Jill B. Hamilton

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.

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.

The influence of mistrust, racism, religious participation, and access to care on patient satisfaction for African American men: the North Carolina-Louisiana Prostate Cancer Project.

OBJECTIVE The purpose of this study was to explore whether a particular combination of individual characteristics influences patient satisfaction with the health care system among a sample of African American men in North Carolina with prostate cancer. Patient satisfaction may be relevant for improving African American mens use of regular care, thus improving the early detection of prostate cancer and attenuating racial disparities in prostate cancer outcomes. METHODS This descriptive correlation study examined relationships of individual characteristics that influence patient satisfaction using data from 505 African American men from North Carolina, who prospectively enrolled in the North Carolina-Louisiana Prostate Cancer Project from September 2004 to November 2007. Analyses consisted of univariate statistics, bivariate analysis, and multiple regression analysis. RESULTS The variables selected for the final model were: participation in religious activities, mistrust, racism, and perceived access to care. In this study, both cultural variables, mistrust (p=<.0001, F=95.58) and racism (p=<.002, F=5.59), were significantly negatively associated with patient satisfaction and accounted for the majority of the variability represented by individual characteristics. CONCLUSION Mistrust and racism are cultural factors that are extremely important and have been negatively associated with patient satisfaction and decreased desires to utilize health care services for African American men. To overcome barriers in seeking health care services, health care providers need to implement a patient-centered approach by creating a clinical environment that demonstrates cultural competence and eliminating policies, procedures, processes, or personnel that foster mistrust and racism.

Predictors of depression among older African American cancer patients.

Background: Depression is becoming an increasing concern in cancer patients because of its impact on quality of life. Although risk factors of having depression have been examined in the literature, there has been no research examining these factors in older African American cancer patients. Objective: This study explores the demographic and illness-related risk factors in older African American cancer patients. Methods: Two hundred eighty-three patients were recruited from outpatient oncology clinics. These older African American patients completed a questionnaire that included the Geriatric Depression Scale as well as sociodemographic characteristics and medical information. χ2 Tests, trend tests, and logistic regression were used to identify the demographic and illness-related factors that predict depression in the sample. Results: The overall prevalence of depression in the sample was 27.2%. Younger age (<65 years), employment status, proximity to family, and multiple symptoms due to cancer or treatment were independent predictors of depression. Conclusion: This study represents the first attempt to describe the risk factors of depression within older African American cancer patients. Findings indicate a high prevalence of depression in African American cancer patients which can be attributed to identifiable risk factors. Implications for Practice: An understanding of the risk factors associated with depression can be used to identify those cancer patients at risk for depression and initiate early interventions to improve psychological outcomes and lessen the potential burden of cancer on these patients.

Reliability and Validity of the Perspectives of Support From God Scale

Background:Existing spiritual support scales for use with cancer survivors focus on the support believed to come from a religious community, clergy, or health care providers. Objective:The objective of this study was to evaluate the reliability and validity of a new measure of spiritual support believed to come from God in older Christian African American cancer survivors. Methods:The Perceived Support From God Scale was administered to 317 African American cancer survivors aged 55-89 years. Psychometric evaluation involved identifying underlying factors, conducting item analysis and estimating reliability, and obtaining evidence on the relationship to other variables or the extent to which the Perceived Support From God Scale correlates with religious involvement and depression. Results:The Perceived Support From God Scale consists of 15 items in two subscales (Support From God and Gods Purpose for Me). The two subscales explained 59% of the variance. Cronbachs &agr; coefficients were .94 and .86 for the Support From God and Gods Purpose for Me subscales, respectively. Test-retest correlations were strong, supporting the temporal stability of the instrument. Pearsons correlations to an existing religious involvement and beliefs scale were moderate to strong. Subscale scores on Support From God were negatively correlated to depression. Discussion:Initial support for reliability and validity was demonstrated for the Perceived Support From God Scale. The scale captures a facet of spirituality not emphasized in other measures. Further research is needed to evaluate the scale with persons of other racial/ethnic groups and to explore the relationship of spirituality to other outcome measures.

“You Need a Song to Bring You Through”: The Use of Religious Songs to Manage Stressful Life Events

PURPOSE To explore in a sample of older African Americans how religious songs were used to cope with stressful life events and to explore the religious beliefs associated with these songs. DESIGN AND METHODS Sixty-five African American older adults residing in the Southeastern US participated in a qualitative descriptive study involving criterion sampling, open-ended semi-structured interviews, qualitative content analysis, and descriptive statistics. RESULTS Religion expressed through song was a coping strategy for participants experiencing stressful life events who described feelings of being comforted, strengthened, able to endure, uplifted, and able to find peace by turning to the types of religious songs described here. Five types of songs were used including those evoking Thanksgiving and Praise, Instructive, Memory of Forefathers, Communication with God, and Life after Death. IMPLICATIONS Religious songs are an important form of religious expression important to the mental health of older African Americans. The incorporation of religious songs into spiritual care interventions might enhance the cultural relevance of mental health interventions in this population.

Coping Strategies of African American Head and Neck Cancer Survivors

A cross-sectional study was conducted with 50 African American head and neck cancer survivors. Common coping strategies were identified and examined in relation with quality of life and relationship well-being. Coping through support from God, seeking emotional support from family and friends, and helping others were the most commonly used strategies. Having emotional support, being strong and self-reliant, and engaging in distracting activities with family and friends had strongest associations with quality of life. Coping through emotional support, help from God, assistance from ones church family to maintain religious practices, helping others, and engaging in distracting activities with others was more strongly associated with relationship well-being. Future intervention studies should consider these strategies and their possible impact on the physical, psychological, and relationship well-being of this population.

Development of the Ways Of Helping Questionnaire: a measure of preferred coping strategies for older African American cancer survivors.

Although researchers have identified beneficial coping strategies for cancer patients, existing coping measures do not capture the preferred coping strategies of older African American cancer survivors. A new measure, the Ways of Helping Questionnaire (WHQ), was evaluated with 385 African American cancer survivors. Validity evidence from factor analysis resulted in 10 WHQ subscales (Others There for Me, Physical and Treatment Care Needs, Help from God, Church Family Support, Helping Others, Being Strong for Others, Encouraging My Healthy Behaviors, Others Distract Me, Learning about Cancer, and Distracting Myself). Reliability evidence was generally strong. Evidence regarding hypothesized relationships with measures of well-being and another coping measure was mixed. The WHQs content coverage makes it especially relevant for older African American cancer survivors.

Psychosocial Predictors of Depression Among Older African American Patients With Cancer

PURPOSE/OBJECTIVES To determine whether psychosocial factors predict depression among older African American patients with cancer. DESIGN A descriptive correlational study. SETTING Outpatient oncology clinic of a National Cancer Institute-designated cancer center in the southeastern United States. SAMPLE African American patients with cancer aged 50-88 years. METHODS Fishers exact and Wilcoxon rank-sum tests were used to evaluate differences between patients who were possibly depressed (Geriatric Depression Scale) or not. Multivariate linear regression statistics were used to identify the psychosocial factors that predicted higher depression scores. Education and gender were included as covariates. MAIN RESEARCH VARIABLES Religiosity, emotional support, collectivism, perceived stigma, and depression. FINDINGS Participants (N = 77) had a mean age of 61 years (SD = 8.4), and a majority were well-educated, insured, religiously affiliated, and currently in treatment. Participants who were in the lowest income category, not married, or male had higher depression scores. The multivariable model consisting of organized religion, emotional support, collectivism, education, and gender explained 52% (adjusted R2) of the variation in depression scores. Stigma became insignificant in the multivariable model. CONCLUSIONS Psychosocial factors are important predictors of depression. Emotional support and organized religious activities may represent protective factors against depression, whereas collectivism may increase their risk. IMPLICATIONS FOR NURSING Nurses need to be particularly aware of the potential psychological strain for patients with collectivist values, experienced stigma, disruptions in church attendance, and lack of emotional support. In addition, the treatment plans for these patients should ensure that family members are knowledgeable about cancer, its treatment, and side effects so they are empowered to meet support needs. KNOWLEDGE TRANSLATION Among older African American patients with cancer, emotional support and reassurance from family and friends that they will not abandon them decreases the likelihood of depressive symptoms and minimizes the impact of stigmatizing responses, but the perception that the illness is placing a strain on the family increases the likelihood of such symptoms. Emotional support likely is a stronger predictor of depressive symptoms than religious service attendance.

Reading The Bible for Guidance, Comfort, and Strength During Stressful Life Events

Background:The use of religious practices to promote mental health among African Americans is well documented. African Americans are more likely to report strong religious affiliationsand to use religion over prescribed medications for mental health problems. However, few studies have exploredhow African Americans use religious practices in response to stressful life events. Objective:The aim of this study is to examine how African American women and men find comfort in using scripture passages from The Bible. Methods:Fifty-four African American adults residing in the Southeastern United States participated in a qualitative descriptivestudy using open-ended semistructured interviews. Participants were asked to describe their use of scripture passages from The Bible and the personal meanings associatedwith these scriptures in the context of a family death or life-threatening illness. Results:These participants used scripture passages categorized as God as Protector, God as Beneficent, Praise and Thanksgiving, God as Healer, Memory of Forefathers, Prayers to God, and Life after Death. Few gender differences were noted. However, women were more likely to use scripture passages of God as Protector and Life after Death, whereas men were more likely to use God as Beneficent and God as Healer. Discussion:The religious practice of reading scripture passages from The Bible is a mental health-promoting strategy used during stressful life events. The findings of this study have practical uses for nurses and can be used to inform acceptable and sensitive approaches in addressing mental health issues and spiritual care needs in African American patients.