Fatalism Revisited: Further Psychometric Testing Across Two Studies.

Cancer fatalism may impact outcomes, particularly for African American (AA) women with breast cancer (BrCa). We examined the psychometrics of the modified Powe Fatalism Inventory in sample of AA women with BrCa from two studies. Only the predetermination and God's will items satisfy the conditions to be classified as a strong subscale. Our analysis identified that five items had strong psychometric properties for measuring fatalism for AA women with BrCa. However, these items do not include all the defining attributes of fatalism. A strong measure of fatalism strengthens our understanding of how this concept influences AA patient outcomes.

Social support provided by and strain experienced by African-American cancer caregivers.

BACKGROUND: Cancer is the second most common condition among people over 50, behind only dementia, associated with caregiving. As treatments improve, the number of cancer caregivers will increase. However, there is limited research about African-American cancer caregivers (AACCs). PURPOSE: The purpose of this mixed methods study is to describe (1) the types of social support provided by and (2) the levels of strain reported by AACCs. METHODS: Cancer patients from a regional safety net hospital nominated family caregivers who helped them after their cancer diagnosis. Consented caregivers were interviewed in the waiting room while the patient received treatment or later by phone using the Modified Caregiver Strain Index (MCSI), five structured interview questions, and demographic questions-20 min. Responses to the interview questions were processed using Miles and Huberman's content analysis guide. Descriptive statistics for demographics and the MCSI were performed using SPSS. RESULTS: Of the 45 AACCs, 64 % had medical conditions. Caregivers reported patients' pain (31 %), stress (9 %), and nausea (7 %) as the most common symptoms. AACCs most commonly provided instrumental (67 %) or emotional (42 %) support; spiritual (20 %) and informational (20 %) support were less common. CONCLUSION: Emphasis is needed in providing care assistance information to the AACCs to ensure effective support for their loved ones. This study highlights areas of support where assistance can be useful among AACCs.

Increasing knowledge of cardiovascular risk factors among African Americans by use of community health workers: the ABCD community intervention pilot project.

African Americans have higher rates of cardiovascular disease (CVD) and poorer outcomes compared to others. The American Diabetes Association and the National Diabetes Education Program have promoted use of the ABC approach (glycated hemoglobin A1c, blood pressure, cholesterol) for identifying and controlling the leading indicators of CVD risk. In the present study, researchers added a D factor, for depression, because this disorder is common and also predictive of CVD risk and of control of diabetes. Particularly among low-income African Americans, depression is frequently not targeted or treated. The current study tests the effectiveness of recruiting African Americans in churches and training community health workers (CHWs) to educate their peers about CVD and risk reduction. For the intervention group, CHWs participated in a 16-hour training session and delivered a 6-week tailored educational program with counseling sessions and demonstrations. The control group received a weekly lecture by clinical experts. The CHW active-learning intervention was more effective than lectures by clinical experts in increasing the knowledge of CVD risk. The only significant difference in clinical measures reflected a worsening of HbA1c levels in the control group; the CHW intervention group showed a slight improvement. Participants also learned self-management skills, such as taking blood pressure, measuring glucose, and reading labels. Nevertheless, more longitudinal research and a larger sample size are needed to confirm the impact of CHWs in community settings to change factors associated with CVD risk.

Complementary and alternative medicine (CAM) use among men with a history of prostate cancer.

Complementary and alternative medicine (CAM) has been commonly used among Americans; however, less is known about its use among men with a history of prostate cancer. This study used the 2002 National Health Interview Survey (NHIS) to explore the amount and type of CAM use among 218 Black and White men with a history of prostate cancer. Over 90% of men reported having ever used any form of CAM and most men used biologically-based and mind-body therapies. Nurses are in a unique position to discuss, to assess needs and practices, and perhaps, to act as intermediaries for physicians and other healthcare professionals and prostate cancer survivors who use CAM.

Religiosity, spirituality, and cancer fatalism beliefs on delay in breast cancer diagnosis in African American women.

African American women are more likely than any other racial or ethnic group to present with a later stage of breast cancer at initial diagnosis. Delay in breast cancer detection is a critical factor in diagnosis at a later stage. Available data indicate a delay of 3 months or more is a significant factor in breast cancer mortalty. Numerous factors have been reported as contributing to delay in time to seek medical care including religiosity, spirituality, and fatalistic beliefs. This study examined the influence of religiosity, spirituality, and cancer fatalism on delay in diagnosis and breast cancer stage in African American women with self-detected breast symptoms. A descriptive correlation, retrospective methodology using an open-ended questionnaire and three validated measurement scales were used: the Religious Problem Solving Scale (RPSS), the Religious Coping Activity Scale (RCAS) subscale measuring spiritually based coping, and the modified Powe Fatalism Inventory (mPFI). A convenience sample of 129 women ages between 30 and 84 years who self-reported detecting a breast symptom before diagnosis of breast cancer within the preceding 12 months were included in the study. Outcome variables were time to seek medical care and breast cancer stage. Other variables of interest included marital status, income, education, insurance status, and to whom the women spoke about their breast symptoms. Data were analyzed using descriptive statistics, logistic regression analysis, Pearson r correlations, Mann-Whitney U analysis, and Chi Square analysis. Participants were found to be highly religious and spiritual but not fatalistic. While most women delayed more than 3 months in seeking medical care, no associations were found between the three predictor variables and time to seek medical care. The median delay in time from self detection of a breast symptom to seeking medical care was 5.5 months. Women who were less educated, unmarried, and talked to God only about their breast change were significantly more likely to delay seeking medical care. An association was found between disclosing a breast symptom to God only and delay in seeking medical care. In contrast, women who had told a person about their breast symptom were more likely to seek medical care sooner. African American women who delayed seeking medical care for longer than 3 months were more likely to present with a later stage of breast cancer than women who sought care within 3 months of symptom discovery.

Religious beliefs and delay in breast cancer diagnosis for self-detected breast changes in African-American women.

African-American women have a one-third higher death rate from breast cancer. Delay in breast cancer detection is a significant factor in being diagnosed at a later stage. The objective of this research was to examine the relationship between religious beliefs and delay in diagnosis of breast cancer and breast cancer stage for self-detected breast symptoms. Participants ranged in age from 30 to 84 years, with a median age of 54 years. This was a descriptive, correlational study, which utilized an open-ended questionnaire. Statistically significant association was found between Time to Seek Medical Care and Stage of Breast Cancer at p = 0.001, with 67% of the participants (n = 87) presenting with > Stage I breast cancer, and with the mean time to seek medical care at 5.4 months. A statistically significant association was also found related to "did you tell anyone about the breast change"? (i. e., Yes, No, or Only Talked to God). Delay in time to seek medical care was significantly associated with only talking to God about the breast change at (p = 0.02). Telling someone about their breast symptom was also statistically significant at p = 0.01 for reducing delay.

Prostate-specific antigen test use and digital rectal examinations among African-American men, 2002-2006.

African-American men experience greater incidence and mortality from prostate cancer compared to White men as well as men from other groups. Few studies have examined prostate-specific antigen (PSA) test and digital rectal examination (DRE) use in African-American men. This study examined use of the PSA test and DRE among African-American men over time and identified correlates associated with the use of these procedures. Overall trends for years 2002-2006 showed a significant decrease in recent PSA test use and DRE among African-American men in 2004 and 2006 compared to year 2002. Recent PSA test use and DRE were associated with several factors including older ages, being married, higher levels of education and income, and overweight and obese body mass index (BMI). PSA test use and DRE among African-American men should be monitored over time to find out if this pattern continues.

Eliminating cancer-related disparities: how nurses can respond to the challenge.

OBJECTIVES: To review disparities in cancer incidence and mortality among several distinct population groups in the US and the challenges nurses face in eliminating these disparities. DATA SOURCES: Journal articles, books, and government reports. CONCLUSION: Despite the phenomenal progress in cancer detection and control, many populations in the US suffer needlessly and die from potentially curable cancers. IMPLICATIONS FOR NURSING PRACTICE: Nurses can address cancer care needs of population groups at increased risk for developing and/or dying from cancer.

Attitudes and beliefs about smoking among African-American college students at historically black colleges and universities.

Smoking rates are lower among African Americans compared to Caucasians, but African Americans have higher lung cancer mortality. Guided by the Powe Fatalism Model, this descriptive study reports on attitudes and beliefs and predictors of lifetime cigarette smoking behaviors among students at historically black colleges and universities (HBCUs). Data were collected using the Attitudes and Beliefs about Perceived Consequences of Smoking Scale and a Demographic Data Questionnaire. The majority (N = 438) were female and single. More than 50% reported trying cigarettes in their lifetime and reported smoking a whole cigarette at age 15.5 years. Only 7.5% of the sample were lifetime smokers. The likelihood that a student would smoke was 15 times greater if their friends smoked and almost seven times greater if they were not members of a Greek organization compared to other students. Males associated smoking with self-confidence, endorsed the emotional benefits and influencing factors of smoking compared to females. Intervention efforts should focus on preventing the initiation of smoking as well as cessation efforts for students at HBCUs. Campus clubs and organizations can play a vital role in long-term changes in smoking behaviors for these students.

Perceptions about breast cancer among African American women: do selected educational materials challenge them?

Despite the availability of factual information about breast cancer, there continues to be an abundance of misperceptions about the disease. This study, guided by the Patient/Provider/System Model for cancer screening, describes perceptions about breast cancer among African American women (N = 179) at primary care centers. Data were collected using the Breast Cancer Perceptions and Knowledge Survey and a demographic questionnaire. Breast cancer pamphlets available at the centers were evaluated (readability, extent they challenged misperceptions). The average age of the women was 34 years with an average educational level of 12 years. A number of misperceptions were prevalent. The majority viewed breast self-examination as a form of early detection and some viewed pain as an indicator of cancer. Pamphlets did not explicitly challenge the misperceptions and the SMOG reading level was high. Intervention studies are needed to identify the effective methods to challenge and correct misperceptions about breast cancer for these women.

Perceptions about breast cancer among college students: implications for nursing education.

Nurses are in a key position to enhance knowledge, correct misperceptions, and allay fears related to breast cancer. However, little attention is given to these psychosocial issues in nursing texts, and the extent to which they are covered within nursing curricula is unclear. This study, guided by the Powe Fatalism Model, compared perceptions about breast cancer and sources of cancer information among a random sample (n = 158) of nursing and non-nursing female students (mean age = 24). Data were collected using a Breast Cancer Perceptions and Knowledge Survey and a demographic questionnaire. A significant number of myths and misperceptions related to breast cancer were prevalent within both groups. Few nursing students reported obtaining information on common perceptions about cancer from their coursework. More research is needed to understand how the nursing students' perceptions about breast cancer influence their ability to provide patient care across the cancer continuum.

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.

Colorectal cancer in African-Americans: addressing the need for further research and research utilization.

Research on colorectal cancer and screening has lagged behind when compared to other cancers such as breast and prostate cancer. The purpose of this paper is to provide a brief overview of colorectal cancer including risks, development of the cancer, and screening and early detection recommendations. A critical analysis of nurse-initiated research on colorectal cancer in African-Americans, published in nursing research-intensive journals, was conducted to further the understanding of the factors that influence these disparities. The findings indicated that this body of research is very sparse. Given this fact, nurses need to consider the types of research that are being conducted and where this research is published. Given the current focus on health disparities, it is time that nurses step into the forefront to lead the way in research and research utilization. It is crucial that we start to see real and significant decreases in colorectal cancer disparities in African-Americans.

Nursing contributions to the elimination of health disparities among African-Americans: review and critique of a decade of research--Part III.

The excessive burden of disease experienced by African-Americans has long been described by authorities in the public, private, and professional sector as a national health concern. Several reports have been published in the peer-reviewed literature that describe the outcomes of nurse-directed studies aimed at addressing the factors associated with the disparities experienced by African-Americans and these reports were also aimed toward the design of interventions to reduce and/or eliminate them. However, little is known about the scope, quality, and impact of these efforts relative to the promotion of health and the prevention of disease among African-American population groups. This report presents the results of a review, analysis, and critique of reports of outcomes of nursing research aimed toward reducing health-related disparities among African-Americans. These reports were described in a selected group of African-American nursing organizations and journals dedicated to providing a forum for the discussion of issues focused on cultural diversity, transcultural nursing, and multicultural health care issues. Included among the journals were the Journal of the National Black Nurses Association, the Journal of the Association of Black Nursing Faculty, the Journal of Chi Eta Phi Sorority, the Journal of Cultural Diversity, the Journal of Transcultural Nursing, and the Journal of Multicultural Nursing and Health. Results of the review will be reported in three parts. The first part was reported in an earlier edition (Journal of National Black Nurses Association, Volume 15, No. 1), the second part was reported in Volume 16, No 1, of the Journal of National Black Nurses Association, and the third part is reported here. The results of this critique revealed that this body of nursing research provides the profession with a broad base of knowledge and insights. This knowledge is relative to the individual and familial impact of cardiovascular disease, cancer, diabetes, HIV/AIDS, mental health and mental illness, and sickle cell disease within the African-American community. Knowledge and insights relative to the concerns and needs of childbearing, parenting, the elderly caregivers and care giving in African-American population groups is essential if health care disparities are to be truly eliminated. This review, analysis, and critique also revealed several gaps and limitations within this body of nursing research.

Nursing contributions to the elimination of health disparities among African-Americans: review and critique of a decade of research.

The excessive burden of disease experienced by African-Americans has long been described by authorities in the public, private, and professional sector as a national health concern. Several reports have been published in the peer-reviewed literature that describe the outcomes of nurse-directed studies aimed at addressing the factors associated with the disparities experienced by African-Americans and these reports were also aimed toward the design of interventions to reduce and/or eliminate them. However, little is known about the scope, quality, and impact of these efforts relative to the promotion of health and the prevention of disease among African-Americans. This report presents the results of a review, analysis, and critique of reports of outcomes of nursing research aimed toward reducing health-related disparities among African-Americans. These reports were described in a selected group of African-American nursing organizations and journals dedicated to providing a forum for the discussion of issues focused on cultural diversity, transcultural nursing, and multicultural health care issues. Included among the journals were the Journal of the National Black Nurses Association, the Journal of the Association of Black Nursing Faculty, the Journal of Chi Eta Phi Sorority, the Journal of Cultural Diversity, the Journal of Transcultural Nursing, and the Journal of Multicultural Nursing and Health. Results of the review will be reported in three parts, the first of which was reported in an earlier edition (Journal of National Black Nurses Association, Volume 15, No. 1) and the second part of which is reported here. The third part will be reported in a future issue of the Journal of National Black Nurses Association. The results revealed that this body of nursing research provides the profession with a broad base of knowledge and insights. This knowledge is relative to the individual and familial impact of cardiovascular disease, cancer, diabetes, HIV/AIDS, mental health and mental illness, and Sickle Cell Disease within the African-American community. Knowledge and insights relative to the concerns and needs of childbearing, parenting the elderly caregivers and caregiving in African-American population groups is essential if health-care disparities are to be truly eliminated. This review, analysis, and critique also revealed several gaps and limitations within this body of nursing research.

Health Information Seeking Among Rural African Americans, Caucasians, and Hispanics: It Is Built, Did They Come?

This cross-sectional study examines health information-seeking behaviors and access to and use of technology among rural African Americans, Caucasians, and Hispanics. There was a low level of health information seeking across the sample. Few used smartphones or tablets and did not endorse receiving health information from their health care provider by e-mail. Printed materials remained a source of health information as did friends and family. Information should be shared using multiple platforms including more passive methods such as television and radio. More research is needed to ensure the health literacy, numeracy, and ability to navigate the online environment.

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.

Cancer in U.S. ethnic and racial minority populations.

Discoveries, breakthroughs, and advances made in the area of cancer prevention and cancer control over the last 2 decades have led to declines in the rates of cancer incidence and mortality and increases in life expectancy and survival for many cancer patients. However, although the trends relative to cancer incidence, mortality, and 5-year survival for the nation as a whole have significantly improved, data reveal that there are significant disparities in the degree to which the burden of cancer that remains is borne by racial and ethnic minority population groups. As a practice-oriented discipline grounded in research, nursing could have a dominant role in efforts aimed toward eliminating the cancer disparities experienced by racial and ethnic population groups. Several reports of nursing studies have been published in the peer-reviewed literature that address factors associated with the cancer disparities experienced between and among U.S. racial and ethnic minority groups. However, given that few efforts have been undertaken to comprehensively review and critique this body of research, little is known about the scope, quality, and potential impact of this body of nursing science. This report presents the results of one of the first comprehensive reviews of nursing research undertaken to explore and address factors associated with the evolution of the cancer-related health disparities in ethnic and racial minority population groups within the United States. The findings reveal that, while the body of nursing research has contributed much to the identification and understanding of factors associated with the excess cancer morbidity and mortality of minority populations, in order for the profession to more fully contribute to the elimination of cancer-related disparities, there is a need for nurses to further expand and strengthen this base of knowledge.