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Transforming patient-centered cancer care using telehealth: the MATCHES Center. 利用远程医疗转变以患者为中心的癌症护理:MATCHES 中心。
Pub Date : 2024-06-26 DOI: 10.1093/jncimonographs/lgae004
Erin M Bange, Robert M Daly, Allison Lipitz-Snyderman, Gilad Kuperman, Fernanda C G Polubriaginof, Chris Liebertz, Sahil D Doshi, Kristina Stevanovic, Kiana Chan, Camila Bernal, Yasin Khadem Charvadeh, Yuan Chen, Susan Chimonas, Peter Stetson, Deborah Schrag, Michael J Morris, Katherine S Panageas

Modern cancer care is costly and logistically burdensome for patients and their families despite an expansion of technology and medical advances that create the opportunity for novel approaches to care. Therefore, there is a growing appreciation for the need to leverage these innovations to make cancer care more patient centered and convenient. The Memorial Sloan Kettering Making Telehealth Delivery of Cancer Care at Home Efficient and Safe Telehealth Research Center is a National Cancer Institute-designated and funded Telehealth Research Center of Excellence poised to generate the evidence necessary to inform the appropriate use of telehealth as a strategy to improve access to cancer services that are convenient for patients. The center will evaluate telehealth as a strategy to personalize cancer care delivery to ensure that it is not only safe and effective but also convenient and efficient. In this article, we outline this new center's research strategy, as well as highlight challenges that exist in further integrating telehealth into standard oncology practice based on early experiences.

尽管技术的发展和医学的进步为新颖的治疗方法创造了机会,但现代癌症治疗对患者及其家属来说成本高昂、后勤负担沉重。因此,人们越来越认识到需要利用这些创新技术,使癌症治疗更加以病人为中心,更加方便。纪念斯隆-凯特琳癌症研究中心(Memorial Sloan Kettering Making Telehealth Delivery of Cancer Care at Home Efficient and Safe Telehealth Research Center)是美国国立癌症研究所指定并资助的远程医疗卓越研究中心,该中心准备提供必要的证据,为适当使用远程医疗作为改善患者获得便捷癌症服务的策略提供信息。该中心将对远程医疗进行评估,将其作为提供个性化癌症治疗的一种策略,以确保远程医疗不仅安全有效,而且方便高效。在本文中,我们将概述这一新中心的研究策略,并根据早期经验强调在将远程医疗进一步整合到标准肿瘤实践中时所面临的挑战。
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引用次数: 0
Telehealth Research and Innovation for Veterans with Cancer: the THRIVE Center. 针对癌症退伍军人的远程医疗研究与创新:THRIVE 中心。
Pub Date : 2024-06-26 DOI: 10.1093/jncimonographs/lgae019
Leah L Zullig, Danil Makarov, Daniel Becker, Navid Dardashti, Ivonne Guzman, Michael J Kelley, Irina Melnic, Janeth Juarez Padilla, Sidney Rojas, Jerry Thomas, Christa Tumminello, Scott E Sherman

Background: In recent years the US health-care system has witnessed a substantial increase in telehealth use. Telehealth enhances health-care access and quality and may reduce costs. However, there is a concern that the shift from in-person to telehealth care delivery may differentially improve cancer care access and quality in certain clinical settings and for specific patient populations while potentially exacerbating disparities in care for others. Our National Cancer Institute-funded center, called Telehealth Research and Innovation for Veterans with Cancer (THRIVE), is focused on health equity for telehealth-delivered cancer care. We seek to understand how social determinants of telehealth-particularly race and ethnicity, poverty, and rurality-affect the use of telehealth.

Methods: THRIVE draws from the Health Disparities Research Framework and the Consolidated Framework for Implementation Research. THRIVE consists of multiple cores that work synergistically to assess and understand health equity for telehealth-delivered cancer care. These include the Administrative Core, Research and Methods Core, Clinical Practice Network, and Pragmatic Trial.

Results: As of October 2023, we identified and trained 5 THRIVE scholars, who are junior faculty beginning a research career. We have reviewed 20 potential pilot studies, funding 6. Additionally, in communication with our funders and advisory boards, we have adjusted our study design and analytic approach, ensuring feasibility while addressing our operational partners' needs.

Conclusions: THRIVE has several key strengths. First, the Veterans Health Administration's health-care system is large and diverse regarding health-care setting type and patient population. Second, we have access to longitudinal data, predating the COVID-19 pandemic, about telehealth use. Finally, equitable access to high-quality care for all veterans is a major tenet of the Veterans Health Administration health-care mission. As a result of these advantages, THRIVE can focus on isolating and evaluating the impact of social determinants of telehealth on equity in cancer care.

背景:近年来,美国医疗保健系统对远程医疗的使用大幅增加。远程医疗提高了医疗服务的可及性和质量,并可降低成本。然而,有人担心,从面对面医疗服务到远程医疗服务的转变可能会在某些临床环境和特定患者群体中对癌症治疗的可及性和质量产生不同程度的改善,同时可能会加剧其他患者在治疗方面的差异。我们的国家癌症研究所资助中心名为 "癌症退伍军人远程医疗研究与创新"(THRIVE),主要研究远程医疗提供的癌症护理的健康公平性。我们试图了解远程医疗的社会决定因素,特别是种族和民族、贫困和农村地区如何影响远程医疗的使用:THRIVE 借鉴了 "健康差异研究框架 "和 "实施研究综合框架"。THRIVE 由多个核心组成,通过协同工作来评估和了解远程医疗提供的癌症护理的健康公平性。这些核心包括行政管理核心、研究与方法核心、临床实践网络和实用性试验结果:截至 2023 年 10 月,我们确定并培训了 5 名 THRIVE 学者,他们都是刚开始研究事业的初级教师。我们审查了 20 项潜在的试点研究,资助了 6 项。此外,通过与资助方和顾问委员会沟通,我们调整了研究设计和分析方法,在确保可行性的同时满足业务合作伙伴的需求:THRIVE 有几个主要优势。首先,退伍军人健康管理局的医疗保健系统规模庞大,在医疗保健机构类型和患者人群方面具有多样性。其次,我们可以获得 COVID-19 大流行之前有关远程医疗使用情况的纵向数据。最后,所有退伍军人都能公平地获得高质量的医疗服务,这也是退伍军人健康管理局医疗保健任务的主要宗旨。由于这些优势,THRIVE 可以专注于分离和评估远程医疗的社会决定因素对癌症治疗公平性的影响。
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引用次数: 0
A Framework for Integrating Telehealth Equitably across the cancer care continuum. 在癌症治疗过程中公平整合远程医疗的框架。
Pub Date : 2024-06-26 DOI: 10.1093/jncimonographs/lgae021
Katharine A Rendle, Andy S L Tan, Bonnie Spring, Erin M Bange, Allison Lipitz-Snyderman, Michael J Morris, Danil V Makarov, Robert Daly, Sofia F Garcia, Brian Hitsman, Olugbenga Ogedegbe, Siobhan Phillips, Scott E Sherman, Peter D Stetson, Anil Vachani, Jocelyn V Wainwright, Leah L Zullig, Justin E Bekelman

The COVID-19 pandemic placed a spotlight on the potential to dramatically increase the use of telehealth across the cancer care continuum, but whether and how telehealth can be implemented in practice in ways that reduce, rather than exacerbate, inequities are largely unknown. To help fill this critical gap in research and practice, we developed the Framework for Integrating Telehealth Equitably (FITE), a process and evaluation model designed to help guide equitable integration of telehealth into practice. In this manuscript, we present FITE and showcase how investigators across the National Cancer Institute's Telehealth Research Centers of Excellence are applying the framework in different ways to advance digital and health equity. By highlighting multilevel determinants of digital equity that span further than access alone, FITE highlights the complex and differential ways structural determinants restrict or enable digital equity at the individual and community level. As such, achieving digital equity will require strategies designed to not only support individual behavior but also change the broader context to ensure all patients and communities have the choice, opportunity, and resources to use telehealth across the cancer care continuum.

COVID-19 大流行凸显了在整个癌症护理过程中大幅增加远程医疗使用的潜力,但远程医疗能否以及如何在实践中以减少而非加剧不平等的方式实施,在很大程度上还是未知数。为了帮助填补研究和实践中的这一重要空白,我们开发了公平整合远程医疗框架 (FITE),这是一个流程和评估模型,旨在帮助指导将远程医疗公平整合到实践中。在本手稿中,我们介绍了 FITE,并展示了美国国家癌症研究所远程保健研究卓越中心的研究人员如何以不同的方式应用该框架来促进数字和健康公平。通过强调数字公平的多层次决定因素,FITE 突出了结构性决定因素在个人和社区层面限制或促进数字公平的复杂性和差异性。因此,要实现数字公平,不仅需要制定支持个人行为的策略,还需要改变更广泛的环境,以确保所有患者和社区都有选择、机会和资源在整个癌症护理过程中使用远程医疗。
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引用次数: 0
University of Pennsylvania Telehealth Research Center of Excellence. 宾夕法尼亚大学远程医疗卓越研究中心。
Pub Date : 2024-06-26 DOI: 10.1093/jncimonographs/lgae011
Jocelyn V Wainwright, Charu Aggarwal, Sarah Beucker, David W Dougherty, Peter E Gabriel, Linda A Jacobs, Jillian Kalman, Kristin A Linn, Anthony O Martella, Shivan J Mehta, Corinne M Rhodes, Megan Roy, Marilyn M Schapira, Lawrence N Shulman, Jennifer Steltz, Alisa J Stephens Shields, Andy S L Tan, Jeffrey C Thompson, Hannah Toneff, Richard C Wender, Sana Zeb, Katharine A Rendle, Anil Vachani, Justin E Bekelman

Drawing from insights from communication science and behavioral economics, the University of Pennsylvania Telehealth Research Center of Excellence (Penn TRACE) is designing and testing telehealth strategies with the potential to transform access to care, care quality, outcomes, health equity, and health-care efficiency across the cancer care continuum, with an emphasis on understanding mechanisms of action. Penn TRACE uses lung cancer care as an exemplar model for telehealth across the care continuum, from screening to treatment to survivorship. We bring together a diverse and interdisciplinary team of international experts and incorporate rapid-cycle approaches and mixed methods evaluation in all center projects. Our initiatives include a pragmatic sequential multiple assignment randomized trial to compare the effectiveness of telehealth strategies to increase shared decision-making for lung cancer screening and 2 pilot projects to test the effectiveness of telehealth to improve cancer care, identify multilevel mechanisms of action, and lay the foundation for future pragmatic trials. Penn TRACE aims to produce new fundamental knowledge and advance telehealth science in cancer care at Penn and nationally.

宾夕法尼亚大学远程医疗卓越研究中心(Penn TRACE)从传播学和行为经济学中汲取灵感,正在设计和测试远程医疗策略,这些策略有可能改变整个癌症治疗过程中的治疗机会、治疗质量、治疗效果、健康公平和医疗效率,重点是了解其作用机制。宾大 TRACE 将肺癌治疗作为远程医疗的典范,涵盖了从筛查到治疗再到生存的整个治疗过程。我们汇集了一支由国际专家组成的多元化跨学科团队,并在所有中心项目中采用快速循环方法和混合评估方法。我们的计划包括:一项实用性顺序多重分配随机试验,以比较远程医疗策略在肺癌筛查中增加共同决策的有效性;两个试点项目,以测试远程医疗在改善癌症护理、确定多层次作用机制方面的有效性,并为未来的实用性试验奠定基础。宾夕法尼亚大学 TRACE 项目旨在为宾夕法尼亚大学和全国的癌症治疗提供新的基础知识,推动远程医疗科学的发展。
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引用次数: 0
Advancing a telehealth and cancer control research agenda at the US National Cancer Institute. 在美国国家癌症研究所推进远程保健和癌症控制研究议程。
Pub Date : 2024-06-26 DOI: 10.1093/jncimonographs/lgae016
Robin C Vanderpool, Abigail Muro, Roxanne E Jensen
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引用次数: 0
National Cancer Institute-funded grants focused on synchronous telehealth cancer care delivery: a portfolio analysis. 美国国家癌症研究所资助的侧重于同步远程医疗癌症护理服务的赠款:组合分析。
Pub Date : 2024-06-26 DOI: 10.1093/jncimonographs/lgae003
Roxanne E Jensen, Rachelle Brick, Joshua Medel, Priyanga Tuovinen, Paul B Jacobsen, Rebecca Hardesty, Robin C Vanderpool

Background: Telehealth use increased during the COVID-19 pandemic and remains a complementary source of cancer care delivery. Understanding research funding trends in cancer-related telehealth can highlight developments in this area of science and identify future opportunities.

Methods: Applications funded by the US National Cancer Institute (NCI) between fiscal years 2016 and 2022 and focused on synchronous patient-provider telehealth were analyzed for grant characteristics (eg, funding mechanism), cancer focus (eg, cancer type), and study features (eg, type of telehealth service). Of 106 grants identified initially, 60 were retained for coding after applying exclusion criteria.

Results: Almost three-quarters (73%) of telehealth grants were funded during fiscal years 2020-2022. Approximately 67% were funded through R01 or R37 mechanism and implemented as randomized controlled trials (63%). Overall, telehealth grants commonly focused on treatment (30%) and survivorship (43%); breast cancer (12%), hematologic malignancies (10%), and multiple cancer sites (27%); and health disparity populations (ie, minorities, rural residents) (73%). Both audio and video telehealth were common (65%), as well as accompanying mHealth apps (20%). Telehealth services centered on psychosocial care, self-management, and supportive care (88%); interventions were commonly delivered by mental health professionals (30%).

Conclusion: NCI has observed an increase in funded synchronous patient-provider telehealth grants. Trends indicate an evolution of awards that have expanded across the cancer control continuum, applied rigorous study designs, incorporated additional digital technologies, and focused on populations recognized for disparate cancer outcomes. As telehealth is integrated into routine cancer care delivery, additional research evidence will be needed to inform clinical practice.

背景:在 COVID-19 大流行期间,远程保健的使用有所增加,目前仍是癌症护理服务的补充来源。了解与癌症相关的远程医疗的研究资助趋势可以突出这一科学领域的发展并确定未来的机会:对美国国家癌症研究所(NCI)在 2016 财年至 2022 财年期间资助的、以患者-医护人员同步远程医疗为重点的申请进行了分析,分析内容包括资助特点(如资助机制)、癌症重点(如癌症类型)和研究特点(如远程医疗服务类型)。在最初确定的 106 项资助中,有 60 项在应用排除标准后被保留下来进行编码:结果:近四分之三(73%)的远程医疗基金是在 2020-2022 财年获得资助的。约 67% 通过 R01 或 R37 机制获得资助,并以随机对照试验的形式实施(63%)。总体而言,远程医疗拨款通常侧重于治疗(30%)和幸存者(43%);乳腺癌(12%)、血液恶性肿瘤(10%)和多部位癌症(27%);以及健康差异人群(即少数民族、农村居民)(73%)。音频和视频远程保健都很常见(65%),配套的移动医疗应用程序也很常见(20%)。远程保健服务以社会心理护理、自我管理和支持性护理为中心(88%);干预措施通常由心理健康专业人员提供(30%):NCI观察到受资助的患者-提供者同步远程医疗补助金有所增加。这一趋势表明,获奖项目的范围已扩展到癌症控制的各个环节,采用了严格的研究设计,融入了更多的数字技术,并将重点放在了被公认为癌症结果不同的人群上。随着远程保健被纳入常规癌症护理服务,需要更多的研究证据为临床实践提供依据。
{"title":"National Cancer Institute-funded grants focused on synchronous telehealth cancer care delivery: a portfolio analysis.","authors":"Roxanne E Jensen, Rachelle Brick, Joshua Medel, Priyanga Tuovinen, Paul B Jacobsen, Rebecca Hardesty, Robin C Vanderpool","doi":"10.1093/jncimonographs/lgae003","DOIUrl":"10.1093/jncimonographs/lgae003","url":null,"abstract":"<p><strong>Background: </strong>Telehealth use increased during the COVID-19 pandemic and remains a complementary source of cancer care delivery. Understanding research funding trends in cancer-related telehealth can highlight developments in this area of science and identify future opportunities.</p><p><strong>Methods: </strong>Applications funded by the US National Cancer Institute (NCI) between fiscal years 2016 and 2022 and focused on synchronous patient-provider telehealth were analyzed for grant characteristics (eg, funding mechanism), cancer focus (eg, cancer type), and study features (eg, type of telehealth service). Of 106 grants identified initially, 60 were retained for coding after applying exclusion criteria.</p><p><strong>Results: </strong>Almost three-quarters (73%) of telehealth grants were funded during fiscal years 2020-2022. Approximately 67% were funded through R01 or R37 mechanism and implemented as randomized controlled trials (63%). Overall, telehealth grants commonly focused on treatment (30%) and survivorship (43%); breast cancer (12%), hematologic malignancies (10%), and multiple cancer sites (27%); and health disparity populations (ie, minorities, rural residents) (73%). Both audio and video telehealth were common (65%), as well as accompanying mHealth apps (20%). Telehealth services centered on psychosocial care, self-management, and supportive care (88%); interventions were commonly delivered by mental health professionals (30%).</p><p><strong>Conclusion: </strong>NCI has observed an increase in funded synchronous patient-provider telehealth grants. Trends indicate an evolution of awards that have expanded across the cancer control continuum, applied rigorous study designs, incorporated additional digital technologies, and focused on populations recognized for disparate cancer outcomes. As telehealth is integrated into routine cancer care delivery, additional research evidence will be needed to inform clinical practice.</p>","PeriodicalId":73988,"journal":{"name":"Journal of the National Cancer Institute. Monographs","volume":"2024 64","pages":"55-61"},"PeriodicalIF":0.0,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11207831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141461174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cancer stigma: the need for policy and programmatic action. 癌症耻辱化:政策和计划行动的必要性。
Pub Date : 2024-06-05 DOI: 10.1093/jncimonographs/lgae014
Sonali Elizabeth Johnson, Mélanie Samson

Cancer is a stigmatized disease in many countries that impacts the quality of life and mental health of people affected by cancer. This commentary examines some dimensions of cancer stigma and has been developed based on insights from participants in a Union for International Cancer Control program dedicated to cancer patient organizations in low- and middle-income countries. Aimed at program managers and policy makers, this commentary highlights the importance of developing strategies to reduce cancer stigma in cancer control programs in different contexts, working closely with community-based civil society organizations and those with lived experience of cancer to understand, evaluate, and take action regarding the impact of cancer stigma on health-seeking behavior and patients' quality of life.

在许多国家,癌症是一种被污名化的疾病,影响着癌症患者的生活质量和心理健康。本评论探讨了癌症污名化的一些方面,是根据国际癌症控制联盟专门为中低收入国家癌症患者组织开展的一项计划的参与者提出的见解编写的。本评论针对项目管理人员和政策制定者,强调了在不同情况下制定战略以减少癌症控制项目中的癌症污名化的重要性,与社区民间社会组织和癌症患者密切合作,了解、评估癌症污名化对寻求健康行为和患者生活质量的影响,并采取相应行动。
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引用次数: 0
A "What Matters Most" approach to investigating intersectional stigma toward HIV and cancer in Hanoi, Vietnam. 采用 "什么最重要 "的方法,调查越南河内对艾滋病和癌症的交叉污名。
Pub Date : 2024-06-05 DOI: 10.1093/jncimonographs/lgae002
Evan L Eschliman, Dung Hoang, Nasim Khoshnam, Vivian Ye, Haruka Kokaze, Yatong Ji, Yining Zhong, Aditi Morumganti, Wenyu Xi, Sijia Huang, Karen Choe, Ohemaa B Poku, Gloria Alvarez, Trang Nguyen, Nam Truong Nguyen, Donna Shelley, Lawrence H Yang

Background: Vietnam is experiencing a growing burden of cancer, including among people living with HIV. Stigma acts as a sociocultural barrier to the prevention and treatment of both conditions. This study investigates how cultural notions of "respected personhood" (or "what matters most") influence manifestations of HIV-related stigma and cancer stigma in Hanoi, Vietnam.

Methods: Thirty in-depth interviews were conducted with people living with HIV in Hanoi, Vietnam. Transcripts were thematically coded via a directed content analysis using the What Matters Most conceptual framework. Coding was done individually and discussed in pairs, and any discrepancies were reconciled in full-team meetings.

Results: Analyses elucidated that having chữ tín-a value reflecting social involvement, conscientiousness, and trustworthiness-and being successful (eg, in career, academics, or one's personal life) are characteristics of respected people in this local cultural context. Living with HIV and having cancer were seen as stigmatized and interfering with these values and capabilities. Intersectional stigma toward having both conditions was seen to interplay with these values in some ways that had distinctions compared with stigma toward either condition alone. Participants also articulated how cultural values like chữ tín are broadly protective against stigmatization and how getting treatment and maintaining employment can help individuals resist stigmatization's most acute impacts.

Conclusions: HIV-related and cancer stigma each interfere with important cultural values and capabilities in Vietnam. Understanding these cultural manifestations of these stigmas separately and intersectionally can allow for greater ability to measure and respond to these stigmas through culturally tailored intervention.

背景:越南的癌症负担日益加重,其中包括艾滋病毒感染者。污名化是预防和治疗这两种疾病的社会文化障碍。本研究调查了在越南河内,"受尊重的人格"(或 "最重要的东西")的文化观念如何影响艾滋病相关污名化和癌症污名化的表现形式:对越南河内的艾滋病病毒感染者进行了 30 次深入访谈。采用 "什么最重要 "概念框架,通过定向内容分析对访谈记录进行主题编码。编码工作由个人完成,然后两人一组进行讨论,如有任何差异,则在全组会议上进行协调:分析结果表明,在当地文化背景下,拥有 "chítín"--一种反映社会参与、认真负责和值得信赖的价值观--以及成功(如在事业、学术或个人生活方面)是受人尊敬的人的特征。艾滋病病毒感染者和癌症患者被认为是被污名化的,会影响这些价值观和能力。人们认为,对患有这两种疾病的交叉性污名化与这些价值观在某些方面相互影响,与单独对其中一种疾病的污名化有所不同。参与者还阐明了文化价值观(如 "中国")如何在很大程度上保护人们免受鄙视,以及接受治疗和保持就业如何帮助个人抵御鄙视带来的最严重影响:结论:在越南,与艾滋病相关的鄙视和癌症鄙视都会干扰重要的文化价值观和能力。单独和交叉地了解这些鄙视的文化表现形式,可以提高通过文化定制干预来衡量和应对这些鄙视的能力。
{"title":"A \"What Matters Most\" approach to investigating intersectional stigma toward HIV and cancer in Hanoi, Vietnam.","authors":"Evan L Eschliman, Dung Hoang, Nasim Khoshnam, Vivian Ye, Haruka Kokaze, Yatong Ji, Yining Zhong, Aditi Morumganti, Wenyu Xi, Sijia Huang, Karen Choe, Ohemaa B Poku, Gloria Alvarez, Trang Nguyen, Nam Truong Nguyen, Donna Shelley, Lawrence H Yang","doi":"10.1093/jncimonographs/lgae002","DOIUrl":"10.1093/jncimonographs/lgae002","url":null,"abstract":"<p><strong>Background: </strong>Vietnam is experiencing a growing burden of cancer, including among people living with HIV. Stigma acts as a sociocultural barrier to the prevention and treatment of both conditions. This study investigates how cultural notions of \"respected personhood\" (or \"what matters most\") influence manifestations of HIV-related stigma and cancer stigma in Hanoi, Vietnam.</p><p><strong>Methods: </strong>Thirty in-depth interviews were conducted with people living with HIV in Hanoi, Vietnam. Transcripts were thematically coded via a directed content analysis using the What Matters Most conceptual framework. Coding was done individually and discussed in pairs, and any discrepancies were reconciled in full-team meetings.</p><p><strong>Results: </strong>Analyses elucidated that having chữ tín-a value reflecting social involvement, conscientiousness, and trustworthiness-and being successful (eg, in career, academics, or one's personal life) are characteristics of respected people in this local cultural context. Living with HIV and having cancer were seen as stigmatized and interfering with these values and capabilities. Intersectional stigma toward having both conditions was seen to interplay with these values in some ways that had distinctions compared with stigma toward either condition alone. Participants also articulated how cultural values like chữ tín are broadly protective against stigmatization and how getting treatment and maintaining employment can help individuals resist stigmatization's most acute impacts.</p><p><strong>Conclusions: </strong>HIV-related and cancer stigma each interfere with important cultural values and capabilities in Vietnam. Understanding these cultural manifestations of these stigmas separately and intersectionally can allow for greater ability to measure and respond to these stigmas through culturally tailored intervention.</p>","PeriodicalId":73988,"journal":{"name":"Journal of the National Cancer Institute. Monographs","volume":"2024 63","pages":"11-19"},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141249146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The global landscape of cancer stigma research and practice: perspectives, measures, interventions, and actions for change. 全球癌症耻辱化研究与实践:观点、措施、干预和变革行动。
Pub Date : 2024-06-05 DOI: 10.1093/jncimonographs/lgae009
Kathryn Heley, Vidya Vedham, Robin C Vanderpool
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引用次数: 0
Examining evidence of lung cancer stigma among health-care trainees. 研究医护受训人员对肺癌的污名化证据。
Pub Date : 2024-06-05 DOI: 10.1093/jncimonographs/lgae010
Jamie L Studts, Catherine M Deffendall, Shelby L McCubbin, Heidi A Hamann, Kaitlyn Hoover, Whitney M Brymwitt, Timothy J Williamson

Background: Innovations in lung cancer control and care have started to transform the landscape of lung cancer outcomes, but lung cancer stigma and biases have been implicated as a deterrent to realizing the promise of these innovations. Research has documented lung cancer stigma among the general public and lung cancer survivors (self-blame), as well as clinicians across many disciplines. However, studies have not explored lung cancer stigma in health-care trainees. These data seek to address that gap and inform efforts to prevent the emergence or mitigate the presence of lung cancer stigma among future clinicians.

Methods: Using clinical vignettes and a 2x2 factorial design, this investigation evaluated the impact of a history of smoking (yes vs no) and cancer diagnosis (lung vs colorectal) on perceptions of the described patient among 2 groups of preclinical health-care trainees (medical = 94 and nursing = 138). A charitable giving paradigm also asked participants to donate provided funds to 1 of 2 cancer advocacy organizations: one serving the lung cancer community and one serving the colorectal cancer community.

Results: In study 1, results revealed a consistent pattern of statistically significant and medium to large effect size differences regarding stigmatized perceptions (eg, higher stigmatizing behavior, increased pity, greater anger, and less helping) for individuals with a history of smoking but no reliable differences regarding cancer diagnosis. Analysis of data from nursing trainees in study 2 showed a similar pattern of statistically significant and medium to large effects pertaining to stigma behavior and perceptions of individuals who had a history of smoking depicted in the vignettes. The charitable giving paradigm did not identify any reliable difference between the groups in either study.

Conclusions: Findings revealed a consistent pattern of health-care trainee perceptions that varied by smoking status but much less evidence that the cancer diagnosis contributed to different perceptions. This suggests that efforts to integrate consideration of stigma and biases in health-care training needs to adopt an approach that seeks to mitigate or eliminate stigmatizing perceptions and behaviors toward individuals with a history of smoking.

背景:肺癌控制和护理方面的创新已开始改变肺癌的治疗效果,但肺癌耻辱感和偏见已被认为是阻碍实现这些创新承诺的因素。研究记录了公众和肺癌幸存者(自责)以及许多学科的临床医生对肺癌的成见。然而,还没有研究探讨过医护受训人员的肺癌耻辱感。这些数据旨在填补这一空白,并为防止未来临床医生出现或减轻肺癌蔑视提供信息:本调查采用临床小故事和 2x2 因式设计,评估了吸烟史(有与无)和癌症诊断(肺癌与结直肠癌)对两组临床前医护受训人员(医护 = 94 人和护理 = 138 人)对所描述病人的看法的影响。慈善捐赠范式还要求参与者将提供的资金捐赠给两个癌症宣传机构中的一个:一个为肺癌群体服务,另一个为结直肠癌群体服务:在研究 1 中,结果显示有吸烟史的人在鄙视感(如更高的鄙视行为、更多的怜悯、更大的愤怒和更少的帮助)方面存在一致的具有统计学意义的大中型效应大小差异,但在癌症诊断方面没有可靠的差异。对研究 2 中护理受训者数据的分析表明,与小故事中描述的有吸烟史的人的鄙视行为和看法有关的统计显著性和中至大效应的模式类似。在这两项研究中,慈善捐赠范式均未发现组间存在任何可靠的差异:研究结果显示,医护受训人员的认知模式因吸烟状况而异,但癌症诊断导致不同认知的证据却少得多。这表明,要在医护培训中考虑污名化和偏见问题,就必须采取一种方法来减轻或消除对有吸烟史的人的污名化观念和行为。
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引用次数: 0
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