Psychological wellness and health‐related stigma: a pilot study of an acceptance‐focused cognitive behavioural intervention for people with lung cancer

Abstract

People with lung cancer experience health-related stigma that is related to poorer psychosocial and quality of life outcomes. The present Phase 1 study applied mixed methods to test the acceptability of an acceptance-focused cognitive behavioural intervention targeting stigma for this patient group. Fourteen lung cancer patients completed a 6-week Psychological Wellness intervention with pre- and post-test outcome measures of psychological and cancer-specific distress, depression, health-related stigma and quality of life. In-depth interviews applying interpretative phenomenological analysis assessed participants' experiences of the intervention. Moderate to large improvements were observed in psychological (ηp2 = 0.182) and cancer-specific distress (ηp2 = 0.056); depression (ηp2 = 0.621); health-related stigma (ηp2 = 0.139). In contrast, quality of life declined (ηp2 = 0.023). The therapeutic relationship; self-management of distress; and relationship support were highly valued aspects of the intervention. Barriers to intervention included avoidance and practical issues. The lung cancer patients who completed the Psychological Wellness intervention reported improvements in psychological outcomes and decreases in stigma in the face of declining quality of life with patients reporting personal benefit from their own perspectives. A randomised controlled trial is warranted to establish the effectiveness of this approach.

Cancer survivors’ perspectives on adjustment-focused self-management interventions: a qualitative meta-synthesis

“…Facilitators were an important source of emotional and informational support for participants in both one-on-one 20 [27,28] and group-based [26,29,31,[34][35][36][37] interventions. Their knowledge of cancer survivorship and 21 understanding of the various challenges it poses were positively received by participants [27,28,31,37], who valued having the opportunity to ask questions about their illness and its consequences [26,35,37] and appreciated 23 their ability to convey information in everyday language [35,37].…”

“…Their knowledge of cancer survivorship and 21 understanding of the various challenges it poses were positively received by participants [27,28,31,37], who valued having the opportunity to ask questions about their illness and its consequences [26,35,37] and appreciated 23 their ability to convey information in everyday language [35,37]. Some commented that they were especially 24 skilled at managing group discussions and ensuring that everyone's voice was heard [35,36] participants' emotional wellbeing [26-29, 31, 37].…”

“…Participants noted how the support and understanding provided by peers and/or facilitators helped to foster an 1 open and "non-stigmatised" [34, p. 1494] environment in which sensitive issues relating to their experiences of 2 cancer -such as recurrence [37], death [27], sexuality [28], or stigma (of lung cancer) [27] -could be discussed 3 freely and without self-censorship [25-28, 34, 35, 37]. Testicular cancer survivors in Martin and colleagues' [35] 4 study remarked that men rarely talked openly about their experiences, which made this aspect of their intervention 5 particularly important to them.…”

“…Testicular cancer survivors in Martin and colleagues' [35] 4 study remarked that men rarely talked openly about their experiences, which made this aspect of their intervention 5 particularly important to them. Some participants talked about how their loved ones had trouble understanding or 6 accepting what they were going through [26,27]; having a "neutral" [27, p. 66] audience, independent from other 7 sources of support in their lives, with whom they could talk about their experiences was greatly valued. …”

“…Across studies, participants reported receiving education and training in the use of various skills and practices that 26 enhanced their ability to self-manage the consequences of cancer and its treatment [25][26][27][28][29][30][31][32][34][35][36]. Goal setting…”