Quantitative And Qualitative Research On Stigma Among Patients With Lung Cancer

Lung cancer diagnosis,subsequent treatment and a variety of uncertainties have brought serious psychological distresses patients with lung cancer like anxiety,depression,stigma and so on.Stigma refers to disapproval of individuals due to undesirable features such as special appearance,behavior,or group identity.There is a certain degree of stigma associated with lung cancer patients.This stigma could have negative impacts on the mental and physical health of patients with lung cancer,delaying the recovery of the disease.In recent years,research on stigma of lung cancer patients has become a hot spot.To better understand this stigma and its effects on patients,Cataldo developed the Cataldo Lung Cancer Stigma Scale(CLCSS),a reliable and valid measure of health-related stigma for lung cancer patients.At present,there is lack of a valid and reliable measure of lung cancer stigma in China.And little is known about the experiences of stigma and how Chinese patients cope with stigma.Part ?REVISING THE CATALDO LUNG CANCER STIGMA SCALE ObjectiveTo translate the Cataldo Lung Cancer Stigma Scale(CLCSS)into Chinese and test its reliability and validity,in order to provide a reliable and valid measure of health-related stigma among lung cancer patients.Methods1.Translation and development: The original CLCSS was introduced with authorization of Dr.Cataldo.(1)A nursing postgraduate and an English postgraduate translated literally CLCSS into Chinese developing draft A.(2)An oncology nursing professor re-examination draft A developing draft B.(3)Draft B was translated into English by a nursing postgraduate and an English postgraduate who are unfamiliar with CLCSS.They compared and discussed the original and the re-translated drafts developing draft C.(4)Ask gerontologists to modify draft C.(5)Draft C was used in lung cancer patients to make cultural debugging,some items were modified developing the first draft of Chinese version of CLCSS.2.Psychometric testing: A total of 150 lung cancer patients were recruited from three hospitals in Shandong province and were tested using the Chinese version of CLCSS,Rosenberg Self-esteem Scale(RSES)and Self-Rating Depression Scale(SDS)to assess its validity and reliability.To assess test-retest reliability,we re-administered the questionnaires to 40 extracted patients three weeks after the initial survey.The content validity index(CVI),exploratory factor analysis,criterion-related validity was used to evaluate the validity of the Chinese version of CLCSS;Cronbach's ? coefficient,test-retest reliability was used to evaluate the reliability of the Chinese version of CLCSS.Results1.The items and subscales of the Chinese version of CLCSS: The Chinese version of CLCSS includes 21 items and 4 subscales.Each item was measured through a four-point Likert scale ranging from 1(strongly disagree)to 4(strongly agree).And 2 items were scored inversely.Higher scores indicate a stronger stigma feeling perceived by patients.2.Validity and Reliability of the Chinese version of CLCSS(1)Validity:(1)Index of Content validity(CVI)was 0.875,and all experts considered the items of the Chinese version of CLCSS were concise and applicable.(2)Construct validity was supported by factor analysis with varimax and four factors were stigma and shame,social isolation,discrimination,and smoking,which is in agreement with the original CLCSS with the cumulative variance explained(58.6%).(3)Criterion-Related Validity: The total stigma score correlated negatively with RSES scores(r=-0.69,p<0.01).By contrast,the total stigma scale scores was positively related to the SDS(r=0.37,p<0.01).(2)Reliability:(1)The Cronbach's ? coefficient of the Chinese version of CLCSS was 0.88,and the four primary factors ranged from 0.60 to 0.87.(2)3-weeks test-retest reliability was provided with the resulting Cronbach's ? coefficient of the total stigma scale and the four primary factors was 0.88,0.88,0.79,0.60,and 0.63 respectively.ConclusionThe Chinese version of CLCSS is a reliable and valid measure of stigma among Chinese patients with lung cancer.Part IIAPPLICATION OF THE CATALDO LUNG CANCER STIGMA SCALE AMONG PATIENTS WITH LUNG CANCER ObjectiveTo describe and analysis the level and influencing factors of stigma among patients with lung cancer by initial application of the Chinese version of CLCSS.MethodsTotally 270 hospitalized patients with lung cancer recruited randomly were investigated with general demographic questionnaire,disease information questionnaire,the Chinese version of CLCSS.SPSS 13.0 was used for statistical analysis.Results1.The level of lung cancer stigmaThe average total score of Chinese version of CLCSS was(2.68±0.40).The results of the test of patients with lung cancer with moderate stigma 51.2%.The average score of stigma and shame was(2.67±0.44),the average score of social isolation was(2.47±0.55),the average score of discrimination was(2.87±0.54),the average score of smoking was(2.90±0.58).2.The influencing factors of lung cancer stigma(1)ANOVA showed that the degree of education,profession,the working condition,the number of children,main caregivers,the health status of caregivers,the time of illness,the clinical stage are the influencing factors of the lung cancer stigma.The patients with senior high school or technical secondary school,professional free,demission,having an only child,main caregivers is spouses,the health of caregivers is poor,the time of illness>12 months,the clinical stage is ? rated higher scores on the Chinese version of CLCSS.(2)Regression analysis showed that the number of children and the clinical stage are important predictor variables of lung cancer stigma,where regression coefficients are-0.07?0.14 respectively,coefficients of determination(R2=0.18)were good.Conclusion1.More than half of the patients with lung cancer had a moderate or higher level of stigma;The average score of smoking>the average score of discrimination>the average score of stigma and shame>the average score of social isolation.2.The degree of education,profession,the working condition,the number of children,main caregivers,the health status of caregivers,the time of illness,the clinical stage are the influencing factors of the lung cancer stigma.Part III STIGMA AND COPING STRATEGIES FOR CHINESE PATIENTS WITH LUNG CANCER: QUALITATIVE RESEARCH ObjectiveTo elaborate the experiences of stigma and coping strategies in patients with lung cancer to raise medical staffs' understanding and awareness,in order to provide the theory basis for assisting patients deal with stigma.MethodsA qualitative descriptive approach was chosen for this investigation.17 lung cancer patients were recruited from Liaocheng City People's Hospital and completed an in-depth interviews.Colaizzi's approach guided data analysis.ResultsThree main thematic elements emerged from interviews data are(1)sources of stigma such as smoking,high medical costs,decreased ability to work,difficulties caring for self and family,damage of self-image,and cough and expectoration;(2)experiences of stigma including feelings of stigma,remorse,loss of dignity and useless;perceived social isolation,exclusion,rejection and discrimination;and(3)coping strategies consisting of concealing the fact of sickness,reducing social activities,seeking medical assistance,reconstructing self-image,adherence to treatment,disclosing dissatisfaction.ConclusionThe results indicated that there are perceived stigma among patients with lung cancer and they take different coping strategies.As point of care providers,staff nurses are well poised to focus on the stigma level of patients,analyze the source of stigma in order to take positive and individualized interventions for assisting patients deal with stigma.