Barbara D. Powe

Cancer fatalism: The state of the science

Cancer fatalism—the belief that death is inevitable when cancer is present—has been identified as a barrier to participation in cancer screening, detection, and treatment. Yet this literature has not been reviewed in a comprehensive and systematic manner. Therefore, this literature review addressed (1) philosophical and theoretical underpinnings of cancer fatalism; (2) relationships among demographic factors, cancer fatalism, and cancer screening; (3) the role of cancer fatalism for patients diagnosed with cancer; and (4) intervention strategies. Most of the reviewed studies were descriptive or correlational, did not have an explicit theoretical framework, had varied definitions of fatalism, and reported screening as “intent to screen” or as “past screening behaviors.” Review of the studies suggests that cancer fatalism develops over time and is most frequently reported among medically underserved persons and those with limited knowledge of cancer. Cancer fatalism may be modified through culturally relevant interventions that incorporate spirituality. Emphasis must be placed on recognizing the role of cancer fatalism when planning health promotion activities. Future studies should focus on the consistent measurement of cancer fatalism and testing intervention strategies.

Spirituality among African American cancer survivors: having a personal relationship with God.

African American breast and prostate cancer survivors describe their personal relationship with God as very real, close, and intimate. During their cancer trajectory, God was there with them, healing, protecting, and in control of their lives. Participants believed that God provided types of support not available from family members or friends. In return, these participants dedicated their lives to God through service in their churches or through helping others. Findings can help healthcare professionals and others in clinical practice to understand the reliance that many African American cancer survivors have on their spirituality. These findings also suggest that many African Americans perceive their survival from cancer as a gift from God. Therefore, for them, finding a way to give back is an important component of their spirituality.

Quality of life of African American cancer survivors : A review of the literature

African Americans are more likely to present with advanced stages of cancer at the time of diagnosis, and their survival rates continue to lag behind those of Caucasian survivors. Although the need to address the quality of life (QOL) of cancer survivors is well documented, little is known about the QOL of African American cancer survivors. A comprehensive literature search from 1990 to 2005 was conducted in 5 phases as outlined by Cooper. Inclusion criteria included the measurement of QOL as an outcome and the report and/or comparison of QOL for African Americans in the sample. The studies that met the criteria for inclusion focused on breast and prostate cancer. All were descriptive (quantitative or qualitative). Overall, the QOL of African American cancer survivors described in this research is poorer than for Caucasians, although in 1 study African American breast cancer survivors reported better emotional adjustment, sexual functioning, and lower symptom distress. Nonetheless, because of the limited and conflicting research as well as inconsistent measurements and methodologies, it is not possible to adequately describe the QOL of African American cancer survivors. Research is needed that uses consistent, culturally appropriate measures, theoretical frameworks, and definitions across studies. Cancer 2007.

Perceptions of Support Among Older African American Cancer Survivors

PURPOSE/OBJECTIVES To explore the perceived social support needs among older adult African American cancer survivors. RESEARCH APPROACH Qualitative design using grounded theory techniques. SETTING Outpatient oncology clinics in the southeastern United States. PARTICIPANTS Focus groups with 22 older adult African American cancer survivors. METHODOLOGIC APPROACH Purposeful sampling technique was used to identify focus group participants. In-depth interviews were conducted and participants were interviewed until informational redundancy was achieved. MAIN RESEARCH VARIABLES Social support needs of older adult African American patients with cancer. FINDINGS Social support was influenced by (a) symptoms and treatment side effects, (b) perceptions of stigma and fears expressed by family and friends, (c) cultural beliefs about cancer, and (d) desires to lessen any burden or disruption to the lives of family and friends. Survivors navigated within and outside of their networks to get their social support needs met. In some instances, survivors socially withdrew from traditional sources of support for fear of being ostracized. Survivors also described feeling hurt, alone, and socially isolated when completely abandoned by friends. CONCLUSIONS The support from family, friends, and fellow church members is important to positive outcomes among older African American cancer survivors. However, misconceptions, fears, and negative cultural beliefs persist within the African American community and negatively influence the social support available to this population. INTERPRETATION Early identification of the factors that influence social support can facilitate strategies to improve outcomes and decrease health disparities among this population.

Comparing Perceptions of Cancer Fatalism among African American Patients and Their Providers

Purpose To describe perceptions of cancer fatalism and identify demographic correlates; to explore whether providers believe their patients are fatalistic about cancer and compare these views to the patients’ views. Data sources Both patients (n= 52) and providers (n= 35) were recruited at federally funded, community primary care centers. Data were collected using the Powe Fatalism Inventory, the Perceived Patient Fatalism Inventory, and a demographic data questionnaire. Data were analyzed using descriptive statistics, Pearson correlations, and t‐test. Conclusions The majority of patients were African American women. The majority of providers were physicians and nurses. Patients indicated low perceptions of cancer fatalism, but providers believed patients were highly fatalistic. As the patients’ educational level increased, perceptions of cancer fatalism decreased. Implications for practice The providers’ belief that patients are fatalistic about cancer may influence patient–provider communication. They may be less likely to recommend screening, and patients may be less likely to initiate a discussion about cancer. Strategies are needed that target providers and their patients to address actual and/or perceived perceptions and their influence on cancer screening.

Perceptions of cancer fatalism and cancer knowledge: a comparison of older and younger African American women.

Abstract Cancer fatalism (the belief that death is inevitable when cancer is present) may influence cancer screening practices among older African American women. Little is known about cancer fatalism among younger women. Guided by the Patient/Provider/System Model, this descriptive study compares cancer fatalism and cancer knowledge among African American college students (n = 353) and women from primary care centers (n = 361). Their average age was 29 years. Data were collected using the Powe Fatalism Inventory and breast and cervical cancer knowledge scales. Women at health centers had higher cancer fatalism and lowercancer knowledge. Differences in life experiences may help explain these findings.

Comparing Knowledge of Colorectal and Prostate Cancer Among African American and Hispanic Men

African American and Hispanic men are less likely to participate in prostate and colorectal cancer screening and have poorer outcomes from these diseases. Guided by the Patient/Provider/System Theoretical Model for Cancer Screening, this study compares the relationships among knowledge of prostate and colorectal cancer, perceptions of cancer fatalism, common sources of cancer information, and awareness of cancer resources screening between African American (n = 72) and Hispanic (n = 47) men who attend federally qualified health centers and a hospital-based primary care clinic in a southern state. African American men were older, had higher levels of education, and were more knowledgeable about cancer than Hispanic men were. However, Hispanic men were more fatalistic about cancer. Most men in both groups were more likely to get cancer information from the television and/or radio, with few accessing the Internet for this information. The men were not aware of many of the leading cancer-related organizations and programs. Nurses continue to play a critical role in patient education and enhancing screening rates. These findings suggest that culturally and educationally appropriate intervention strategies are needed to enhance knowledge and that the television/radio may be an effective medium for delivering these strategies.

Enhancing knowledge of colorectal cancer among African Americans: why are we waiting until age 50?

Because of low rates of colorectal cancer screening among African Americans, it may be beneficial to begin educating persons about this disease before age 50. Using the Patient/Provider/System Theoretical Model for cancer screening, this study compared knowledge of colorectal cancer, sources of information, and awareness of programs among participants of age 20–29, 30–49, and 50–75 years. The majority (n = 354) were women and African American (mean age = 37 years, mean education = 12th grade). Younger participants tended to know less about the disease, but there were few differences in knowledge between the two older groups. Persons in the 40–49-year age group were more likely to be familiar with the role diet plays in the risk of colorectal cancer. Participants associated the need for screening with the presence of symptoms. Television and radio were listed as the most frequent source of information about cancer. The Internet was the least used. The majority were not familiar with selected national programs and services focused on increasing awareness of cancer. Findings suggest that colorectal cancer-related information should be targeted toward this population before age 50, using multiple sources such as TV/radio, providers, magazines, and cancer-related organizations. An estimated 104,950 colon and 40,340 rectal cancer cases will be diagnosed in 2005 with an estimated 56,290 deaths from the disease (American Cancer Society [ACS], 2005). Despite a stabilization of colorectal cancer (CRC) incidence rates since the 1980s, African American males and females have higher incidence and mortality rates associated with this disease compared to Whites. The 5-year survival rate for CRC among African Americans improved to 54% during the years 1995–2000, but lagged well behind the 64% survival rate for Whites during the same time period. Screening and early detection of CRC followed by effective treatment is crucial to reducing these mortality rates.

Testicular Cancer Among African American College Men: Knowledge, Perceived Risk, and Perceptions of Cancer Fatalism

African American men present at later stages of testicular cancer and have higher mortality rates than Caucasian men. Lack of awareness, beliefs, and access to care may influence this disparity. Guided by the Powe fatalism model, this comparative study assessed knowledge of testicular cancer, perceived risk, and cancer fatalism among African American and Caucasian men who attended selected colleges and universities. Data were collected using the Powe Fatalism Inventory, the Testicular Cancer Knowledge Survey, and the Perceived Cancer Risk Survey. The majority (n = 190) of men were African American (70%), and the remainder were Caucasian. African American men were significantly younger than Caucasian men. African American men also had lower testicular cancer knowledge scores, higher perceptions of cancer fatalism, and lower perceived risk for the disease. Rates of testicular cancer screening were low for all the men. Research should focus on further understanding the relationship between cancer fatalism and health-promoting behaviors among African American men.

Self-Reported Cancer Screening Rates Versus Medical Record Documentation: Incongruence, Specificity, and Sensitivity for African American Women

PURPOSE/OBJECTIVES To evaluate levels of incongruence, specificity, and sensitivity between self-reported screening and medical record documentation for breast, cervical, and colorectal cancer screening. DESIGN Descriptive, quantitative. SETTING Federally qualified health centers in the southeastern United States. SAMPLE 116 African American women. The mean age was 35 years, and the mean educational level was 12.6 years. METHODS Women were eligible to participate in the study if they were older than age 18 and able to understand English or Spanish. They were recruited from the waiting areas of health centers over a consecutive five-day period. MAIN RESEARCH VARIABLES Self-reported rates of screening and screening rates documented in the medical record. FINDINGS The level of incongruence between self-report and medical record documentation was more than 50% for some procedures. Rates of specificity were high, particularly over time. Rates of sensitivity were 33% or less. CONCLUSIONS The women tended to overreport screenings in the past year when compared to medical records. The women and medical records indicated that the screenings had not been performed in the past two to five years or more than five years ago. IMPLICATIONS FOR NURSING Nurses are in a unique position to educate women about cancer screening in a culturally and educationally appropriate way while ensuring that those conversations and procedures are documented in the medical record by all providers.