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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 STUDIES 2023; 48:905-915. [PMID: 38117258 PMCID: PMC11186974 DOI: 10.1080/07481187.2023.2293711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [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, USA
| | - Smita C. Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA
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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 EDUCATION AND COUNSELING 2022; 105:2913-2922. [PMID: 35597700 DOI: 10.1016/j.pec.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [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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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] [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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Virago MC. Art psychotherapy and public health. Public Health 2021; 196:150-157. [PMID: 34218075 DOI: 10.1016/j.puhe.2021.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/13/2021] [Accepted: 05/18/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of this study was to explore the role of art psychotherapy as a biopsychosocial approach to bodymind medicine in ameliorating the effects of psychophysical stress among people with non-metastatic cutaneous malignant melanoma (CMM), post-surgical resection. STUDY DESIGN Mixed methods. METHODS This study followed a mixed-methods research design, utilising qualitative data gained from a 6-month weekly group art therapy intervention, including both the images made and explored during the 3-h sessions and the accompanying narratives. The narratives were the subject of thematic analysis. The quantitative data arose from ELISA assays for secretory immunoglobulin A (S-IgA) and secretory interferon-γ (S-IFN- γ), DTH (PPD) tests were delivered at timepoints t0, t1, t5, t13, t24 and t52, and questionnaires were delivered at t0, t24 and t52: MAC, HAD, COPE & EORTC-QLQ-C-30. RESULTS The findings of this study included themes of 'otherness' and 'isolation', which also preceded diagnosis, and an upward trend in S-IgA, which continued over time. CONCLUSIONS This study found that art psychotherapy promotes enhanced immunological function, coping skills and interpersonal relations. Positive psychoneuroimmunological change can result from group art psychotherapy, facilitating integration of psychological content in a supportive and interactive environment, which improves quality of life, thereby reducing the public health burden.
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Affiliation(s)
- M-Ch Virago
- University of Newcastle, NSW, Australia; School of Social Sciences, Art Therapy at Western Sydney University, NSW, Austalia.
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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] [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: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [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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Behan JM, Arora RS, Carnevale FA, Bakhshi S, Bhattacharjee B, Tsimicalis A. An Ethnographic Study of the Moral Experiences of Children with Cancer in New Delhi, India. Glob Qual Nurs Res 2021; 8:2333393621995814. [PMID: 33748333 PMCID: PMC7905724 DOI: 10.1177/2333393621995814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 11/15/2022] Open
Abstract
There is a paucity of research examining children’s experiences with cancer in India. Childhood ethics is an emerging field, focusing on the moral dimension of children’s experiences, to promote children’s participation in their health care. A focused ethnography, using a moral experience framework, was conducted to better understand children’s participation in decisions, discussions, and actions in three oncology settings in New Delhi, India. We interviewed key informants, retrieved key documents, and conducted semi-structured interviews and participant observations with children. All 22 children demonstrated interest in varying aspects of their cancer care. Certain factors facilitated or impeded their participation. Some children became distressed when they lacked information about their treatment or were not given opportunities to enhance their understanding. The results advance our understanding of the moral experiences of children with cancer in India for healthcare professionals, policy makers, families, and interested others.
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Affiliation(s)
| | | | | | - Sameer Bakhshi
- All India Institute of Medical Sciences, New Delhi, India
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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] [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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Affiliation(s)
- Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Kandi, Sangareddy District, Telangana, India
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Epton T, Chittem M, Tanikella R, Rajappa S, Sinha S, Harris PR. Indian patient use of cancer euphemisms: Association with psychological outcomes and health behaviours. Psychooncology 2020; 29:1193-1200. [PMID: 32390299 DOI: 10.1002/pon.5408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Euphemisms may be used to reduce the threat associated with the word "cancer." Cancer may be particularly threatening in Indian culture due to the myths surrounding its cause and prognosis. This study explored the prevalence of euphemism use by Indian patients and the relationship among euphemism use and illness cognitions, affect, health behaviour, and spontaneous self-affirmation (a behaviour associated with dealing with threat). METHODS In total, 350 cancer patients in India were recruited to take part in a study exploring patients' experiences of, and thoughts about, having an illness. They responded to a questionnaire measuring illness perceptions, coping strategies, anxiety, depression, health behaviours, and spontaneous self-affirmation. Patients were asked what words they used to describe their illness; euphemism users were those who used a euphemism (ie, non-medical term) as a first word. RESULTS About 51% of patients used a euphemism as a first word. Those with less education, unskilled employment, a lower income, and more children were more likely to be euphemism users. Euphemism users reported (a) weaker illness perceptions (less personal control, greater reporting of symptoms, and less understanding of their condition), (b) less use of 3 of 14 coping strategies, (c) less likelihood of spontaneously self-affirming, and (d) fewer healthy eating days. CONCLUSIONS Euphemism use in patients was not related to distress but was related to negative illness perceptions and use of fewer coping strategies, suggesting that we need further study about the extent to which euphemisms signal issues in psychological adaptation to cancer diagnosis.
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Affiliation(s)
- Tracy Epton
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology, Hyderabad, India
| | - Ravali Tanikella
- Department of Liberal Arts, Indian Institute of Technology, Hyderabad, India
| | - Senthil Rajappa
- Department of Medical Oncology, Basavatakaram Indo-American Cancer Hospital and Research Centre, Hyderabad, India
| | - Sudha Sinha
- Department of Paediatric Oncology, MNJ Institute of Oncology, Hyderabad, India
| | - Peter R Harris
- School of Psychology, University of Sussex, Brighton, UK
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