How do Lung Cancer Patients Experience Stigma?: A Meta-synthesis of Qualitative Studies

Ji Yeon Jeong; Gyeonghui Jeong; Hyang Sook So

doi:10.7469/kjan.2016.28.1.116

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Jeong, Jeong, and So: How do Lung Cancer Patients Experience Stigma?: A Meta-synthesis of Qualitative Studies

Original Article

Korean J Adult Nurs 2016;28(1):116-126.

Published online: February 2016

DOI: https://doi.org/10.7469/kjan.2016.28.1.116

How do Lung Cancer Patients Experience Stigma?: A Meta-synthesis of Qualitative Studies

Ji Yeon Jeong¹, Gyeonghui Jeong^2,, Hyang Sook So³

^¹Chonnam National University Hospital, Gwangju

^²Dream CIS, Seoul

^³College of Nursing, Chonnam National University, Gwangju, Korea

Corresponding author: Jeong, Gyeonghui Dream CIS, 130 Sajik-ro, Jongno-gu, Seoul 03170, Korea. Tel: +82-2-2010-4493, Fax: +82-2-2010-4593, E-mail: gyeonghui.jeong@gmail.com

Received 10 January 201613 February 2016 Accepted 13 February 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Lung cancer patients are often stigmatized since lung cancer is closely associated with smoking, which is a self-administered life style. The stigma of lung cancer has been examined in some qualitative studies; however, their findings were diverse and not yet synthesized. Therefore, this meta-synthesis study aimed to explore how lung cancer patients experience stigma.

Methods

A meta-synthesis method, as suggested by Sandelowski and Barroso in 2007, was applied by aggregating the findings after an evaluation according to consolidated criteria for reporting qualitative research (COREQ).

Results

By synthesizing the findings of the selected seven papers, a synthesized theme was emerged as “experiencing external and internal distances, which mandates authentic and consistent supports.” The four sub-themes included ‘experiencing some distance from the surrounded world,’ ‘experiencing self-made distance between the disease and oneself,’ ‘the disease experience causes social isolation and loneliness,’ and ‘there is lack of supportive care for myself.’

Conclusion

Health care providers should be more attentive to supporting lung cancer patients by providing more effective advocacy programs that improve patients’ quality of life.

Keywords: Lung cancer, Stigma, Qualitative study, Meta-synthesis

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Figure 1.

Flowchart of the search process.

Table 1.

Searching Terms AND “Stigma” (MeSH)

“Lung cancer” (MeSH)
OR
Lung cancer
OR
Pulmonary cancer		“Stigma”: (MeSH)
OR		OR
Lung tumo?r	AND	Stigma∗
OR
Pulmonary tumo?r
OR
Lung carcinoma
OR
Pulmonary carcinoma

Table 2.

Summary of the Included Studies

Author (year)	Title	Nation	Method	Analysis method	Participants	Findings
Brown & Cataldo (2013)	Explorations of lung cancer stigma for female long-term survivors	USA	One-on-one and group interview	Gee's discourse analysis methodology, Fairclough's critical discourse theory, integrates thematic analysis, linguistic analysis, discourse analysis and critical discourse analysis	N=8	Unvoiced precursors-tobacco industry and addiction influence
						․ Perception of LCS-diagnosis and interaction with healthcare providers
						․ Perception of stigma-shifting entities
						․ Responses to stigma-information control, advocacy
						․ Conflicting responses to stigma-simultaneous rejection and assumption of stigma
Chapple et al (2004)	Stigma, shame, and blame experienced by patients with lung cancer qualitative study	United Kingdom	Narrative interview	Not mentioned	N=45	․ Patient's experience and fear of stigma
						․ Resistance to blame and stigmatization
						․ Fear about lack of access to medical care
Hamann et al (2014)	Stigma among patients with lung cancer: A patient-reported measurement model	USA	Semi-structured interviews and focus groups	d Thematic analysis	․ Interview group (n=42)	․ Perceived/felt stigma
					․ Interview group (n=42)	․ Internalized stigma: self-blame, guilt, shame, anger, regret
					․ Five focus groups (n=23)	․ Consequences
Lehto (2014)	Patient views on smoking, lung cancer, and stigma: A focus group perspective	USA	A focus group	Thematic analysis	․ Four focus groups (n=11)	․ Societal attitudes
						․ Institutional practices and experiences
						․ Negative thoughts and emotions
						․ Actual stigmatization experiences
						․ Smoking cessation: personal choice versus addiction
						․ Causal attributions
Rowland et al (2014)	Quality of life, support and smoking in advanced lung cancer patients: a qualitative study	United Kingdom	Semi-structured interviews	Interpretative phenomenological analysis	N=9	․ Effects of illness on quality of life ․ Family support ․ Coping strategies ․ Medical support ․ Smoking
Rowland et al (2014)		United Kingdom	Semi-structured interviews	Interpretative phenomenological analysis	N=9
Scott et al (2015)	Stigma as a barrier to diagnosis of lung cancer: patient and general practitioner perspectives	Australia	Semi-structured in-depth interview	Thematic analysis	N=20	․ Experience of blame and stigma
					․ Patient (n=10), GP (n=10)	․ GPs preconceptions of lung cancer risk
					․ Patient (n=10), GP (n=10)	․ Anti-smoking messaging
Tod et al (2008)	Diagnostic delay in lung cancer	United Kingdom	Semi-structured individual interviews	Framework analysis	N=20	․ Symptom experience
						․ Knowledge
						․ Fear
						․ Blame and stigma
						․ Culture

Table 3.

Quality Appraisal Tool (COREQ)

Item	a1	a2	a3	a4	a5	a6	a7
Domain 1: Research team and reflexivity
1. Interviewer/Facilitator Which author/s conducted the interview or focus group?	nc	✓	nc	✓	nc	nc	✓
2. Credentials What were the researcher's credentials?	✓	✓	nc	✓	✓	X	✓
3. Occupations What was their occupation at the time of the study?	✓	✓	✓	✓	nc	✓	✓
4. Gender Was the researcher male or female?	nc	nc	nc	nc	nc	nc	nc
5. Experience and training What experience or training did the researcher have?	nc	nc	✓	✓	X	nc	X
6. Relationship established Was a relationship established prior to study commencement?	X	X	✓	✓	X	X	X
7. Participant knowledge of interviewer What did the participants know about the researcher?	X	X	✓	✓	X	X	X
8. Interviewer characteristics What characteristics were reported about the interviewer/facilitator?	X	✓	✓	✓	X	nc	X
Domain 2: Study design
9. Methodological orientation and Theory What methodological orientation was stated to underpin the study?	✓	X	✓	v	✓	✓	✓
10. Sampling How were participants selected?	✓	✓	✓	✓	✓	✓	✓
11. Method of approach How were participants approached?	✓	✓	✓	✓	✓	✓	✓
12. Sample size How many participants were in study?	✓	✓	✓	✓	✓	✓	✓
13. Non-participation How many people refused to participate or dropped out? Reasons?	X	X	✓	✓	✓	X	X
14. Setting of data collection Where was the data collected?	nc	✓	✓	✓	✓	X	✓
15. Presence of non-participants Was anyone else present besides the participants and researchers?	X	X	✓	X	X	X	✓
16. Description of sample What are the important characteristics of the sample?	✓	✓	✓	✓	✓	nc	✓
17. Interview guide Were questions, prompts, guides provided by the authors? Was it pilot tested?	✓	X	✓	X	✓	X	X
18. Repeat Interviews Were repeat interviews carried out? If yes, how many?	X	X	X	X	X	X	X
19. Audio/visual recording Did the research use audio or visual recording to collect the data?	✓	✓	✓	✓	✓	✓	✓
20. Field notes Were field notes made during and/or after the interview or focus group?	X	X	X	X	X	X	✓
21. Duration What was the duration of the interviews or focus group?	✓	✓	X	nc	✓	X	✓
22. Data saturation Was data saturation discussed?	X	✓	✓	X	✓	X	X
23. Transcripts returned Were transcripts returned to participants for comment and/or correction?	X	✓	X	X	X	X	X
Domain 3: Analysis and findings
24. Number of data coders How many data coders coded the data?	X	✓	✓	✓	✓	X	✓
25. Description of the coding tree Did authors provide a description of the coding tree?	X	X	nc	X	✓	X	X
26. Derivation of themes Were themes identified in advance or derived from the data?	✓	✓	✓	✓	✓	✓	✓
27. Software What software, if applicable, was used to manage the data?	X	✓	✓	X	X	✓	✓
28. Participant checking Did participants provide feedback on the findings?	X	X	✓	X	X	X	X
29. Quotations presented Were participant quotations presented to illustrate the themes/findings?	✓	✓	✓	✓	✓	✓	✓
30. Data and findings consistent Was there consistency between the data presented and the findings?	✓	✓	✓	✓	✓	✓	✓
31. Clarity of major themes Were major themes clearly presented in the findings?	✓	✓	✓	✓	✓	✓	✓
32. Clarity of minor themes Is there a description of diverse cases or discussion of minor themes?	nc	nc	✓	✓	✓	nc	nc

Key: ✓=Information was provided and described; X=Information was not provided; nc=Information was not clear or sufficient.

Table 4.

Meta-aggregation Process

Findings (Extraction) ➡	Categories (Categorization) ➡	Sub-themes (Categorization) ➡	Synthesis (Synthesization)
53 findings from 7 papers	Perceived stigma by public Perceived stigma by family and friends Perceived stigma by health care providers	Experiencing some distance from the surrounded world	Experiencing external and internal distances, which mandates authentic and consistent supports
	Blame, guilt, shame, and frustration Regret, anger, and fear Shifting of identities Social isolation and loneliness	Experiencing self-made distance between the disease and oneself The disease experience causes social isolation and loneliness
	Lack of supportive care	There is lack of supportive care for myself

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