Stigma and Quality of Life in Women With Breast Cancer: Mediation and Moderation Model of Social Support, Sense of Coherence, and Coping Strategies

Psychometric validation of the 8-Item Urdu Stigma Scale for Chronic Illness (SSCI-8) in people with Parkinson's disease

OBJECTIVES

Disease-related stigma is associated with poor mental health and wellbeing in people with Parkinson's disease. Urdu language tools for measuring stigma are not yet available. The aim of this study was therefore to develop and validate an Urdu version of the Stigma Scale for Chronic Illness-8 (SSCI-8).

METHOD

The Urdu SSCI-8 was developed following the 'Functional Assessment of Chronic Illness Therapy' translation procedure. To assess its reliability and validity, 250 people diagnosed with Parkinson's disease, aged 50-65 years, completed the Urdu SSCI-8, along with Urdu versions of depression and quality of measures.

RESULTS

Confirmatory Factor Analysis revealed that a single factor solution provided a good fit to the data, with high internal consistency (Cronbach Alpha = 0.95), and good fit indices (RMSEA = 0.05, CFI = 0.99, TLI = 0.98, GFI = 0.96). Composite Reliability Co-efficient (0.95) and Average Variance Extracted (0.71) values indicated strong convergent reliability and validity. Scores on the Urdu SSCI-8 correlated positively with depression (r = 0.53, p < 0.001), and negatively with quality of life (r = -0.61, p < 0.001), indicating high levels of convergent and discriminant validity.

CONCLUSION

The Urdu SSCI-8 is a reliable, valid, and culturally appropriate tool for measuring stigma among patients with Parkinson's disease.

[Psychological impacts of mastectomy in elderly people with breast cancer]

Aging is one of the main risk factors for breast cancer and one of the most common treatment options is surgery, including mastectomy, which can result in psychological impacts on women. The scope of this article is to conduct a bibliographical survey on the psychological impacts of mastectomy on elderly women with breast cancer. It involved an integrative literature review, conducted between August and September 2023, via the VHL portal, in the following databases: LILACS, BDENF, SciELO, MEDLINE and Google Scholar. A total of 2,021 articles were located, 22 of which were selected in line with the inclusion criteria. Among the psychological impacts, fear, anguish, sadness, feelings of loss, low self-esteem, shame, changes in body image, depression and anxiety stand out, as well as positive feelings such as resilience, hope, optimism, among others, however the predominance of negative feelings tend to prevail. The conclusion drawn is that the mastectomy process is experienced individually by each woman, bringing with it physical and psychological changes. Social support from family, friends and, especially, partners, are essential aspects of a woman's well-being and mental health.

Impact of cancer-related fatigue on quality of life in patients with cancer: multiple mediating roles of psychological coherence and stigma

OBJECTIVE

The goal of this current research was to explore the impact of cancer-related fatigue on the quality of life among patients with cancer, as well as the multiple mediating roles of psychological coherence and stigma.

METHODS

This study utilized a cross-sectional design. A questionnaire was administered between November 2022 and May 2023 to 364 patients with cancer in two tertiary hospitals in Jinzhou City, Liaoning Province, China. The questionnaires included the General Information Questionnaire, Cancer-Related Fatigue Questionnaire, Psychological Coherence Scale, Stigma Scale, and Quality of Life Questionnaire. SPSS 25.0 and PROCESS 3.5 macros were used for descriptive statistics and correlation analysis of the data, as well as multiple mediation effect tests.

RESULTS

Cancer-related fatigue directly affects quality of life (β = -0.950, 95% CI = -1.138 to -0.763) and indirectly through three mediators: psychological coherence (β = -0.172, 12.58% of total effect), stigma (β = -0.193, 14.12% of total effect), and both psychological coherence and stigma (β = -0.052, 3.80% of total effect), totaling a 30.50% mediating effect.

CONCLUSION

Overall, psychological coherence and stigma may play an important mediating role between cancer-related fatigue and quality of life in patients with cancer. This suggests that alleviating cancer-related fatigue, while enhancing psychological coherence and reducing stigma, could be effective strategies for improving patients' quality of life. Therefore, healthcare professionals and related professionals should pay attention to and adopt effective interventions to alleviate cancer-related fatigue, enhance psychological coherence, and reduce stigma, thereby contributing to the overall well-being and quality of life of patients with cancer.

Experiences of social burden amongst survivors of breast cancer in Gaza: A qualitative study

PURPOSE

This qualitative study explores how social-cultural factors can either amplify or attenuate prospects for social support following a breast cancer diagnosis. The aim of the study is to analyse narratives of individuals diagnosed with breast cancer to examine how the illness influences social support and hence their post-illness experiences.

METHODS

Forty semi-structured interviews, including thirty-eight with breast cancer survivors, are analysed using a grounded theory approach. Data were collected between September 2020 and April 2021.

RESULTS

Participants' perceptions indicate that three main factors influenced experiences and the level of social support received. The first involves stigmatised cancer-related discourses and practices affecting women's social interactions and roles. The second is specific to (ex)married participants. It reveals how the foundation of marriage prior to the illness is a determining and influencing factor in the experience of women after illness. The third demonstrates how specific social identities enable coping, negotiation, and challenging cancer-related stigma, turning their experiences toward positivity.

CONCLUSIONS

The study concludes that breast cancer acts as a figurative magnifying glass, illuminating latent social practices in the community. This highlights the need to nurture existing social bonds or address the fragility of ties within distinct social categories. The research suggests implementing customised support interventions aligned with each group of survivors' unique needs. Furthermore, enhancing awareness within patients' social networks regarding the illness and how to provide support, along with enhancing survivors' financial security through economic empowerment, may contribute to more effective coping with the social consequences of the illness.

[Pain-related stigma in patients with breast, colon, prostate or lung cancer : Results of a bicentric register-based cross-sectional study]

BACKGROUND

Studies on cancer patients show a moderately high relevance of perceived stigmatization. However, no studies have explored the perceived stigmatization in relation to cancer-associated pain. In this work, we analysed the relationship between pain and perceived stigmatization across a large sample of four major cancer entities.

METHODS

Quantitative data of 858 patients (45.6% women, mean age 60.7 years) with breast, bowel, lung and prostate cancer were evaluated in a register-based, bicentric study. Perceived stigmatization was measured using the social impact cale (SIS-D), including a total score and four subscales. Pain was assessed with the brief pain inventory (BPI). The data were analysed using correlation und multiple regression with various sociodemographic and medical predictors.

RESULTS

Of all 858 cancer patients, those with lung and breast cancer were characterized by the greatest pain. The intensity of the pain was a predictor of the perceived stigma in patients with breast and colorectal cancer. In addition, younger age was also a predictor for perceived stigmatization. A good quality of life resulted as a protective factor. The final models showed a high goodness of the fit (corr. R2 > 0.35), except for the lung cancer patients.

CONCLUSIONS

Our findings support the assumption that the experience of pain can have an impact on the perceived stigmatization of cancer patients. Depression might influence the perceived stigmatization. Therefore, this group of patients should receive special attention and psycho-oncological care in clinical practice. Further research on the course and mechanisms of action of pain-related perceived stigmatization is also required.

Culture, community, and cancer: understandings of breast cancer from a non-lived experience among women living in Soweto

BACKGROUND

Individual perceptions, socio-cultural beliefs and health system factors are key determinants of people's health seeking behavior and are widely cited as the causes of delayed breast cancer diagnosis among women from structurally vulnerable settings. Asking: "how do women with a non-lived experience of cancer understand the disease and, what informs their health seeking behaviors?", we qualitatively explored, individual, sociocultural and health system elements from a conceptual model derived from the Socioecological, Health Belief and Cancer Stigma Frameworks, to understand perspectives of breast cancer in a South African urban community setting.

METHODS

Using a deductive approach and allowing new themes to emerge inductively, we investigated phenomenologically, breast cancer perceptions among 34 women from Soweto, Johannesburg (aged 35-74 years) in 6 Focus Group Discussions. We then conducted 20 follow-up semi-structured in-depth interviews to explore novel themes and suggestions for increasing breast cancer screening.

RESULTS

Findings revealed some awareness of breast and other cancers, but confusion and gaps in understanding of the disease, resulting in socio-culturally influenced misperceptions of risks, causes, and outcomes following treatment of breast cancer. This fueled perceptions of profound fear and stigma against people with breast and other cancers. These findings together with participant perceptions of primary healthcare providers being unwelcoming, under-resourced, and insufficiently trained to deal with breast cancer, resulted in women reporting being reluctant to participating in screening/early detection care seeking behavior. Women only accessed primary care when experiencing extreme pain or ill-health. Participants suggested as solutions for future interventions, the need for sustained community engagement, harnessing existing clinic and community stakeholders and resources to provide clear and understandable breast cancer information and encouragement for screening uptake.

CONCLUSIONS

Health literacy gaps surrounding breast cancer fuels socio-culturally influenced misperceptions, fear, stigma, and fatalism among women from Soweto. Women perceive primary care providers of having insufficient knowledge, skills, and resources to provide effective breast cancer screening services. Participants suggested the need for greater community engagement involving primary clinics and existing community stakeholders working collaboratively. Clear, understandable, and consistent information about breast cancer must be regularly disseminated and communities must be regularly encouraged to utilize breast cancer screening services.

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.

Assessing the current situation and the influencing factors affecting perceived stigma among older patients after leukemia diagnosis

BACKGROUND

Psychological problems are becoming increasingly prominent among older patients with leukemia, with patients potentially facing stigmatization after diagnosis. However, there is limited research on the stigma experienced by these patients and the factors that may contribute to it.

AIM

To investigate the stigma faced by older patients after being diagnosed with leukemia and to analyze the potential influencing factors.

METHODS

A retrospective analysis was conducted using clinical data obtained from questionnaire surveys, interviews, and the medical records of older patients with leukemia admitted to the Hengyang Medical School from June 2020 to June 2023. The data obtained included participants' basic demographic information, medical history, leukemia type, family history of leukemia, average monthly family income, pension, and tendency to conceal illness. The Chinese versions of the Social Impact Scale (SIS), Perceived Social Support Scale (PSSS), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) were used to assess indicators related to stigma, social support, and mental health status. We used Pearson's correlation coefficient to analyze the strength and direction of the relationship between the scores of each scale, and regression analysis to explore the factors related to the stigma of older patients with leukemia after diagnosis.

RESULTS

Data from 120 patients with leukemia aged 65-80 years were analyzed. The total score on the SIS and PSSS was 43.60 ± 4.07 and 37.06 ± 2.87, respectively. The SAS score was 58.35 ± 8.32 and the SDS score was 60.58 ± 5.97. The stigma experienced by older leukemia patients was negatively correlated with social support (r = -0.691, P < 0.05) and positively correlated with anxiety and depression (r = 0.506, 0.382, P < 0.05). Age, education level, smoking status, average monthly family income, pension, and tendency to conceal illness were significantly associated with the participants' level of stigma (P < 0.05). Age, smoking status, social support, anxiety, and depression were predictive factors of stigmatization among older leukemia patients after diagnosis (all P < 0.05), with a coefficient of determination (R2) of 0.644 and an adjusted R2 of 0.607.

CONCLUSION

Older patients commonly experience stigmatization after being diagnosed with leukemia. Factors such as age, smoking status, social support, and psychological well-being may influence older patients' reported experience of stigma.

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.

The stigma in patients with breast cancer: A concept analysis

Objective

Stigma is a common problem among patients having breast cancer. However, the concept of stigma is vague and not specifically described or clearly defined in the literature. The lack of description or definition has further limited stigma research among patients having breast cancer. Therefore, this study aimed to clarify and analyze the concept of stigma in patients with breast cancer.

Methods

Walker and Avant's concept analysis method was applied to analyze the connotation of stigma in patients with breast cancer. PubMed, Web of Science, PsycINFO, CNKI, Wanfang, VIP, and SinoMed databases were searched from inception until May 31, 2023.

Results

Five stigma-related attributes of patients having breast cancer were identified: (1) impaired body image and physiological function; (2) negative stereotypes; (3) mixed negative feelings about developing breast cancer; (4) a feeling of avoidance; (5) experienced discrimination. Antecedents included the implementation of breast surgery and postoperative time, negative psychological factors, lack of social support, and cultural beliefs. This stigma among patients having breast cancer had significant negative effects on their quality of individual life and marriage, postoperative rehabilitation, and healthcare-seeking behavior.

Conclusions

The concept analysis results clarified the concept of stigma in patients with breast cancer and provided theoretical guidance for the development of the conceptual model of stigma in these patients. What is more, it offered a theoretical basis for future studies related to the development of stigma assessment tools for breast cancer patients and for devising nursing intervention strategies.

Culturally-informed adaptation and psychometric properties of the Cataldo Cancer Stigma Scale in Northern Tanzania

BACKGROUND

Cancer-related stigma impacts patients' emotional health, care engagement, and cancer outcomes, but few measures of cancer stigma exist. We culturally adapted and assessed psychometric properties of the Cataldo Cancer Stigma Scale (CCSS) in Tanzania.

METHODS

We administered the CCSS short version (21 items), plus 12 locally-derived items, to 146 adult cancer patients. We conducted exploratory factor analysis, examined internal consistency/reliability, and assessed convergent validity with relevant measures.

RESULTS

We identified a 17-item cancer stigma scale with strong psychometric properties and four subscales: enacted stigma, shame and blame, internalized stigma, and disclosure concerns. Stigma was rare except for disclosure concerns. Stigma was positively associated with depression and anxiety and negatively associated with social support, quality of life, and illness acceptance.

CONCLUSIONS

The scale provides valid, culturally-informed measurement of cancer stigma in Tanzania. Future studies should assess associations with care engagement, which will inform interventions to reduce stigma and improve outcomes.

Estimation of a Structural Equation Modeling of Quality of Life Mediated by Difficulty in Daily Life in Survivors of Breast Cancer

BACKGROUND

The purpose of this study was to clarify the structural relationship of quality of life (QOL) in survivors of breast cancer, including difficulty in daily life and negative experiences in daily activities, as health-related indicators.

METHODS

Participants were survivors of breast cancer for more than 2 years after primary breast cancer surgery and belonged to self-help groups. The assessment used FACT-B (QOL), HADS (anxiety and depression), SOC (sense of coherence), WHODAS 2.0 (difficulties in daily life), and CAOD (negative experiences in daily activities). Bayesian structural equation modeling (BSEM) was performed to analyze the hypothesized model. If the causal model was significant, multiplication of the path coefficient from emotional distress (anxiety and depression) to QOL, and from SOC to emotional distress, was considered a direct effect on QOL, and from SOC to difficulty in daily life, from difficulty in daily life to negative experiences in daily activities, and from negative experiences in daily activities to anxiety and depression were considered indirect effects on QOL.

RESULTS

The participants comprised 73 survivors of breast cancer. The goodness of fit of the model in the BSEM was satisfactory. The direct effect was 0.274, and the indirect effect was 0.164.

CONCLUSIONS

An additional finding of this study is that coping with difficulty in daily life and negative experiences in daily activities related to QOL may improve QOL.

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.

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

OBJECTIVE

This study was conducted to examine the factors associated with stigma in breast cancer women.

METHODS

PubMed, Embase, the Cochrane Library, Web of Science, and two Chinese electronic databases were electronically searched to identify eligible studies that reported the correlates of stigma for patients with breast cancer from inception to July 2022. Two researchers independently performed literature screening, data extraction, and risk of bias assessment. R4.1.1 software was used for statistical analysis.

RESULTS

Twenty articles including 4161 patients were included in the systematic review and meta-analysis. Results showed that breast cancer stigma was positively correlated with working status, type of surgery, resignation coping, depression, ambivalence over emotional expression, and delayed help-seeking behavior and negatively correlated with age, education, income, quality of life, social support, confrontation coping, psychological adaptation, self-efficacy, and self-esteem. Descriptive analysis showed that breast cancer stigma was positively correlated with intrusive thoughts, body image, anxiety, and self-perceived burden but negatively correlated with a sense of coherence, personal acceptance of the disease, sleep quality, cancer screening attendance and doctor's empathy.

CONCLUSION

Many demographic, disease-related, and psychosocial variables are related to breast cancer stigma. Our view can serve as a basis for health care professionals to develop health promotion and prevention strategies for patients with breast cancer.

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.. [DOI: 10.21203/rs.3.rs-2076682/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

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.