthy behaviors, and good health. Although the cross-cultural nature of SOC is supported, there is limited research exploring SOC in Asian cultures. Understanding how people orient themselves toward health and leveraging this in the development of health interventions within the unique cultural context of India is necessary. The current paper will review the theory of salutogensis and SOC concept, the measurement of SOC, the relationship between SOC, chronic illnesses, and culture, concluding with suggestions for possible areas of SOC research in India.
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Affiliation(s)
- Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology, Hyderabad, India
| | - Bengt Lindström
- Department of Social Work and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ramesh Byrapaneni
- Consultant Cardiologist, Medwin Hospital, Hyderabad, Telangana, India
| | - Geir Espnes
- Center for Health Promotion Research, Norwegian University of Science and Technology, Trondheim, Norway
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26
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Broom A, Kenny K, Kirby E, George N, Chittem M. Improvisation, therapeutic brokerage and antibiotic (mis)use in India: a qualitative interview study of Hyderabadi physicians and pharmacists. Critical Public Health 2018. [DOI: 10.1080/09581596.2018.1516032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Alex Broom
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Katherine Kenny
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Emma Kirby
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Nimesh George
- Department of Applied Psychology, University of Mumbai, Mumbai, India
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Sangareddy, India
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27
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Broom A, Chittem M, Bowden V, Muppavaram N, Rajappa S. Illness Experiences, Collective Decisions, and the Therapeutic Encounter in Indian Oncology. Qual Health Res 2017; 27:951-963. [PMID: 27179019 DOI: 10.1177/1049732316648125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Social science scholarship on cancer has been almost exclusively focused on Organization for Economic Cooperation and Development (OECD) countries, despite a significant epidemiological transition taking place in many non-OECD contexts, with cancer emerging as a prominent, and strongly feared, illness experience. With cancer gaining an increasingly high profile in India, there is an urgent need to explore how experiences of cancer may be socially and culturally embedded, and in turn, how localized practices may shape the therapeutic encounter. Here, drawing on interviews with 40 people living with cancer in Hyderabad, India, we focus on some specific components of their therapeutic journeys, including diagnostic and prognostic disclosure, collective versus individual decision making, the dynamics of medical authority, and the reception of cancer within their social milieu. These participants' accounts provide insight into a range of cultural sensibilities around illness and care, and reinforce the importance of understanding the cultural inflections of communication, decisions, and illness experiences.
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Affiliation(s)
- Alex Broom
- 1 The University of New South Wales, Sydney, Australia
| | | | | | | | - Senthil Rajappa
- 3 Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, India
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Affiliation(s)
- Alex Broom
- School of Social Sciences, The University of New South Wales, Sydney, Australia
| | - Katherine Kenny
- School of Social Sciences, The University of New South Wales, Sydney, Australia
| | - Vanessa Bowden
- School of Social Sciences, The University of New South Wales, Sydney, Australia
| | - Nagesh Muppavaram
- Department of Liberal Arts, Indian Institute of Technology, Hyderabad, India
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology, Hyderabad, India
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Chittem M, Norman P, Harris PR. Illness representations and psychological distress in Indian patients with cancer: does being aware of one's cancer diagnosis make a difference? Psychooncology 2015; 24:1694-700. [DOI: 10.1002/pon.3837] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 03/31/2015] [Accepted: 04/07/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Mahati Chittem
- Department of Liberal Arts; Indian Institute of Technology Hyderabad; Medak India
| | - Paul Norman
- Department of Psychology; University of Sheffield; Sheffield UK
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Chittem M, Butow P. Responding to family requests for nondisclosure: The impact of oncologists′ cultural background. J Cancer Res Ther 2015; 11:174-80. [DOI: 10.4103/0973-1482.140836] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Research in psycho-oncology investigates the psycho-social and emotional aspects of cancer and how this is related to health, well-being and overall patient care. Coping with cancer is a prime focus for researchers owing to its impact on patients' psychological processing and life in general. Research so far has focused mainly on quantitative study designs such as questionnaires to examine the coping strategies used by cancer patients. However, in order to gain a rich and deep understanding of the reasons, processes and types of strategies that patients use to deal with cancer, qualitative study designs are necessary. Few studies have used qualitative designs such as semi-structured interviews to explore coping with cancer. The current paper aims to review the suitability and benefits of using qualitative research designs to understand coping with cancer with the help of some key literature in psycho-oncology research.
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Affiliation(s)
- Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology, Yeddumailaram, Hyderabad, Andhra Pradesh, India
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Chittem M, Norman P, Harris PR. Relationships between perceived diagnostic disclosure, patient characteristics, psychological distress and illness perceptions in Indian cancer patients. Psychooncology 2012; 22:1375-80. [DOI: 10.1002/pon.3149] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 05/28/2012] [Accepted: 07/11/2012] [Indexed: 01/06/2023]
Affiliation(s)
- Mahati Chittem
- Department of Liberal Arts; Indian Institute of Technology Hyderabad; Yeddumailaram; Andhrapradesh; India
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