Korean J Adult Nurs.  2018 Feb;30(1):89-97. 10.7475/kjan.2018.30.1.89.

Stigma and Distress among Cancer Patients: The Mediating Effect of Self-blame

• Yang KM
• Chae MJ
• So HS

• KMID: 2405702
• DOI: http://doi.org/10.7475/kjan.2018.30.1.89

Abstract

PURPOSE
The purpose of this study was to identify the mediating effect of reported self-blame in the relationship between stigma and distress among cancer patients.
METHODS
A convenience sample of 247 inpatients and outpatients diagnosed with one of the five major cancers was recruited. A cross-sectional survey design was used. Data were collected from June 2013 to November 2013. The instruments used for data collection were the Korean Cancer Stigma Scale, the Psychological Symptom Inventory, and the Social Shame and Guilt Scale. Data were analyzed using descriptive statistics, correlation, and multiple regression using Baron and Kenny steps for mediation.
RESULTS
The mean score reported for cancer stigma was 35.34, the mean score for distress was 13.77, and the mean for self-blame was 19.25. There was a significant correlation among stigma, distress, and self-blame. Self-blame was directly affected by stigma (R2=34.3%). Distress was directly affected by stigma (R2=13.0%). Stigma and self-blame impacted reported distress (R2=20.9%). Self-blame had a partial mediating effect (β=.35, p < .001) in the relationship between stigma and distress (Sobel test: Z=3.64, p < .001).
CONCLUSION
Based on the findings of this study, nursing intervention programs focusing on reducing stigma and decreasing self-blame may relieve the distress reported by patients with cancer.

MeSH Terms

Cross-Sectional Studies
Data Collection
Guilt
Humans
Inpatients
Negotiating*
Nursing
Outpatients
Shame
Social Stigma

Figure

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  Figure 1. Mediating effect of self-blame in the relationship between stigma and distress.

Reference

1.National Cancer Information Center. Cancer incidence trend analysis [Internet]. Seoul: National Cancer Information Center;2017. [cited 2017 December 26]. Available from. https://www.cancer.go.kr/lay1/S1T639C643/contents.do.

2.Statistics Korea. Cause of death statistics in 2016 [Internet]. Seoul: Statistics Korea;2017. [cited 2017 September 22]. Available from. http://kostat.go.kr/portal/korea/kor_nw/2/6/1/index.board?bmode=read&aSeq=363268.

3.Lee JL., Kim KS. The relationships between stigma, distress, and quality of life in patients with lung cancer. Journal of Korean Oncology Nursing. 2011. 11(3):237–46. https://doi.org/10.5388/jkon.2011.11.3.237.

4.Chapple A., Ziebland S., McPherson A. Stigma, shame and blame experienced by patients with lung cancer: qualitative study. British Medical Journal. 2004. 328(7454):1470–3. https://doi.org/10.1136/bmj.38111.639734.7C.

5.LoConte NK., Else-Quest NM., Eickhoff J., Hyde J., Schiller JH. Assessment of guilt and shame in patients with non-small-cell lung cancer compared with patients with breast and prostate cancer. Clinical Lung Cancer. 2008. 9(3):171–8. https://doi.org/10.3816/CLC.2008.n.026.

6.Corrigan PW., Watson AC. The stigma of psychiatric disorders and the gender, ethnicity, and education of the perceiver. Com-munity Mental Health Journal. 2007. 43(5):439–58. https://doi.org/10.1007/s10597-007-9084-9.

7.Cho J., Smith K., Choi EK., Kim IR., Chang YJ., Park HY, et al. Public attitudes toward cancer and cancer patients: a national survey in Korea. Psycho-Oncology. 2013. 22(3):605–13. https://doi.org/10.1002/pon.3041.

8.Cataldo JK., Jahan TM., Pongquan VL. Lung cancer stigma, depression, and quality of life among ever and never smokers. European Journal of Oncology Nursing. 2012. 16(3):264–9. https://doi.org/10.1016/j.ejon.2011.06.008.

9.Else-Quest NM., LoConte NK., Schiller JH., Hyde JS. Perceived stigma, self-blame, and adjustment among lung, breast and prostate cancer patients. Psychology and Health. 2009. 24(8):949–64. https://doi.org/10.1080/08870440802074664.

10.Phelan SM., Griffin JM., Jackson GL., Zafar SY., Hellerstedt W., Stahre M, et al. Stigma, perceived blame, self-blame, and de-pressive symptoms in men with colorectal cancer. Psycho-Oncology. 2013. 22(1):65–73. https://doi.org/10.1002/pon.2048.

11.National Comprehensive Cancer Network. Managing stress and distress 2017 [Internet]. [cited 2017 July 10]. Available from. https://www.nccn.org/patients/resources/life_with_cancer/distress.aspx.

12.National Cancer Information Center. Recommendations for distress management in cancer patients [Internet]. Seoul: Min-istry for Health, Welfare and Family Affairs;2008. [cited 2012 May 20]. Available from. http://www.cancer.go.kr/ebook/6/PC/6.html.

13.Zabora J., Brintzenhofeszoc K., Curbow B., Hooker C., Pianta-dosi S. The prevalence of psychological distress by cancer site. Psycho-Oncology. 2001. 10(1):19–28. https://doi.org/10.1002/1099-1611(200101/02)10:1<19::AID-PON501>3.0.CO;2-6.

14.Shim EJ., Shin JW., Jeon HJ., Hahm BJ. Distress and its correlates in Korean cancer patients: pilot use of the distress thermometer and the problem list. Psycho-Oncology. 2008. 17(6):548–55. https://doi.org/10.1002/pon.1275.

15.Jeong KS., Heo JE., Tae YS. Relationships among distress, fam-ily support, and health promotion behavior in breast cancer survivors. Asian Oncology Nursing. 2014. 14(3):146–54. https://doi.org/10.5388/aon.2014.14.3.146.

16.Kwon EJ., Yi MS. Distress and quality of life in breast cancer survivors in Korea. Asian Oncology Nursing. 2012. 12(4):289–96. https://doi.org/10.5388/aon.2012.12.4.289.

17.Seo JY., Yi MS. Distress and quality of life in cancer patients re-ceiving chemotherapy. Asian Oncology Nursing. 2015. 15(1):18–27. https://doi.org/10.5388/aon.2015.15.1.18.

18.Hamer M., Chida Y., Molloy GJ. Psychological distress and cancer mortality. Journal of Psychosomatic Research. 2009. 66(3):255–8. https://doi.org/10.1016/j.jpsychores.2008.11.002.

19.Brown KW., Levy AR., Rosberger Z., Edgar L. Psychological distress and cancer survival: a follow-up 10 years after diagnosis. Psychosomatic Medicine. 2003. 65(4):636–43. https://doi.org/10.1097/01.PSY.0000077503.96903.A6.

20.Raleigh ZT. A biopsychosocial perspectives on the experience of lung cancer. Journal of Psychosocial Oncology. 2010. 28(1):116–25. https://doi.org/10.1080/07347330903438990.

21.Chambers SK., Baade P., Youl P., Aitken J., Occhipinti S., Vinod S, et al. Psychological distress and quality of life in lung cancer: the role of health-related stigma, illness appraisals and social constraints. Psycho-Oncology. 2015. 24(11):1569–77. https://doi.org/10.1002/pon.3829.

22.Bennett KK., Compas BE., Beckjord E., Glinder JG. Self-blame and distress among women with newly diagnosed breast can-cer. Journal of Behavioral Medicine. 2005. 28(4):). 313–23. https://doi.org/10.1007/s10865-005-9000-0.

23.So HS., Chae MJ., Kim HY. Reliability and validity of the Korean version of the cancer stigma scale. Journal of Korean Acad-emy of Nursing. 2017. 47(1):121–32. https://doi.org/10.4040/jkan.2017.47.1.121.

24.Marschall D., Sanftner J., Tangney JP. The state shame and guilt scale. Fairfax, VA: George Mason University;1994.

25.Baron RM., Kenny DA. The moderator-mediator variable dis-tinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology. 1986. 51(6):1173–82.

26.Byun HS., Kim EK., Kim GD. Impacts of stigma and distress on the quality of life in patients with lung cancer. Crisisonomy. 2015. 11(8):223–40.

27.Brown Johnson CG., Broadsky JL., Cataldo JK. Lung cancer stigma, anxiety, depression, and quality of life. Journal of Psychosocial Oncology. 2014. 32(1):59–73. https://doi.org/10.1080/07347332.2013.855963.

28.Glinder JG., Compas BE. Self-blame attributions in women with newly diagnosed breast cancer: a prospective study of psychological adjustment. Health Psychology. 1999. 18(5):475–81. https://doi.org/10.1037/0278-6133.18.5.475.