Correlates of stigma for patients with breast cancer: a systematic review and meta-analysis

Stigma towards functional disability and anxiety among patients with cancer: The moderating role of physicians' behaviors

OBJECTIVE

To explore the moderating role of physicians' behaviors in medical encounters with cancer patients in the association between physicians' public stigma towards functional disability and post-meeting patient anxiety.

METHODS

A three time-point prospective nested study was conducted between November 2019 and July 2022 in two medical centres. Before the medical encounters, 32 physicians completed the Disability Attitudes in Health Care Scale, and 150 adult cancer patients completed the State-Trait Anxiety Inventory (STAI), pre and post medical encounters. During the medical encounters, structured 'real-time' observations of the physicians' behaviors were recorded using the Four Habits Coding Scheme.

RESULTS

The mixed linear analysis model revealed that the two-way interaction between stigma towards functional disability and physicians' communication behaviors was significantly associated with post-meeting anxiety (b=.161, p < .05). When physicians' behaviors were more negative, the association between physicians' stigma and patients' post-meeting anxiety was stronger. Additionally, pre-meeting anxiety was positively associated with post-meeting anxiety (b=.578, p < .01).

CONCLUSIONS

The findings highlight the positive effect of stigma and the importance of physicians' communication behaviors in alleviating patients' anxiety associated stigma towards functional disability.

PRACTICE IMPLICATIONS

Healthcare training programs should address stigma and develop protocols encouraging healthcare professionals to request patients' to share their specific needs.

A Critical Discourse Analysis of the Language of Stigmatization of Breast Cancer Patients in Nigeria

Breast cancer is a significant health concern globally, including in Nigeria, where its incidence is rising. An essential component of breast cancer care is the psychosocial wellbeing of patients, which is often shaped by the language used in healthcare and society. While some research has explored stigmatization of breast cancer patients, no study has focused on language as a tool for this stigmatization in Nigeria. This study examines how language perpetuates the stigmatization of breast cancer patients and explores ways to use language to improve their lives and health. Using Norman Fairclough's model of critical discourse analysis and a descriptive design, data was collected through interviews with 50 respondents at the University College Hospital in Ibadan, Nigeria. The study's discourse analysis revealed that stigmatization is perpetuated through language, including negative stereotypes, body shaming, spiritual interpretations, and derogatory terms. These discourses reflect broader social and cultural factors such as norms, beliefs, and power dynamics that reinforce stigmatization. The research highlights the effects of stigmatizing language, including denial, loss of femininity, shame, and fear of a new identity. The findings call for policies and interventions to reduce stigma, improve patient experiences, and raise public awareness of breast cancer.

Factors related to stigma among patients with cervical cancer having chemotherapy after surgery in China: A cross-sectional study

Background

Stigma is a significant issue among patients with cervical cancer undergoing postoperative chemotherapy, yet the factors contributing to stigma are not well understood. While research has explored the relationships between self-efficacy, illness perception, self-esteem, social support, and stigma, fewer studies have focused on Chinese patients, and even fewer have specifically examined stigma within this population.

Objective

This study aimed to describe stigma and assess its association with self-efficacy, self-esteem, illness perception, and social support in postoperative chemotherapy patients diagnosed with cervical cancer.

Methods

A total of 132 participants were recruited from the gynecology department of Wenzhou Medical University's First Affiliated Hospital using a random sampling technique. Data were collected between December 2023 and April 2024 using validated instruments. Descriptive statistics and Spearman's rank correlation were used for data analysis.

Results

The average stigma score was 76.3 (SD = 10.84), indicating a high level of stigma. Self-efficacy, self-esteem, illness perception, and social support were negatively correlated with stigma (r = -0.085, r = -0.158, r = -0.254, r = -0.238, all p <0.05).

Conclusion

All participants experienced significant stigma. The negative correlations found between stigma and self-efficacy, self-esteem, illness perception, and social support offer a theoretical basis for developing nursing interventions to reduce stigma in these patients.

Physical activity and exercise behaviour of breast cancer survivors: nationwide cross-sectional survey

OBJECTIVES

High physical activity levels have been associated with longer, healthier lifespans and improved quality of life among breast cancer survivors. The Japanese clinical guidelines for breast cancer survivors, similar to those in the USA, strongly recommend maintaining high physical activity levels. However, the extent of adherence to these guidelines among breast cancer survivors in Japan is unclear. This study aimed to assess adherence to guideline-recommended physical activities and identify associated factors.

METHODS

Self-administered questionnaires were distributed to breast cancer survivors without recurrence or metastasis from 34 facilities across Japan, with approximately 30 survivors per facility, between March 2019 and August 2020. The questionnaire collected information on participants' backgrounds, physical activity levels (assessed using the Global Physical Activity Questionnaire) and potential factors influencing their physical activity. Logistic regression analysis was performed to identify the factors associated with meeting the guideline recommendations.

RESULTS

In total, 791 patients (77.5%) were investigated, with 50.5% meeting the physical activity recommendations outlined in the guidelines. Factors associated with meeting the guideline recommendations included higher self-efficacy (OR 1.58, 95% CI 1.29 to 1.94), greater perceived social support (OR 1.54, 95% CI 1.26 to 1.89), lower annual household income (OR 1.58, 95% CI 1.07 to 2.33), relief from cancer-related symptoms through physical activity (OR 1.81, 95% CI 1.13 to 2.94) and urban location (OR 1.50, 95% CI 1.03 to 2.20).

CONCLUSIONS

Half of the breast cancer survivors in Japan did not meet the recommended physical activity levels, and several factors influencing adherence were identified.

Stigma, colorectal cancer knowledge and self-efficacy among colorectal cancer survivors: A cross-sectional study based on random forest analysis

PURPOSE

To assess the stigma levels among colorectal cancer (CRC) survivors, identify determinants, examine correlations with CRC knowledge and self-efficacy, and quantify the relative influence of various contributing factors.

METHODS

In total, 301 CRC survivors were enrolled from a tertiary oncology center in southern China. The participants completed the Social Impact Scale (SIS), Bowel Cancer Awareness Measure (Bowel CAM), General Self-Efficacy Scale (GSES), and a demographic and disease-related questionnaire. The analytical framework included multiple linear regression to identify the factors influencing stigma, LASSO regression for variable refinement, and random forest modeling to construct hierarchies of factor importance.

RESULTS

Participants demonstrated moderate levels across all measures: stigma (54.63 ± 8.37), CRC knowledge (8.25 ± 4.74), and self-efficacy (26.81 ± 5.95). Multiple linear regression identified type of medical insurance, support from peers, unwillingness to accept colonoscopy, CRC knowledge, and self-efficacy as significant factors influencing stigma. Random forest analysis ranked factor importance by Gini index: self-efficacy (4366.41), support from peers (1618.03), CRC knowledge (1029.04), type of medical insurance (886.66), and unwillingness to accept colonoscopy (750.16).

CONCLUSIONS

Healthcare providers should pay more attention to stigma among CRC patients. Effective stigma reduction necessitates culturally-sensitive psychosocial interventions, including enhancing patients' confidence in managing their disease, strengthening professional-driven online popularization of science campaigns, and facilitating social support networks.

Impact of a Breast Cancer Diagnosis on Finances and Marital Status in Young Women

PURPOSE

A breast cancer diagnosis can impact every aspect of a woman's life, particularly for women diagnosed before age 45 when they are in the process of establishing stability in their personal and professional lives. This study investigated the impact of a breast cancer diagnosis on employment, finances, and personal relationships among young breast cancer survivors.

METHODS

We conducted descriptive statistical analysis of survey data from 315 women diagnosed with breast cancer before age 45. Surveys were administered electronically and included 40 questions on demographics asking about employment, insurance, income, and marital status at two time points: at diagnosis and at the time the survey was completed. Descriptive and regression analyses were conducted. The McNemar-Bowker Test of Symmetry was used to calculate the significance of changes in employment, insurance, income, and marital status at the two time points.

RESULTS

We found significant changes following diagnosis in employment and insurance. Prior to diagnosis, 68.6% of respondents were employed full time, compared to 52.4% following diagnosis - falling from 212 to 162 respondents. Individuals who were unable to work increased by 14.6% after diagnosis, rising from 4 to 49 respondents. The decline in full-time employment was highest among those with a diagnosis of Stage IV cancer (33.9%), with the number of full-time worker respondents falling from 79 to 41. We found a significant change in insurance (p < .001) with a decline in individuals with private or no insurance of 4.7% and 3.4%, respectively, while those with public insurance increased by 8.1%.

CONCLUSION

Our findings suggest that young breast cancer survivors are particularly vulnerable to changes in employment, with more than a tenfold increase in the number of young women who reported being unable to work following diagnosis. Our findings also indicate a significant shift from private to public insurance, particularly for individuals living with Stage IV cancer. These results point to opportunities to address the specific needs of young women diagnosed with breast cancer and improve their overall quality of life.

Mediating effect of social constraints in the association between stigma and depressive symptoms in Chinese breast cancer patients

PURPOSE

The present study aimed to investigate the effect of stigma on depressive symptoms and explore the mediating role of social constraints between stigma and depressive symptoms in Chinese breast cancer (BC) patients.

METHODS

A cross-sectional design was conducted in China from December 2020 to July 2021. Out of 256 participants, 222 BC patients completed the questionnaires composed of demographic and clinical information, Patient Health Questionnaire-9 (PHQ-9), Social Impact Scale (SIS), and 15-item Social Constraints Scale (SCS-15). The hierarchical regression analysis was adopted to explore the associations of stigma and social constraints with depressive symptoms and the mediating role of social constraints.

RESULTS

Approximately 20% of participants reported having depressive symptoms in Chinese BC patients. The indirect effect of stigma on depressive symptoms through social constraints was significant (a*b = 0.24, 95%CI = 0.15-0.33). When the mediator was controlled for, the direct impact of stigma on depressive symptoms was also significant (c'=0.16, p < 0.01).

CONCLUSION

The current study suggested that stigma may contribute to developing depressive symptoms by increasing social constraints in Chinese BC patients. Interventions based on reducing stigma and social constraints should be conducted to improve mental health in BC patients.

Exploring psychological help-seeking behaviors and stigma perception among cancer patients: a study on their impact on psychosocial adjustment

OBJECTIVE

The study investigates the relationships between psychological help-seeking behaviors, stigma perception, and psychosocial adjustment among cancer patients. Understanding these dynamics is crucial for enhancing the mental health and overall well-being of individuals battling cancer.

METHODS

This descriptive cross-sectional study involved 387 cancer patients, with data collected through structured questionnaires assessing attitudes toward seeking psychological help (ATSPPH-SF), stigma perception (SSRPH), and psychosocial adjustment (PAIS-SR). Statistical analyses, including correlation and hierarchical regression models, were conducted to explore the associations between these variables.

RESULTS

The findings revealed a significant inverse relationship between perceived stigma and help-seeking behaviors, indicating that higher stigma is associated with reduced likelihood of seeking psychological support. Additionally, patients who were more reluctant to seek help demonstrated poorer psychosocial adjustment. Factors such as age, education level, marital status, and treatment status also played significant roles in influencing these outcomes.

CONCLUSION

The study underscores the need for targeted interventions to reduce stigma and encourage help-seeking among cancer patients to improve their psychosocial adjustment and quality of life. Integrating mental health services into oncology care and addressing the stigma associated with psychological support are essential steps in enhancing patient outcomes.

Stigma, coping strategies, distress and wellbeing in individuals with cervical dystonia: a cross-sectional study

Cervical dystonia (CD) is a movement disorder which causes sustained muscle contractions in the neck leading to abnormal postures and repetitive movements. As it is a highly visible condition, people with CD can experience stigma, which may lead to unhelpful coping strategies and increased psychological distress. This study investigated whether adaptive and maladaptive coping strategies mediate the relationship between stigma and psychological outcomes in people with CD. A total of 114 adults with CD completed measures of stigma, coping, health-related quality of life (HRQOL), psychological distress (depression, anxiety, stress), and psychological wellbeing at one time point. Participants' levels of distress were high, compared to the general population. Correlational analyses showed increased stigma and maladaptive coping (e.g. substance use, behavioural disengagement) were both significantly related to increased distress, lower wellbeing and lower HRQOL, whereas higher adaptive coping (e.g. acceptance, humour) was only related to higher wellbeing. In a parallel mediation model, maladaptive coping strategies mediated the relationship between stigma and distress, HRQOL and wellbeing, but adaptive coping strategies did not. These findings suggest that maladaptive coping may play an important role in explaining the relationship between stigma and some aspects of distress and wellbeing in CD. Interventions which focus on reducing different aspects of maladaptive coping may be helpful to improve wellbeing as well as reducing stigma.

Utilizing the Metaverse to Provide Innovative Psychosocial Support for Pediatric, Adolescent, and Young Adult Patients with Rare Cancer

This study investigated the potential of the metaverse in providing psychological support for pediatric and AYA cancer patients, with a focus on those with rare cancers. The research involved ten cancer patients and survivors from four distinct regions in Japan, who participated in metaverse sessions using customizable avatars, facilitating interactions across geographical and temporal barriers. Surveys and qualitative feedback were collected to assess the psychosocial impact of the intervention. The results demonstrated that the metaverse enabled patients to connect with peers, share experiences, and receive emotional support. The anonymity provided by avatars helped reduce appearance-related anxiety and stigma associated with cancer treatment. A case study of a 19-year-old male with spinal Ewing's sarcoma highlighted the profound emotional relief fostered by metaverse interactions. The findings suggest that integrating virtual spaces into healthcare models can effectively address the unique needs of pediatric and AYA cancer patients, offering a transformative approach to delivering psychosocial support and fostering a global patient community. This innovative intervention has the potential to revolutionize patient care in the digital age.

Stigma and related influencing factors in brain cancer patients: a cross-sectional study and parallel mediation analysis

PURPOSE

Patients with brain cancer and painful symptoms of the disease experience heavy pressure and negative inner experiences, leading to a sense of stigma. Therefore, this study assessed the level of stigma in patients with brain cancer and analyzed the risk factors for stigma to analyze the underlying relationships among depression, social support, low self-esteem, and stigma.

METHODS

Patients completed the Social Impact Scale, Self-rating Depression Scale, Rosenberg Self-Esteem Scale, Herth Hope Index, Social Support Rating Scale, and Self-Perceived Burden Scale. Multiple linear regression analysis was used to identify factors independently associated with stigma. Parallel mediation analysis was used to evaluate the mediating role of the relationship between psychoemotional factors and stigma.

RESULTS

A multivariate linear regression analysis demonstrated significant associations between age (β =  - 0.189, P = 0.002), treatment (β = 0.184, P = 0.003), self-esteem (β =  - 0.128, P = 0.046), depression (β = 0.273, P < 0.001), hope (β =  - 0.217, P = 0.003), and self-perceived burden (β = 0.260, P < 0.001) with brain cancer. It was observed that the social support received by brain cancer patients directly impacted their stigma (total effect, - 0.851, P = 0.001). Additionally, this relationship was influenced by depression and self-esteem through two distinct pathways.

CONCLUSION

Increased stigma among brain cancer patients was found to be associated with severe depression, feelings of inferiority, diminished hope, and a heavy perceived burden. The structural equation modeling (SEM) revealed that social support negatively influenced stigma through depression and self-esteem. It is imperative to grasp patients' inner needs, implement psychological interventions, and cultivate a cancer-friendly social environment to prevent stigmatization and discrimination based on their patient status.

Stigma in Pediatric Cancer: An Exploratory Study of Osteosarcoma and Retinoblastoma in Guatemala, Jordan, and Zimbabwe

PURPOSE

Stigma is an understudied barrier to health care acceptance in pediatric oncology. We sought to explore the stigma experience, including its impact on cancer treatment decision making, and identify strategies to mitigate stigma for patients with osteosarcoma and retinoblastoma in Guatemala, Jordan, and Zimbabwe.

METHODS

Participants included caregivers, adolescent patients (age 12-19 years), and health care clinicians. A semistructured interview guide based on The Health Stigma and Discrimination Framework (HSDF) was adapted for use at each site. Interviews were conducted in English, Spanish, Arabic, or Shona, audio-recorded, translated, and transcribed. Thematic analysis focused on stigma practices, experiences, outcomes, drivers, mitigators, and interventions.

RESULTS

We conducted 56 interviews (28 caregivers, 19 health care clinicians, nine patients; 20 in Guatemala, 21 in Jordan, 15 in Zimbabwe). Major themes were organized into categories used to adapt the HSDF to global pediatric cancer care. Themes were described similarly across all sites, ages, and diagnoses, with specific cultural nuances noted. Pediatric cancer stigma was depicted as an isolating and emotional experience beginning at diagnosis and including internalized and associative stigma. Stigma affected decision making and contributed to negative outcomes including delayed diagnosis, treatment abandonment, regret, and psychosocial fragility. Overcoming stigma led to positive outcomes including resilience, treatment adherence, pride, and advocacy. Identified stigma drivers and mitigators were linked to potential interventions.

CONCLUSION

Participants describe a shared stigma experience that transcends geography, cultural context, age, and diagnosis. Stigma manifestations have the potential to impact medical decision making and affect long-term psychological outcomes. Stigma assessment tools and interventions aimed at stigma mitigation including educational initiatives and support groups specific to pediatric cancer should be the focus of future research.

Study on the Profiles of Sleep Disorders, Associated Factors, and Pathways Among Gynecological Cancer Patients - A Latent Profile Analysis

Background

Gynecological cancer generally refers to malignant tumors in gynecology, commonly including cervical cancer, endometrial cancer, and ovarian cancer. Patients with gynecological cancer often suffer from sleep disorders after clinical treatment. Except for serious sleep disorders, female characteristics, family roles, and feudal beliefs make their self-stigma at a medium to high level, leading to huge pressure. This study aims to identify potential categories of sleep disorders, and analyze the relationship between self-stigma, perceived stress, and sleep disorders.

Methods

A cross-sectional study was conducted in 2021-2022. Two hundred and two patients' data were collected from ShengJing Hospital Affiliated to China Medical University in Liaoning, Shenyang by using paper questionnaires for face-to-face surveys. The survey tools included the Pittsburgh Sleep Quality Index (PSQI), the Perceived Stress Scale (PSS), and the Social Impact Scale (SIS). Potential profile analysis (LPA), multiple logistic regression analysis, and structural equation modeling (SEM) were performed by Mplus 8.3, SPSS 26.0, and Amos 24.0 statistical tools, respectively.

Results

Three latent patterns of sleep disorders were found: "Good Sleep group (42.5%)", "Sleep Deficiency group (32.4%)", and "Sleep Disturbance group (25.1%)". Patients with high perceived stress were more likely to report a moderate (OR=1.142, 95% CI: 1.061-1.230) or high (OR=1.455, 95% CI: 1.291-1.640) level of sleep disorders. Self-stigma did not have a direct effect on sleep disorders (0.055, P>0.05), but it could have indirect effect on sleep disorders through perceived stress (0.172, P<0.01).

Conclusion

The perceptions of sleep disorders among gynecological cancer patients varies and exhibits individual differences. Gynecological cancer patients who feels alienated or discriminated may cause high pressure. This internal pressure can exacerbate sleep disorders.

Development and Psychometric Validation of the Breast Cancer Stigma Assessment Scale for Women with Breast Cancer and Its Survivors

BACKGROUND

The increase in breast cancer cases and breast cancer survival makes it advisable to quantify the impact of the health-related stigma of this disease.

PURPOSE/OBJECTIVES

To develop and validate a breast cancer stigma scale in Spanish.

METHODS

Women diagnosed with, or survivors of, breast cancer were included. The development of the Breast Cancer Stigma Assessment Scale (BCSAS) involved both a literature review and personal interviews. Content validity was assessed using a Delphi study and a pilot test; construct validity was evaluated using an exploratory factor analysis; and convergent validity was assessed using six scales. Cronbach's α internal consistency and test-retest reliability were used to determine the reliability of the scales.

RESULTS

231 women responded to the 28-item scale. The BCSAS showed good reliability, with α = 0.897. Seven factors emerged: concealment (α = 0.765), disturbance (α = 0.772), internalized stigma (α = 0.750), aesthetics (α = 0.779), course (α = 0.599), danger (α = 0.502), and origin (α = 0.350). The test-retest reliability was 0.830 (p < 0.001). Significant correlation was observed with event centrality (r = 0.701), anxiety-depression (r = 0.668), shame (r = 0.645), guilt (r = 0.524), and quality of life (r = -0.545).

CONCLUSIONS

The BCSAS is a reliable and valid measure of stigma in women with breast cancer and its survivors. It could be useful for detecting stigma risk and establishing psychotherapeutic and care priorities.

Assessment tools for stigma in breast cancer patients based on COSMIN guidelines: a systematic review

OBJECTIVE

The objective of this study was to conduct a systematic review of the measurement properties and methodological quality of stigma assessment tools designed for breast cancer patients. The aim was to provide clinical medical staff with a foundation for selecting high-quality assessment tools.

METHODS

A comprehensive computer search was carried out across various databases, including SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database(VIP), Embase, PubMed, Web of Science, The Cochrane Library, and Scopus, which were searched from the inception of the databases until March 20, 2023. Literature screening and data extraction were performed independently by two researchers, adhering to predefined inclusion and exclusion criteria. The assessment tools were evaluated using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) systematic evaluation guidelines.

RESULTS

In the final analysis, a total of 9 assessment tools were included. However, none of these tools addressed measurement error, cross-cultural validity, criterion validity, and responsiveness. Following the COSMIN guidelines, BCSS and CSPDS were assigned to Class A recommendations, while the remaining tools received Class B recommendations.

CONCLUSION

The BCSS and CSPDS scales demonstrated comprehensive assessment in terms of their measurement characteristics, exhibiting good methodological quality, measurement attribute quality, and supporting evidence. Therefore, it is recommended to utilize these scales for evaluating breast cancer stigma. However, further validation is required for the remaining assessment tools.

Association between stigma and sleep quality in patients with breast cancer: A latent profile and mediation analysis

PURPOSE

This study aims to identify the heterogeneity in the stigma experienced by patients with breast cancer and examine the mediation effect of resilience on the relation between stigma and sleep quality.

METHOD

A total of 396 patients with breast cancer were enrolled from Be Resilient to Breast Cancer (BRBC) program between January and April 2023. Participants completed the Social Impact Scale, the 10-item Connor-Davidson Resilience Scale, and the Pittsburgh Sleep Quality Index Scale. Latent profile analysis (LPA) and mediation analysis were conducted to analyze the data.

RESULTS

LPA categorized stigma into three subgroups, namely low-stigma (21.9%), moderate-stigma (64.9%), and high-stigma (13.2%). Mediation analysis revealed a fully mediated effect in the comparison between low-stigma and moderate-stigma groups (standard error [SE] = 0.13, 95%CI = 0.06,0.56), whereas a partially mediated effect was observed in the comparison between low-stigma and high-stigma groups (SE = 0.18, 95%CI = 0.39,1.10).

CONCLUSIONS

Stigma is a significant factor to sleep quality in breast cancer and resilience could act as a robust buffer against stigma resulting in improved sleep quality. Resilience-based interventions might be helpful in this population.

"My body, my choice": A qualitative study of women's mastectomy with flat closure experiences

This qualitative study aimed to describe and explore the pre and post-mastectomy experiences of women choosing flat closure after a breast cancer diagnosis. Aesthetic flat closure creates a flat contoured chest wall after a mastectomy. There is limited research on women's flat closure experiences. To fill this gap, we interviewed 19 women (Mage = 53, range 31-72) with breast cancer who underwent a bilateral mastectomy with flat closure, examining decision-making, mirror-viewing, and flat closure experiences. Using a hermeneutic phenomenological design, we generated seven themes. Broadly, women choosing flat closure experienced pressure from their clinicians to undergo breast reconstruction. We found flat closure information to be consistently lacking. Mirror-viewing experiences of women obtaining suboptimal flat closure outcomes led to shattered expectations, mirror avoidance, psychological distress, and body image disturbances. Women negotiated their new reality by discovering ways to feel comfortable with their flat bodies. Regardless of surgical outcome, decision satisfaction was high. These findings illustrate the importance of bodily autonomy and supportive healthcare environments for women making flat closure decisions. Providing comprehensive information on all surgical options and addressing post-operative expectations can improve women's decision-making and mirror-viewing experiences and assist women in adapting to their new body image.

Construction of the structural equation model of stigma, self-disclosure, social support, and quality of life of breast cancer patients after surgery-a multicenter study

Purpose

Stigma is common in patients with breast cancer after surgery, which has a negative impact on the quality of life (QOL). This study aimed to investigate the QOL of breast cancer patients after surgery and to analyze the multiple chains mediating effects of self-disclosure and social support between stigma and QOL.

Methods

A total 292 patients of breast cancer patients after operation were recruited in this study. A questionnaire survey was conducted using the general information questionnaire, the consumer experiences of stigma questionnaire (CESQ), the distress disclosure index(DDI), the perceived social support scale(PSSS), and the functional assessment of cancer therapy-breast(FACT-B). Path analysis was conducted to test the hypothesized serial multiple mediation model.

Results

The total scores of stigma, self-disclosure, social support and QOL were 15 (10 ~ 22), 39 (31 ~ 46), 58 (50 ~ 67) and 88 (74 ~ 104) respectively. QOL of breast cancer patients after the operation was negatively correlated with stigma (p < 0.01), and positively correlated with self-disclosure and social support (p < 0.01). Self-disclosure and social support played a complete mediating effect between stigma and QOL, and the total mediating effect value was 85. 87%.

Conclusions

Self-disclosure and social support play a complete intermediary role between stigma and QOL. In order to improve the quality of life of patients, medical staff should pay attention to the assessment of stigma, encourage patients to express their emotions, and encourage their families and friends to respond to their expression and needs of patients.