An introduction to key event mapping: A primer for nurse researchers

To fully understand the events leading to a diagnosis, retrospective recall can help nurse researchers reconstruct important health behavior-related events. However, retrospective recall can be a challenge. Key event mapping offers nurse researchers a method beyond retrospective chart review to elicit date data to explore the pre-diagnosis time frame of an illness. The purpose of this paper is to introduce the key event mapping method to nurse researchers in search of a method of eliciting date data from participants when designing research studies that include a retrospective recall component

Lung cancer stigma as a barrier to medical help-seeking behavior: Practice implications

Purpose The purpose of this study was to examine the relationship of perceived lung cancer stigma and timing of medical help-seeking behavior in symptomatic individuals. Data sources A convenience sample was recruited from an academic thoracic oncology clinic and community hospital-based outpatient radiation center in a large city in the southeastern United States. This descriptive, cross-sectional study used survey methodology and semi-structured interviews to examine the relationship of perceived lung cancer stigma and delayed medical help-seeking finding a statistically significant positive correlation. Additional examination revealed positive correlations between the stigma and shame, social isolation, and smoking-related stigma subscales and delay. The discrimination-related subscale was not associated with delay. In addition, smoking status was not related to perceived lung cancer stigma. Conclusions Findings support an association between lung cancer stigma and delayed medical help-seeking behavior. Therefore, lung cancer stigma is a potential barrier to timely medical help-seeking behavior in lung cancer symptoms, which can have important patient outcome implications. Implications for practice As primary care nurse practitioners, awareness that lung cancer stigma exists for patients is essential regardless of smoking status and efforts to decrease this barrier to timely healthcare are important

Influential variables on the timing of help-seeking behavior in lung cancer patients.

Lung cancer kills more people than any other cancer worldwide primarily because it is often diagnosed at an advanced stage. One factor that can influence advanced stage lung cancer diagnosis is delayed help-seeking behavior in individuals with symptoms suggestive of lung cancer. Delayed help-seeking behavior has been investigated in acute cardiovascular events and breast cancer, but there is little evidence on specific factors that influence the timing of help-seeking behavior in lung cancer patients. The purpose of this study was to explore the influence of healthcare system distrust, lung cancer stigma, and smoking status on the timing of help-seeking behavior in individuals with symptoms suggestive of lung cancer. This study employed a descriptive, cross-sectional design with 93 participants using the Revised Healthcare System Distrust Scale, Cataldo Lung Cancer Stigma Scale, and investigator-developed Timing of Help-Seeking Behavior and Demographic Questionnaire to assess the variables of interest. Hierarchical linear regression was used to assess the ability of healthcare system distrust, lung cancer stigma, and smoking status to predict greater time to seek help in lung cancer patients, after controlling for annual income, perceived financial status, ethnicity, and social desirability. In Step 1, ethnicity and perceived financial status explained 10% of the variance in time to seek help. After entry of healthcare system distrust, lung cancer stigma, and smoking status at Step 2, the total variance explained by the model as a whole was 23% of the variance in the time to seek help in individuals with symptoms suggestive of lung cancer. Significant findings from this study include the effect of healthcare system distrust, lung cancer stigma, and ethnicity on help-seeking behavior in individuals with lung cancer symptoms. The findings indicate a critical need for public health awareness that targets increasing awareness of lung cancer symptoms, decreasing lung cancer stigma and healthcare system distrust, recognizing the significant proportion of lung cancer patients whom have never smoked, and decreasing delays in help-seeking behaviors in individuals with symptoms suggestive of lung cancer

Preparing Students for Success on Examinations: Readiness Assurance Tests in a Graduate-Level Statistics Course

Formative feedback is one way to foster students' readiness for statistics examinations. The use of Readiness Assurance Tests was examined as an educational intervention in which feedback was provided for both correct and incorrect responses in a graduate-level statistics course. Examination scores in the intervention group ( n = 56) were compared with those in a control group ( n = 42). Intervention group examination scores significantly improved from 75.92 ± 14.52 on the Readiness Assurance Test to 90.06 ± 7.06, p < .001, on the midterm, and final examination scores improved from 78.23 ± 17.29 to 85.6 ± 6.98, p = .002. Intervention group midterm scores were significantly higher than those of the control group (90.06 ± 7.06 versus 79.7 ± 11.6, p < .001); however, no differences were found between the groups on the final examination (85.35 ± 9.46 versus 85.6 ± 6.98, p = .91). Use of Readiness Assurance Tests was an effective modality to increase student self-efficacy, learning experience, and, relative to a control group, midterm examination performance in statistic

Stigma, Smoking and Social Influence in Health Beliefs about Lung Cancer Screening

poster abstractBackground: Lung cancer is the leading cause of all cancer-related deaths in the United States. 158,080 people are expected to die from lung cancer in 2016. Most people are diagnosed at an advanced stage. Lung cancer screening, a recent recommendation by the United States Preventive Services Task Force, is associated with a 20% decreased relative mortality risk secondary to finding lung cancer at an earlier stage. Lung cancer screening is affected by patient, provider, and healthcare system variables. From the patient perspective, individual health beliefs have been shown to predict cancer screening participation in other cancers and are likely associated with lung cancer screening participation. In order for lung cancer screening to be effective, we must first understand what factors affect individual health beliefs about screening. The purpose of this study was to examine the association of social influence and cigarette smoking on individual health beliefs related to lung cancer screening and identify variables associated with stigma in screening-eligible current and former smokers. Methods: Descriptive, cross-sectional design using survey methodology (N=497). Convenience sample of lung cancer screening-eligible smokers. Data collected online measuring sociodemographic variables and lung cancer screening health beliefs. Results: We tested for associations between various variables and perceived smoking-related stigma, along with associations between number of cigarette pack-years, social influence and individual health beliefs (perceived risk, perceived benefits, perceived barriers, self-efficacy). Higher number of cigarette pack-years was associated with perceived barriers to lung cancer screening (p=.022). Higher levels of social influence were associated with perceived benefits of (p<.001) and self-efficacy for (p<.001) lung cancer screening. Conclusions: Results from this study indicate higher pack-year cigarette smoking history, social influence, and stigma may be important components to health beliefs and lung cancer screening participation. Future research is needed to explore the relationships more fully

Development of a Short Version of the Cataldo Lung Cancer Stigma Scale

Lung cancer stigma is an important phenomenon experienced by many lung cancer patients that can be a barrier to medical help-seeking behavior. The purpose of this study was to shorten the Cataldo Lung Cancer Stigma Scale (CLCSS). The original 31-item scale had excellent internal consistency reliability but item redundancy. The majority of lung cancer patients are diagnosed at an advanced stage, and patient burden with survey completion may be higher in this population. To reduce patient burden with participation in lung cancer stigma-related research, a psychometrically sound short measure of lung cancer stigma is valuable. Factor analysis was used to evaluate the dimensionality of the CLCSS. Results were used to shorten the measure to 21 items. The shortened scale showed strong evidence of internal consistency reliability (Cronbach's alpha =.93). Results also indicate the scale is three dimensional with reliable subscales: stigma and blame, social isolation, and discrimination

Pathways to a Lung Cancer Diagnosis

Purpose The purpose of this qualitative descriptive study was to identify and describe pathways to a lung cancer diagnosis based on narratives of persons diagnosed with the disease. Data sources Eleven adults with lung cancer were recruited from an academic thoracic oncology clinic in a large city in the southeastern United States. Moderately structured interviews were conducted by an experienced nurse practitioner (NP) to obtain information regarding the participants’ experiences leading to their diagnosis. Qualitative content analysis was used to develop a typology of pathways. Conclusions Findings revealed four distinct pathways: missing opportunities, waiting and seeing, being alarmed, and being blindsided. Implications for practice The Pathways to a Lung Cancer Diagnosis Typology has important implications for clinical practice and can be used to inform NPs and other healthcare providers who provide care for patients at risk for or diagnosed with lung cancer

Lung Cancer Screening Participation: Developing a Conceptual Model to Guide Research

Purpose: To describe the development of a conceptual model to guide research focused on lung cancer screening participation from the perspective of the individual in the decision-making process. Methods: Based on a comprehensive review of empirical and theoretical literature, a conceptual model was developed linking key psychological variables (stigma, medical mistrust, fatalism, worry, and fear) to the health belief model and precaution adoption process model. Results: Proposed model concepts have been examined in prior research of either lung or other cancer screening behavior. To date, a few studies have explored a limited number of variables that influence screening behavior in lung cancer specifically. Therefore, relationships among concepts in the model have been proposed and future research directions presented. Conclusion: This proposed model is an initial step to support theoretically based research. As lung cancer screening becomes more widely implemented, it is critical to theoretically guide research to understand variables that may be associated with lung cancer screening participation. Findings from future research guided by the proposed conceptual model can be used to refine the model and inform tailored intervention development

Beyond Traditional Newspaper Advertisement: Leveraging Facebook-Targeted Advertisement to Recruit Long-Term Smokers for Research

BACKGROUND: Smokers are a stigmatized population, but an important population to reach for the purpose of research. Therefore, innovative recruitment methods are needed that are both cost-effective and efficacious in recruiting this population. OBJECTIVE: The aim of the present article was to evaluate the feasibility of Facebook-targeted advertisement to recruit long-term smokers eligible for lung cancer screening for a descriptive, cross-sectional survey. METHODS: A social media recruitment campaign was launched using Facebook-targeted advertisement to target age and keywords related to tobacco smoking in the Facebook users profile, interests, and likes. A 3-day newspaper advertisement recruitment campaign was used as a comparison. The study that used both recruitment methods aimed to test the psychometric properties of 4 newly developed lung cancer screening health belief scales. Data were collected via cross-sectional survey methodology using an Web-based survey platform. RESULTS: The Facebook-targeted advertisements were viewed 56,621 times over an 18-day campaign in 2015 in the United States. The advertisement campaign yielded 1121 unique clicks to the Web-based survey platform at a cost of $1.51 per completed survey. Of those who clicked through to the study survey platform, 423 (37.7$40.80 per completed survey. Participants represented current (n=182; 51%) and former smokers (n=178; 49%) with a mean age of 63.4 years (SD 6.0). Cost of the advertisement campaign was $500 total for the 18-day campaign. CONCLUSIONS: Recruitment by Facebook was more efficacious and cost-effective compared with newspaper advertisement. Facebook offers a new venue for recruitment into research studies that offer the potential for wider reach at a lower cost while providing privacy and flexibility for potential study participants. The study's findings extend recent work of other researchers who have demonstrated Facebook's utility with younger smokers, and Facebook is an effective tool to recruit older smokers. Furthermore, Facebook is a cost-effective alternative to traditional newspaper advertisement offering a new, affordable venue to recruit large numbers of older smokers efficiently

Lung cancer screening: what do long-term smokers know and believe?

Objective To explore knowledge and beliefs of long-term smokers about lung cancer, associated risk factors and lung cancer screening. Design Qualitative study theoretically framed by the expanded Health Belief Model based on four focus group discussions. Content analysis was performed to identify themes of knowledge and beliefs about lung cancer, associated risk factors and lung cancer screening among long-term smokers' who had and had not been screened for lung cancer. Methods Twenty-six long-term smokers were recruited; two groups (n = 9; n = 3) had recently been screened and two groups (n = 7; n = 7) had never been screened. Results While most agreed lung cancer is deadly, confusion or inaccurate information exists regarding the causes and associated risk factors. Knowledge related to lung cancer screening and how it is performed was low; awareness of long-term smoking's association with lung cancer risk remains suboptimal. Perceived benefits of screening identified include: (i) finding lung cancer early; (ii) giving peace of mind; and (iii) motivation to quit smoking. Perceived barriers to screening identified include: (i) inconvenience; (ii) distrust; and (iii) stigma. Conclusions Perceived barriers to lung cancer screening, such as distrust and stigma, must be addressed as lung cancer screening becomes more widely implemented. Heightened levels of health-care system distrust may impact successful implementation of screening programmes. Perceived smoking-related stigma may lead to low levels of patient engagement with medical care and decreased cancer screening participation. It is also important to determine modifiable targets for intervention to enhance the shared decision-making process between health-care providers and their high-risk patients