Lung Cancer Stigma: Associated Variables and Coping Strategies

Lung cancer stigma is a burgeoning area of literature, yet two important questions remain unanswered: a) What are the associations between lung cancer stigma and psychosocial outcomes across lung cancer survivors with different smoking histories and b) how would lung cancer survivors describe their experience of coping strategies they utilize to cope with lung cancer stigma. This dissertation presents two studies that seek to answer the above-mentioned questions: a) a quantitative study that describes the rates of Personal Responsibility, Regret, and Medical Stigma and the associations between the above-mentioned constructs and psychosocial outcomes; and b) a qualitative study of coping strategies that lung cancer survivors reported utilizing in response to lung cancer stigma. Results from the quantitative study suggest that, while current and former smokers report significantly greater rates of Personal Responsibility and Regret when compared to never smokers, smoking status did not significantly affect the level of Medical Stigma reported by lung cancer survivors. The most common themes extracted from the qualitative data were coping strategies involving education, avoidance, support, helping others, acceptance, and assertive communication. Further research is needed to investigate exactly how lung cancer stigma relates to psychosocial outcomes. As future interventions geared towards lung cancer stigma are developed and tested, it will be important to a) measure lung cancer stigma and its associated constructs (e.g., regret, guilt/shame, personal responsibility) with instruments that are firmly rooted in testable theoretical frameworks, b) track psychosocial outcome variables and their changes as a result of the treatment response via the intervention, c) and observe any differences in how stigma variables (e.g., perceived stigma and internalized stigma) might be associated differently with outcome variables and change over time differently depending on smoking history (e.g., comparing outcomes between ever vs. never smokers)

Qualitative Study of Psychosocial Needs for Individuals with Lung Cancer

Lung cancer affects many people in the United States, accounting for 14.5% of cancer cases in 2010. Additionally, it is responsible for more cancer-related deaths than any other cancer type. Those living with lung cancer also experience a higher prevalence of psychological distress and mood problems relative to most other cancer types. Despite the high physical and mental health burden borne by those living with lung cancer, psychosocial research on lung cancer generally lags far behind comparable studies in other cancer populations. Evidence from the few interventions developed specifically for lung cancer patients demonstrate an underutilization of those services, which is inferred from generally low response rates from eligible participants. Although a low participation rate may demonstrate the need to investigate the barriers of participating in interventions, little research on that topic is currently available. Also, it is not clear what factors predict refusal to participate in psychosocial interventions for the lung cancer population, despite the available data on demographic and medical differences between eligible those who did and those who did not participate. Overall, there is limited evidence available for preferred interventions, for favored methods of receiving interventions (e.g., Internet, face-to-face, telephone), and for perceived barriers to access and maintain engagement in available psychosocial interventions for lung cancer patients. A qualitative study that utilizes a grounded theory approach to the analysis of interview data from lung cancer patients can address the current gap in understanding of lung cancer patients\u27 perspective on three specific areas: 1) the most important psychosocial needs to address and what factors contribute to higher importance, 2) interest in different psychosocial services and what factors contribute to low and high interest, and 3) what factors serve as barriers to engage in psychosocial interventions. Elucidating these three areas will increase researchers\u27 understanding of lung cancer patients\u27 perspectives via the development of a grounded theory, which investigators can utilize to better address the psychosocial and quality of life needs of this cancer population

Healthcare satisfaction in lung cancer survivors: A cross-sectional secondary data analytic study

Introduction: Lung cancer is commonly associated with high levels of psychosocial distress and symptom burden. Healthcare professionals endeavor to meet complex needs, yet current research is sparse and presents an inconsistent picture of predictors of healthcare satisfaction in lung cancer. We examined psychosocial, physical functioning, demographic, and supportive care factors as predictors of healthcare satisfaction in a sample of lung cancer survivors. Method: We conducted a cross-sectional secondary data analysis to examine psychosocial functioning, physical functioning, supportive care needs, healthcare satisfaction, and demographic and medical characteristics in lung cancer survivors sampled from two southern California hospitals (N = 187). Mean difference tests and Pearson correlations were utilized prior to entering significant predictors into a hierarchical regression model predicting healthcare satisfaction. Results: A hierarchical regression model indicated that greater information needs (beta = -.43, p \u3c .001), greater psychological needs (beta = -.18, p \u3c .04), and more time since diagnosis of lung cancer (beta = -.13, p \u3c .05) independently predicted a lower levels of healthcare satisfaction. Conclusions: Clinicians working with lung cancer survivors are encouraged to assess for unmet supportive care needs at regular intervals. It is unclear whether demographic characteristics that were predictive of healthcare satisfaction in other studies (e.g., ethnic background) were not found in our study due to characteristics of the healthcare settings for our sample or possibly the cross-sectional nature of our study. Future research may expand on our findings by examining predictors of healthcare satisfaction in longitudinal studies

How Positive and Negative Emotions are Regulated by and Associated with Stigma in University Students with and without Mental and Physical Chronic Health Conditions

Introduction: Over one-third of undergraduate students report having at least one mental or physical chronic health condition (CHC). Stigma is associated with undesirable emotion/mood, worse quality of life, and diminished academic performance. Less is known about (a) whether emotional experiences may be regulated differently between students with and without CHCs and (b) whether negative and positive emotion regulation are differentially associated with stigma awareness and internalized stigma in students with CHCs. The present study examines cross-sectional survey data from Fall 2020 quarter. Method: Students without CHCs (n = 51) and students with CHCs (n = 150) were sampled from Eastern Washington University using emailed invitations and online surveys. The Stigma Consciousness and Self Stigma scales assessed stigma awareness and internalized stigma, respectively. The Emotion Regulation Questionnaire assessed positive, negative, and neutral emotion regulation. ANOVAs and t-tests were utilized to assess mean differences between groups on levels of emotion regulation. Pearson correlations were used to assess associations between emotion regulation stigma measures. Significance was set to p \u3c .05. Results: Students with co-occurring mental and physical CHCs reported significantly greater negative emotion suppression compared to students with only mental CHCs and those without CHCs. Positive emotion suppression was positively correlated with internalized stigma in students with mental CHCs, regardless if it was only or co-occurring with physical CHCs. Discussion: This study fills a gap in the literature on emotion regulation in populations that report experiencing stigma. This study highlights the importance of assessing positive and negative emotion regulation separately

Lung Cancer Survivors Who Continue Smoking After Diagnosis Are More Likely to be Living with an Individual Who Smokes

Abstract Introduction: In the United States, lung cancer is the leading cause of cancer death in both men and women. Smoking increases the risk for lung cancer, and smoking cessation after diagnosis improves cancer survival and lowers rates of recurrence. Using the Theory of Planned Behavior (TPB), we examined individual attitudes, perceived control, and subjective norms as predictors of lung cancer survivors’ intention to quit smoking. Method: We conducted a secondary data analysis to examine attitudes, perceived control, and subjective norms of smoking in a sample of lung cancer survivors (N= 171). Analyses were limited to those with a smoking history (i.e., former (n= 139) and current smokers (n= 32)). While logistic regression modeling was considered, unequal subsample sizes ((n= 139 and n= 32) biased results. Chi-square goodness-of-fit tests and independent-samples t-tests were utilized to examine how group differences in smoking history predict theory-related factors of intention to quit smoking (i.e., individual attitudes, perceived control, and subjective norms). Results: When compared to former smokers, we found that significantly more current smokers reported living with an individual who smokes regularly, p\u3c .05. Other predictors and demographic variables were not significantly associated with smoking status (former vs. current), p’s \u3e .05. Conclusions: Some lung cancer survivors may find it difficult to quit smoking due to subjective norms that encourage smoking at home. Indeed, living with someone who smokes regularly may decrease an individual’s intention to quit smoking. Smoking cessation programs that incorporate significant others and close relationships may be more effective than those that focus exclusively on patients who continue to smoke. Further longitudinal research is needed to support our findings and identify other risk factors for continuing to smoke after a lung cancer diagnosis. Keywords: lung cancer, cancer, smoker, smoking cessation, lung cancer survivor, Theory of Planned Behavior, quit smoking, subjective norm

Causal Attribution, Personal Responsibility, and Regret in Lung Cancer Survivors

Introduction: Lung cancer is the second-most common cancer for males and females and the leading cause of cancer-related deaths in the United States. Ninety percent of lung cancer cases are associated with a smoking history. Less is known about (a) how lung cancer survivors with and without smoking histories attribute their cancer to secondhand smoke and (b) how those attributions may be associated with personal responsibility, regret, and stigma from medical staff/professionals. This secondary data analytic study examined 196 lung cancer survivors. Method: Paper surveys included (a) whether secondhand smoking caused their cancer, (b) whether they perceived control over that cause, and (c) whether they expended effort towards avoiding that cause. Independent samples t-tests were used to examine mean differences between ever and never smoking groups on attribution questions and correlations were used to examine associations between attribution questions and personal responsibility, regret, and medical blame. Significance was set to p \u3c .05. Results: Survivors with a smoking history attributed the cause of their cancer to their smoking. Those without a smoking history reported expending greater effort to avoid secondhand smoke. Effort to reduce exposure to secondhand smoke was negatively associated with personal responsibility and regret in those without a smoking history. Discussion: This study fills a gap in the literature by reporting the attribution and personal responsibility for causing their cancer in lung cancer survivors without a smoking history. Results suggest that survivors with no smoking history may attribute cause of their cancer to others smoking around them

Emotional, social, and behavioral factors affecting wellbeing and academic performance in university students with chronic diseases: Proposed longitudinal study

Background: Chronic diseases (CDs) affect about half (45%) of individuals in the U.S., and this population is expected to grow. Despite the high prevalence and psychosocial burden of CDs, less is known about the effects of CDs on university students’ academic performance and psychosocial wellbeing. Research on how CDs might affect pursuit of valued activities (e.g., higher education), psychosocial wellbeing, and internalized stigma is lacking in university students with CDs. Aims: The first aim is to characterize the effects of chronic diseases on academic performance and psychosocial wellbeing in university students. The second aim is to examine the academic performance, psychosocial, and health behavior effects of internalized stigma in students with CDs. Method: A “panel survey” design (Duncan & Kalton, 1987) was chosen to longitudinally assess university students. Two hundred students will be assessed three times at three-month intervals (i.e., once per academic quarter). Since statistical analysis of repeated measures will also involve a between-subjects factor (CD and non-CD students), a mixed design ANOVA will be utilized to assess longitudinal change: Analyses will include the between-subjects factor and two within-subjects repeated measures (time x outcome measure) for each outcome. Anticipated Implications: The increased risk of negative psychosocial and academic outcomes in chronically-diseased students will set the stage for larger investigations that can impact university programming for student support

Miniature exoplanet radial velocity array I: design, commissioning, and early photometric results

The MINiature Exoplanet Radial Velocity Array (MINERVA) is a US-based observational facility dedicated to the discovery and characterization of exoplanets around a nearby sample of bright stars. MINERVA employs a robotic array of four 0.7 m telescopes outfitted for both high-resolution spec- troscopy and photometry, and is designed for completely autonomous operation. The primary science program is a dedicated radial velocity survey and the secondary science objective is to obtain high precision transit light curves. The modular design of the facility and the flexibility of our hardware allows for both science programs to be pursued simultaneously, while the robotic control software provides a robust and efficient means to carry out nightly observations. In this article, we describe the design of MINERVA including major hardware components, software, and science goals. The telescopes and photometry cameras are characterized at our test facility on the Caltech campus in Pasadena, CA, and their on-sky performance is validated. New observations from our test facility demonstrate sub-mmag photometric precision of one of our radial velocity survey targets, and we present new transit observations and fits of WASP-52b—a known hot-Jupiter with an inflated radius and misaligned orbit. The process of relocating the MINERVA hardware to its final destination at the Fred Lawrence Whipple Observatory in southern Arizona has begun, and science operations are expected to commence within 2015

Miniature Exoplanet Radial Velocity Array I: design, commissioning, and early photometric results

The Miniature Exoplanet Radial Velocity Array (MINERVA) is a U.S.-based observational facility dedicated to the discovery and characterization of exoplanets around a nearby sample of bright stars. MINERVA employs a robotic array of four 0.7-m telescopes outfitted for both high-resolution spectroscopy and photometry, and is designed for completely autonomous operation. The primary science program is a dedicated radial velocity survey and the secondary science objective is to obtain high-precision transit light curves. The modular design of the facility and the flexibility of our hardware allows for both science programs to be pursued simultaneously, while the robotic control software provides a robust and efficient means to carry out nightly observations. We describe the design of MINERVA, including major hardware components, software, and science goals. The telescopes and photometry cameras are characterized at our test facility on the Caltech campus in Pasadena, California, and their on-sky performance is validated. The design and simulated performance of the spectrograph is briefly discussed as we await its completion. New observations from our test facility demonstrate sub-mmag photometric precision of one of our radial velocity survey targets, and we present new transit observations and fits of WASP-52b—a known hot-Jupiter with an inflated radius and misaligned orbit. The process of relocating the MINERVA hardware to its final destination at the Fred Lawrence Whipple Observatory in southern Arizona has begun, and science operations are expected to commence in 2015

The Future of Rheumatoid Arthritis and Hand Surgery - Combining Evolutionary Pharmacology and Surgical Technique

Rheumatoid arthritis is a systemic autoimmune disease of uncertain aetiology, which is characterized primarily by synovial inflammation with secondary skeletal destructions