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Banerjee SC, Malling CD, Schofield EA, Carter-Bawa L, Bylund CL, Hamann HA, Parker PA, Shen MJ, Studts JL, Williamson TJ, Ostroff JS. Empathic communication skills training to reduce lung cancer stigma: Study protocol of a cluster randomized control trial. Contemp Clin Trials 2024; 145:107669. [PMID: 39182827 PMCID: PMC11407099 DOI: 10.1016/j.cct.2024.107669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/30/2024] [Accepted: 08/22/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Prior research demonstrates that nearly all (95 %) people with lung cancer (PwLC) report stigma, and approximately half (48 %) PwLC experience stigma during clinical encounters with oncology care providers (OCPs). When stigma is experienced in a medical context, it can have undesirable consequences including patients' delaying and underreporting of symptoms, misreporting of smoking behavior, and avoiding help-seeking such as psychosocial support and cessation counseling. Multi-level interventions are needed to prevent and mitigate lung cancer stigma. One promising intervention for reducing patient perception and experience of stigma is to train OCPs in responding empathically to patient emotions and promoting empathic communication within clinical encounters. METHODS This paper describes the study protocol for a cluster randomized trial comparing Usual Care (waitlist control group) with Empathic Communication Skills (ECS) training (intervention group). For this study, we will recruit 16 community oncology practice sites, 9-11 OCPs per site, and 6 PwLCs per OCP. RESULTS The goal of this trial is to investigate the effect of the ECS training on (a) OCP primary outcomes (communication and empathic skill uptake) and secondary outcomes (ECS training appraisal - relevance, novelty, clarity; self-efficacy, attitude towards communication with patients); and (b) patient-reported primary outcomes (lung cancer stigma), and secondary outcomes (perceived clinician empathy, satisfaction with OCP communication, psychological distress, social isolation, and appraisal of care). CONCLUSION Findings from this trial will advance understanding of the effectiveness of the ECS training intervention and inform future provider-level training interventions that may reduce lung cancer stigma and improve cancer care delivery. CLINICALTRIALS govIdentifier: NCT05456841.
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Affiliation(s)
- Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4th Floor, New York, NY 10017, USA.
| | - Charlotte D Malling
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4th Floor, New York, NY 10017, USA
| | - Elizabeth A Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4th Floor, New York, NY 10017, USA
| | - Lisa Carter-Bawa
- Cancer Prevention Precision Control Institute, Center for Discovery & Innovation @ Hackensack Meridian Health, 111 Ideation Way, Nutley, NJ 07110, USA; Community Outreach & Engagement, Georgetown Lombardi Comprehensive Cancer Center, 3800 Reservoir Rd. NW, Washington D.C. 20057, USA
| | - Carma L Bylund
- Health Outcomes & Biomedical Informatics, University of Florida Health Cancer Center, 1889 Museum Rd Ste 7000 FL7, Gainesville, FL 32611, USA
| | - Heidi A Hamann
- Department of Psychology, University of Arizona, 1503 E. University Blvd., Tucson, AZ 85721, USA
| | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4th Floor, New York, NY 10017, USA
| | - Megan J Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, P.O. Box 19024, Seattle, WA 98109, USA
| | - Jamie L Studts
- Cancer Prevention and Control, University of Colorado Cancer Center, 13001 East 17(th) Place, MS #F434, E5333 Fitzsimons Building, Aurora, CO 80045, USA
| | - Timothy J Williamson
- Department of Psychological Science, Loyola Marymount University, 1 LMU Drive, Suite 4700, Los Angeles, CA 90045, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4th Floor, New York, NY 10017, USA
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Banerjee SC, Haque N, Bylund CL, Shen MJ, Rigney M, Hamann HA, Parker PA, Ostroff JS. Responding empathically to patients: a communication skills training module to reduce lung cancer stigma. Transl Behav Med 2021; 11:613-618. [PMID: 32080736 PMCID: PMC7963287 DOI: 10.1093/tbm/ibaa011] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Most lung cancer patients report perceiving stigma surrounding their diagnosis, and routine clinical interactions with their health care providers (HCPs) are reported as a common source. The adverse effects of lung cancer stigma are associated with several adverse psychosocial and behavioral outcomes. One potential clinician-level intervention target is empathic communication because of its association with higher rates of patients' satisfaction, treatment adherence, and lower levels of psychological distress. This study describes the conceptual model and evaluation of clinician-targeted empathic communication skills training to reduce lung cancer patients' experience of stigma. The goal of the training module is to enhance clinician recognition and responsiveness to lung cancer patients' empathic opportunities by communicating understanding, reducing stigma and distress, and providing support. Thirty multidisciplinary HCPs working in thoracic oncology, thoracic surgery, or pulmonary medicine participated in 2.25 hr of didactic and experiential training on responding empathically to patients with lung cancer. Overall, participants reported highly favorable evaluations of the training, with at least 90% of participants agreeing or strongly agreeing to 11 of the 12 items assessing clinical relevance, novelty, clarity, and facilitator effectiveness. Participants' self-efficacy to communicate empathically with lung cancer patients increased significantly from pretraining to posttraining, t(29) = -4.58, p < .001. The empathic communication skills training module was feasible and well received by thoracic and pulmonary medicine HCPs and demonstrated improvements in self-efficacy in empathic communication from pretraining to posttraining. The examination of patient outcomes is warranted.
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Affiliation(s)
- Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Noshin Haque
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carma L Bylund
- Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Megan J Shen
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Heidi A Hamann
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Wang Y, Lu S, Liu J, Tan J, Zhang J. The Influence of Culture on Attitudes Towards Humorous Advertising. Front Psychol 2019; 10:1015. [PMID: 31139109 PMCID: PMC6519312 DOI: 10.3389/fpsyg.2019.01015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/16/2019] [Indexed: 11/13/2022] Open
Abstract
Humor has been widely used in advertising in recent decades. Various studies found that humor could significantly improve advertising performance. However, most of these studies were conducted in a Eastern context and did not consider cultural factors. In a cross-cultural research framework, the current study explored the effects of advertisement characteristics (i.e., brand nationality and humor tactics) on Chinese and United States audiences' attitudes toward humorous advertisements. Results showed that the attitudinal differences between Chinese audiences and United States audiences was not significant at the aggregate level. Instead, the differences lie in an audience's responsiveness to characteristics of the ads. Specifically, while United States audiences showed a strong preference for ads featuring Chinese brands compared to those of United States brands, Chinese audiences did not differentiate them. United States audiences preferred ads using self-enhancing tactics to those using affiliative tactics, whereas, again Chinese audiences did not differentiate. We also explored whether individual differences in cultural values could account for the effect of audience nationality. Results suggest that differences embedded in culture groups, as indicated by audience nationality, could not be explained or substituted by individual variance in humor tolerance and uncertainty avoidance. Limitations and future directions were discussed.
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Affiliation(s)
- Yi Wang
- Business School, Central University of Finance and Economics, Beijing, China
| | - Su Lu
- Business School, University of International Business and Economics, Beijing, China
| | - Jia Liu
- Business School, Central University of Finance and Economics, Beijing, China
| | - Jiahui Tan
- Business School, Central University of Finance and Economics, Beijing, China
| | - Juyuan Zhang
- Business School, Central University of Finance and Economics, Beijing, China
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Hamann HA, Shen MJ, Thomas AJ, Craddock Lee SJ, Ostroff JS. Development and Preliminary Psychometric Evaluation of a Patient-Reported Outcome Measure for Lung Cancer Stigma: The Lung Cancer Stigma Inventory (LCSI). STIGMA AND HEALTH 2018; 3:195-203. [PMID: 30393760 PMCID: PMC6208151 DOI: 10.1037/sah0000089] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Among patients with lung cancer, stigma is associated with negative psychosocial and behavioral outcomes. There is a need to develop psychometrically robust patient-reported outcome (PRO) measures for stigma that incorporate perspectives of patients diagnosed with lung cancer. As part of our multi-phase process of measure development and validation, we report on scale formation and preliminary psychometric evaluation of the Lung Cancer Stigma Inventory (LCSI). METHOD Building on previously reported concept elicitation (Phase I) work, Phase II of LCSI development involved item generation and refinement, informed by literature review, provider input, and patient (N=20) feedback. Phase III focused on initial psychometric scale evaluation in a unique sample of 231 lung cancer patients. RESULTS Based on provider input and patient cognitive interviews, 49 items were included in a preliminary measure. In an exploratory factor analysis (EFA) of the 37 retained items, three factors emerged: Perceived Stigma, Internalized Stigma, and Constrained Disclosure. Internal consistency of the final, 25-item LCSI scale was high (Cronbach's alpha= 0.89) and the three subscales demonstrated good internal consistency. The test-retest correlation was high (r = 0.91), suggesting strong stability of measurement over time. There was good convergent validity between the LCSI and an existing measure of lung cancer stigma, the Cataldo Lung Cancer Stigma Scale (CLCSS; r= 0.58, p< 0.001). DISCUSSION In a multi-phase process, we have developed a reliable, multi-dimensional measure of lung cancer stigma, the Lung Cancer Stigma Inventory (LCSI). Subsequent work will be conducted to establish further evidence of validity and clinically meaningful change.
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Affiliation(s)
- Heidi A Hamann
- Department of Psychology, Department of Family and Community Medicine, University of Arizona, Tucson, AZ
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX
- Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Megan J Shen
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Anna J Thomas
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
| | - Simon J Craddock Lee
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX
- Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
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Aesthetic Surgery in Patients with Lung Cancer. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1086. [PMID: 27826480 PMCID: PMC5096535 DOI: 10.1097/gox.0000000000001086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 08/23/2016] [Indexed: 11/26/2022]
Abstract
Background: Methods: Results: Conclusions:
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Lewinski P, Fransen ML, Tan ES. Embodied Resistance to Persuasion in Advertising. Front Psychol 2016; 7:1202. [PMID: 27574512 PMCID: PMC4983544 DOI: 10.3389/fpsyg.2016.01202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/28/2016] [Indexed: 11/24/2022] Open
Abstract
From the literature on resistance to persuasion in advertising, much is known about how people can resist advertising by adopting resistance strategies, such as avoidance, counter-arguing, and selective attention (e.g., Fransen et al., 2015b). However, the role of emotion regulation and bodily expression in resisting persuasion is so far underexplored. This is a surprising observation if one considers that at least 40% of advertisements use positive emotions (i.e., happiness) to persuade people to like the ad, brand, and product (Weinberger et al., 1995). In this article we present a framework in which we apply previous knowledge and theories on emotion regulation and embodiment to the process of resistance to persuasion. In doing so, we specifically address the role of facial expression in the course of resistance. The literature and findings from our own research lead us to propose that people can resist persuasion by controlling their facial expression of emotion when exposed to an advertisement. Controlling the expression of emotions elicited by an ad (for example refusing to smile) might be a fruitful way to resist the ad’s persuasive potential. Moreover, we argue that co-viewers can affect embodied resistance to persuasion. Showing the viability of embodied resistance to persuasion is relevant in view of the fact that ads trying to persuade us by addressing our positive emotions are ubiquitous. Embodied resistance might help people to cope with these induced positive emotions in order to resist advertisements and might therefore work as a novel and effective strategy to resist persuasion.
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Affiliation(s)
- Peter Lewinski
- Amsterdam School of Communication Research, Department of Communication Science, University of Amsterdam, AmsterdamNetherlands; Kozminski University, WarsawPoland
| | - Marieke L Fransen
- Amsterdam School of Communication Research, Department of Communication Science, University of Amsterdam, Amsterdam Netherlands
| | - Ed S Tan
- Amsterdam School of Communication Research, Department of Communication Science, University of Amsterdam, AmsterdamNetherlands; Department of Media, Cognition and Communication, University of Copenhagen, CopenhagenDenmark
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Al-Ayoubi AM, Flores RM. Lung cancer screening: did we really need a randomized controlled trial? Eur J Cardiothorac Surg 2016; 50:29-33. [DOI: 10.1093/ejcts/ezw043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Kaptein AA, Kobayashi K, Matsuda A, Kubota K, Nagai S, Momiyama M, Sugisaki M, Bos BC, Warning TD, Dik H, Klink RV, Inoue K, Ramai R, Taube C, Kroep JR, Fischer MJ. We’re in this together: Patients’, caregivers’ and health care providers’ illness perceptions about non-small-cell lung cancer (NSCLC). Lung Cancer 2015; 90:575-81. [DOI: 10.1016/j.lungcan.2015.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/08/2015] [Accepted: 10/12/2015] [Indexed: 12/17/2022]
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Association between patient-provider communication and lung cancer stigma. Support Care Cancer 2015; 24:2093-2099. [PMID: 26553030 DOI: 10.1007/s00520-015-3014-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/01/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE The majority (95 %) of lung cancer patients report stigma, with 48 % of lung cancer patients specifically reporting feeling stigmatized by their medical providers. Typically associated with the causal link to smoking and the historically poor prognosis, lung cancer stigma can be seen as a risk factor for poor psychosocial and medical outcomes in the context of lung cancer diagnosis and treatment. Thus, modifiable targets for lung cancer stigma-reducing interventions are needed. The present study sought to test the hypothesis that good patient-provider communication is associated with lower levels of lung cancer stigma. METHODS Lung cancer patients (n = 231) across varying stages of disease participated in a cross-sectional, multisite study designed to understand lung cancer stigma. Patients completed several survey measures, including demographic and clinical characteristics, a measure of patient-provider communication (Consumer Assessment of Healthcare Providers and Systems Program or CAHPS), and a measure of lung cancer stigma (Cataldo Lung Cancer Stigma Scale). RESULTS As hypothesized, results indicated that good patient-provider communication was associated with lower levels of lung cancer stigma (r = -0.18, p < 0.05). These results remained significant, even when controlling for relevant demographic and clinical characteristics (Stan. β = -0.15, p < 0.05). CONCLUSIONS Results indicate that good patient-provider communication is associated with lower levels of lung cancer stigma, suggesting that improving patient-provider communication may be a good intervention target for reducing lung cancer stigma.
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Blum T, Schönfeld N. The lung cancer patient, the pneumologist and palliative care: a developing alliance. Eur Respir J 2014; 45:211-26. [DOI: 10.1183/09031936.00072514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Considerable evidence is now available on the value of palliative care for lung cancer patients in all stages and at all times during the course of the disease. However, pneumologists and their institutions seem to be widely in arrears with the implementation of palliative care concepts and the development of integrated structures.This review focuses on the available evidence and experience of various frequently unmet needs of lung cancer patients, especially psychological, social, spiritual and cultural ones. A PubMed search for evidence on these aspects of palliative care as well as on barriers to the implementation, on outcome parameters and effectiveness, and on structure and process quality was performed with a special focus on lung cancer patients.As a consequence, this review particularly draws pneumologists’ attention to improving their skills in communication with the patients, their relatives and among themselves, and to establish team structures with more far-reaching competences and continuity than existing multilateral cooperations and conferences can provide. Ideally, any process of structural and procedural improvement should be accompanied by scientific evaluation and measures for quality optimisation.
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Shen MJ, Coups EJ, Li Y, Holland JC, Hamann HA, Ostroff JS. The role of posttraumatic growth and timing of quitting smoking as moderators of the relationship between stigma and psychological distress among lung cancer survivors who are former smokers. Psychooncology 2014; 24:683-90. [PMID: 25345591 DOI: 10.1002/pon.3711] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 09/25/2014] [Accepted: 09/26/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Patients diagnosed with lung cancer report high levels of stigma and psychological distress. This study examined posttraumatic growth among lung cancer survivors as a potential buffer against this relationship between stigma and psychological distress and examined how these relationships differed by the timing of quitting smoking (pre versus post-diagnosis). METHODS Stages IA and IB non-small-cell lung cancer survivors (N = 141) who were former smokers, 1-6 years post-treatment, and had no evidence of disease completed standardized questionnaires assessing stigma, posttraumatic growth, timing of quitting smoking history, and psychological distress. RESULTS Hierarchical linear regression and simple slope analyses indicated that among those who quit smoking prior to diagnosis (pre-diagnosis quitters), stigma had a positive association with psychological distress at high levels of posttraumatic growth (p = 0.003) and had a positive (but non-significant) association with psychological distress among those with low levels of posttraumatic growth (p = 0.167). Among those who quit smoking after diagnosis (post-diagnosis quitters), stigma had a positive association with psychological distress among those with low levels of posttraumatic growth (p = 0.004) but had no relationship among those with high levels of posttraumatic growth (p = 0.880). CONCLUSIONS Findings indicate that posttraumatic growth buffers against the negative effects of stigma on psychological distress but only among post-diagnosis quitters. Future interventions could focus on fostering posttraumatic growth as a way to decrease the negative effects of stigma.
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Affiliation(s)
- Megan Johnson Shen
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elliot J Coups
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jimmie C Holland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heidi A Hamann
- Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Hamann HA, Ostroff JS, Marks EG, Gerber DE, Schiller JH, Lee SJC. Stigma among patients with lung cancer: a patient-reported measurement model. Psychooncology 2013; 23:81-92. [PMID: 24123664 DOI: 10.1002/pon.3371] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 07/08/2013] [Accepted: 07/12/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Although stigma may have negative psychosocial and behavioral outcomes for patients with lung cancer, its measurement has been limited. A conceptual model of lung cancer stigma and a patient-reported outcome measure are needed to mitigate these sequelae. This study identified key stigma-related themes to provide a blueprint for item development through a thematic analysis of semi-structured interviews and focus groups with lung cancer patients. METHODS Participants were recruited from two outpatient oncology clinics and included (i) 42 lung cancer patients who participated in individual interviews and (ii) 5 focus groups (inclusive of 23 new lung cancer patients). Never smokers, long-term quitters, recent quitters, and current smokers participated. Individual interviews facilitated theme development and a conceptual model of lung cancer stigma, whereas subsequent focus groups provided feedback on the conceptual model. Qualitative data analyses included iterative coding and validation with existing theory. RESULTS Two main thematic elements emerged from interviews with lung cancer patients: perceived (felt) stigma and internalized (self) stigma. Discussions of perceived stigma were pervasive, whereas those of internalized stigma were more commonly endorsed among current and recently quit smokers. Participants also discussed maladaptive (e.g., decreased disclosure) and adaptive (e.g., increased advocacy) stigma-related consequences. CONCLUSIONS Results indicate widespread acknowledgment of perceived stigma among lung cancer patients but varying degrees of internalized stigma and associated consequences. Next steps for patient-reported outcome measure development are item consolidation, item development, expert input, and cognitive interviews before field testing and psychometric analysis. Future work should address stigma-related consequences and interventions for reducing lung cancer stigma.
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Affiliation(s)
- Heidi A Hamann
- Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA; Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA; Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA
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