Advertisement

Journal of Behavioral Medicine

, Volume 39, Issue 2, pp 241–253 | Cite as

Personal responsibility, regret, and medical stigma among individuals living with lung cancer

  • Kevin R. Criswell
  • Jason E. Owen
  • Andrea A. Thornton
  • Annette L. Stanton
Article

Abstract

Understanding the degree to which adults with lung cancer perceive personal responsibility for their disease, personal regret for actions that may have contributed to lung cancer, and potential stigmatization from others is important, because these perceptions and experiences may be linked with treatment nonadherence, feelings of isolation, avoidance of healthcare providers, and poor quality of life. The purpose of this study was to evaluate rates and intensity of these types of experiences and to characterize the extent to which they are linked with smoking status and psychological adjustment in those living with lung cancer. Adults with lung cancer (N = 213) were recruited from two major cancer centers to complete a mail survey. Perceived responsibility was frequent in those who had ever smoked (74–80 %), whereas regret and feelings of stigmatization were less frequent. When present, however, personal regret and stigmatization were associated with adverse psychological outcomes, particularly for never smokers. These results are consistent with the theory of stereotype threat and have clinical implications for management of people with lung cancer.

Keywords

Lung cancer Stigma Smoking Mental health Distress 

Notes

Compliance with ethical standards

Conflict of interest

Kevin R. Criswell, Jason E. Owen, Andrea A. Thornton and Annette L. Stanton declare that they have no conflict of interest.

Human and animal rights and Informed consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

References

  1. Abrams, R., & Finesinger, J. (1953). Guilt reactions in patients with cancer. Cancer, 6, 474–482.CrossRefPubMedGoogle Scholar
  2. Alberg, A., Ford, J., & Samet, J. (2007). Epidemiology of lung cancer: ACCP evidence-based clinical practice guidelines. Chest, 132, 29S–55S. doi: 10.1378/chest.07-1347 CrossRefPubMedGoogle Scholar
  3. Aronson, J., Burgess, D., Phelan, S. M., & Juarez, L. (2013). Unhealthy interactions: The role of stereotype threat in health disparities. American Journal of Public Health, 103, 50–56.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Baker, F., Denniston, M., Zabora, J., Polland, A., & Dudley, W. N. (2002). A POMS short form for cancer patients: Psychometric and structural evaluation. Psycho-Oncology, 11, 273–281.CrossRefPubMedGoogle Scholar
  5. Bonevski, B., Sanson-Fisher, R., Girgis, A., Burton, L., Cook, P., & Boyes, A. (2000). Evaluation of an instrument to assess the needs of patients with cancer. Cancer, 88, 217–225.CrossRefPubMedGoogle Scholar
  6. Carter-Harris, L. (2015). Lung cancer stigma as a barrier to medical help-seeking behavior: Practice implications. Journal of the American Association of Nurse Practitioners, 27, 240–245. doi: 10.1002/2327-6924.12227 CrossRefPubMedGoogle Scholar
  7. Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 45, 267–283.CrossRefGoogle Scholar
  8. Cataldo, J. K., & Brodsky, J. L. (2013). Lung cancer stigma, anxiety, depression and symptom severity. Oncology, 85, 33–40. doi: 10.1159/000350834 CrossRefPubMedGoogle Scholar
  9. Cataldo, J. K., Jahan, T. M., & Pongquan, V. L. (2012). Lung cancer stigma, depression, and quality of life among ever and never smokers. European Journal of Oncology Nursing, 16, 264–269.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Cataldo, J., Slaughter, R., Jahan, T., Pongquan, V., & Hwang, W. (2011). Measuring stigma in people with lung cancer: Psychometric testing of the cataldo lung cancer stigma scale. Oncology Nursing Forum, 38, E46–E54.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Chambers, S. K., Dunn, J., Occhipinti, S., Hughes, S., Baade, P., Sinclair, S., et al. (2012). A systematic review of the impact of stigma and nihilism on lung cancer outcomes. BMC Cancer, 12, 184. doi: 10.1186/1471-2407-12-184 CrossRefPubMedPubMedCentralGoogle Scholar
  12. Chang, V. T., Hwang, S. S., Feuerman, M., Kasimis, B. S., & Thaler, H. T. (2000). The Memorial Symptom Assessment Scale Short Form (MSAS-SF). Cancer, 89, 1162–1171.CrossRefPubMedGoogle Scholar
  13. Chapple, A., Ziebland, S., & McPherson, A. (2004). Stigma, shame, and blame experienced by patients with lung cancer: Qualitative study. BMJ, 328, 1–5. PsycINFO, Ipswich, MA. Accessed 19 Dec 2012.Google Scholar
  14. Earnshaw, V., & Chaudoir, S. (2009). From conceptualizing to measuring HIV stigma: A review of HIV stigma mechanism measures. AIDS and Behavior, 13, 1160–1177.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Edgar, L., Rosberger, Z., & Nowlis, D. (1992). Coping with cancer during the first year after diagnosis: Assessment and intervention. Cancer, 69, 817–828.CrossRefPubMedGoogle Scholar
  16. Else-Quest, N., LoConte, N., Schiller, J., & Hyde, J. (2009). Perceived stigma, self-blame, and adjustment among lung, breast and prostate cancer patients. Psychology & Health, 24(8), 949–964. PsycINFO, Ipswich, MA. Accessed 19 Dec 2012.Google Scholar
  17. Faller, H., Schilling, S., & Lang, H. (1995). Causal attribution and adaptation among lung cancer patients. Journal of Psychosomatic Research, 39, 619–627.CrossRefPubMedGoogle Scholar
  18. Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
  19. Gonzalez, B., & Jacobsen, P. (2010). Depression in lung cancer patients: The role of perceived stigma. Psycho-Oncology, 21, 239–246.CrossRefPubMedGoogle Scholar
  20. Good, D. W., Delaney, H., Laird, A., Hacking, B., Stewart, G. D., & McNeill, S. A. (2015). Consultation audio-recording reduces long-term decision regret after prostate cancer treatment: A non-randomised comparative cohort study. Surgeon. doi: 10.1016/j.surge.2014.10.006.PubMedGoogle Scholar
  21. Graves, K. D., Arnold, S. M., Love, C. L., Kirsh, K. L., Moore, P. G., & Passik, S. D. (2007). Distress screening in a multidisciplinary lung cancer clinic: Prevalence and predictors of clinically-significant distress. Lung Cancer, 55, 215–224.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Hamann, H. A., Ostroff, J. S., Marks, E. G., Gerber, D. E., Schiller, J. H., & Craddock Lee, S. J. (2014). Stigma among patients with lung cancer: A patient-reported measurement model. Psycho-Oncology, 23, 81–92.CrossRefPubMedPubMedCentralGoogle Scholar
  23. Hann, D., Winter, K., & Jacobson, P. (1999). Measurement of depressive symptoms in cancer patients: Evaluation of the Center for Epidemiological Studies Depression Scale (CES-D). Journal of Psychosomatic Research, 46, 437–443.CrossRefPubMedGoogle Scholar
  24. Holland, J. (2002). History of psycho-oncology: Overcoming attitudinal and conceptual barriers. Psychosomatic Medicine, 64, 206–221.CrossRefPubMedGoogle Scholar
  25. Horn, J. L. (1965). A rationale and test for the number of factors in factor analysis. Psychometrika, 30, 179–185. doi: 10.1007/BF02289447 CrossRefPubMedGoogle Scholar
  26. Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of events scale: A measure of subjective stress. Psychosomatic Medicine, 41, 209–218.CrossRefPubMedGoogle Scholar
  27. Jacobsen, P. B., Donovan, K. A., Trask, P. C., Fleishman, S. B., Zabora, J., Baker, F., & Holland, J. C. (2005). Screening for psychologic distress in ambulatory cancer patients. Cancer, 103, 1494–1502.CrossRefPubMedGoogle Scholar
  28. Kinsler, J. J., Wong, M. D., Sayles, J. N., Davis, C., & Cunningham, W. E. (2007). The effect of perceived stigma from a health care provider on access to care among a low-income HIV-positive population. AIDS Patient Care and STDs, 21, 584–592. doi: 10.1089/apc.2006.0202 CrossRefPubMedGoogle Scholar
  29. Lebel, S., Castonguay, M., Mackness, G., Irish, J., Bezjak, A., & Devins, G. M. (2013). The psychosocial impact of stigma in people with head and neck or lung cancer. Psycho-Oncology, 22, 140–152. doi: 10.1002/pon.2063 CrossRefPubMedGoogle Scholar
  30. Lobchuk, M., McClement, S., McPherson, C., & Cheang, M. (2008). Does blaming the patient with lung cancer affect the helping behavior of primary caregivers? Oncology Nursing Forum, 35, 681–689.CrossRefPubMedGoogle Scholar
  31. LoConte, N., Else-Quest, N., Eickhoff, J., Hyde, J., & Schiller, J. (2008). Assessment of guilt and shame in patients with non-small-cell lung cancer compared with patients with breast and prostate cancer. Clinical Lung Cancer, 9, 171–178.CrossRefPubMedGoogle Scholar
  32. McElduff, P., Boyes, A., Zucca, A., & Girgis, A. (2004). The supportive care needs survey: A guide to administration, scoring, and analysis. Newcastle: Center for Health Research and Psychology Oncology.Google Scholar
  33. Myrdal, G., Valtysdottir, S., Lambe, M., & Ståhle, M. (2003). Quality of life following lung cancer surgery. Thorax, 58, 194–197.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Parker-Pope, T. (2008, March 6). Cancer funding: Does it add up? The New York Times. Retrieved from http://www.nytimes.com
  35. Portenoy, R. K., Thaler, H. T., Kornblith, A. B., McCarthy Lepore, J., Friedlander-Klar, H., Kiyasu, E., et al. (1994). The Memorial Symptom Assessment Scale: An instrument for the evaluation of symptom prevalence, characteristics and distress. European Journal of Cancer, 30A, 1326–1336.CrossRefPubMedGoogle Scholar
  36. Radloff, L. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 3, 385–401.CrossRefGoogle Scholar
  37. Roth, A. J., Kornblith, A. B., Batel-Copel, L., Peabody, E., Scher, H. I., & Holland, J. C. (1998). Rapid screening for psychological distress in men with prostate carcinoma: A pilot study. Cancer, 82, 1907–1908.CrossRefGoogle Scholar
  38. Salander, P. (2007). Attributions of lung cancer: My own illness is hardly caused by smoking. Psycho-Oncology, 16, 587–592.CrossRefPubMedGoogle Scholar
  39. Sanders, S. L., Bantum, E. O., Owen, J. E., Thornton, A. A., & Stanton, A. L. (2010). Supportive care needs in patients with lung cancer. Psycho-Oncology, 19, 480–489.CrossRefPubMedGoogle Scholar
  40. Shah, K., McMahon, J. M., Trabold, N., Aidala, A. A., Chen, M., Pouget, E. R., et al. (2015). Determinants of physical and global functioning in adult HIV-positive heterosexual men. AIDS Care. doi:  10.1080/09540121.2015.1026308. PubMedCentralGoogle Scholar
  41. Shaver, K. G., & Drown, D. (1986). On causality, responsibility, and self-blame: A theoretical note. Journal of Personality and Social Psychology, 50, 697–702.CrossRefPubMedGoogle Scholar
  42. Steele, C. M., & Aronson, J. (1995). Stereotype threat and the intellectual test performance of African Americans. Journal of Personality and Social Psychology, 69, 797–811.CrossRefPubMedGoogle Scholar
  43. Thornton, A. A., Owen, J. E., Kernstine, K., Koczywas, M., Grannis, F., Cristea, M., et al. (2012). Predictors of finding benefit after lung cancer diagnosis. Psychooncology, 21, 365–373. doi: 10.1002/pon.1904 CrossRefPubMedGoogle Scholar
  44. Thurstone, L. L. (1947). Multiple-factor analysis. Chicago, IL: The University of Chicago Press.Google Scholar
  45. Tod, A., Craven, J., & Allmark, P. (2011). Diagnostic delay in lung cancer: A qualitative study. Journal of Advanced Nursing, 61, 336–343.CrossRefGoogle Scholar
  46. van der Beek, K. M., Bos, I., Middel, B., & Wynia, K. (2013). Experienced stigmatization reduced quality of life of patients with a neuromuscular disease: A cross-sectional study. Clinical Rehabilitation, 27, 1029–1038. doi: 10.1177/0269215513487234 CrossRefPubMedGoogle Scholar
  47. Wang, L. D., Zhan, L., Zhang, J., & Xia, Z. (2015). Nurses’ blame attributions towards different types of cancer: A cross-sectional study. International Journal of Nursing Studies, 52, 1600–1606. doi:  10.1016/j.ijnurstu.2015.06.005.CrossRefPubMedGoogle Scholar
  48. Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30, 473–483.CrossRefPubMedGoogle Scholar
  49. Wassenaar, T. R., Eickhoff, J. C., Jarzemsky, D. R., Smith, S. S., Larson, M. L., & Schiller, J. H. (2007). Differences in primary care clinicians’ approach to non-small cell lung cancer patients compared with breast cancer. Journal of Thoracic Oncology, 2, 722.CrossRefPubMedGoogle Scholar
  50. Wrosch, C., Bauer, I., Miller, G. E., & Lupien, S. (2007). Regret intensity, diurnal cortisol secretion, and physical health in older individuals: Evidence for directional effects and protective factors. Psychology and Aging, 22, 319–330. doi: 10.1037/0882-7974.22.2.319 CrossRefPubMedGoogle Scholar
  51. Zabora, J., BrintzenhofeSzoc, K., Curbow, B., Hooker, C., & Piantadosi, S. (2001). The prevalence of psychological distress by cancer site. Psycho-Oncology, 10, 19–28. doi: 10.1002/1099-1611(200101/02)10:1<19::aid-pon501>3.0.co CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York (outside the USA) 2015

Authors and Affiliations

  • Kevin R. Criswell
    • 1
  • Jason E. Owen
    • 2
  • Andrea A. Thornton
    • 3
  • Annette L. Stanton
    • 4
  1. 1.Department of PsychologyLoma Linda UniversityLoma LindaUSA
  2. 2.National Center for PTSDVeterans Affairs Palo Alto Health Care SystemMenlo ParkUSA
  3. 3.Neuropsychiatric InstituteUniversity of California, Los AngelesLos AngelesUSA
  4. 4.Departments of Psychology and Psychiatry/Biobehavioral Sciences and Jonsson Comprehensive Cancer CenterUniversity of California, Los AngelesLos AngelesUSA

Personalised recommendations