Appraisal of a systematic review using the John Hopkins Nursing Evidence-Based Practice Research Evidence Appraisal Tool.

As previously expressed, I have chosen cancer as my national practice problem of focus. Cancer is the number two healthcare problem in the United States associated with morbidity and mortality. This week I have chosen to further explore one of the factors that could cause the death toll to be so high. One factor I considered was delayed screening or no screening. Vrinten, Gallagher, Waller, and Marlow (2019), sought to further explore this idea as it relates to stigma and delate screening or no screening for cancer at recommended times. Kang, Kim, Kim, and Kim (2020) describe stigma as the feeling of isolation, rejection, degradation, and criticism during a social process or personal experience which influences the outcomes of physical, psychological, and social adjustment. Badihian, Choi, Kim, Parnia, Manoucherhri, Badihian, Tanha, Guallar, and Cho (2017), also found that negative attitudes and the thought of the impossibility of recovery led to increased mortality and decreased support of patients diagnosed with cancer. Furthermore, Alcaraz, Wiedt, Daniels, Yabroff, Guerra, and Wender (2019), report that social circumstances can increase the burden of cancer and other disparities in the United States.

In their exploration and research this group of researchers decided to specifically investigate how stigma from the healthy population regarding cancer affects when/if people are screened. They found the higher the severity of cancer, the higher the stigma, and the association of being screen as recommended in the three focus areas, cervical, breast, and colorectal did not occur. They also found that stigma was higher in men and those with different ethnic backgrounds. They even drilled down to the type of as it relates to cancer severity, acceptability of making financial decisions, policy opposition statements, feelings awkward around someone with cancer, personal responsibility (someone with cancer is to blame for their diagnosis), and avoiding someone with cancer. I feel as though this group was able to not only answer the research question but took their exploration a step further by providing specific subcategories to support how stigma affects cancer screening.

For the purposes of this study the sample was represented. They were selected during several waves using the assistance of the Kantar TNS Omnibus survey during several waves in April and May of 2016. Kantar TNS is a market research agency that uses random location sampling to recruit participants. Participants were adults, with ages ranging from 18-70 years old. The lower age limit was selected to ensure the maturity of informed consent was obtained and the higher age limit to represent people who were no longer required to have screening completed. Weights were also provided to ensure population representativeness.

Regarding limitations this group mentioned several. The first of these limitations was they had to reduce the number of items on the Cancer Stigma Scale (CASS) due to space restrictions and this caused the internal validity to be lowered. Next, the Attitudes, Behavior, and Cancer UK Survey (ABACUS) had no response rate recorded by the market agency. This means that this research can be generalized to this population sample but not the association between cancer stigma and cancer screening uptake, and the strength of the associations found here may be limited by the smaller sample sizes (Vrinten, Gallagher, Waller & Marlow, 2019). They also mention that their CASS was only applicable to cancer in general not specific types of cancer and other research has shown that there is a greater stigma to other specific types of cancer. An additional limitation was that due to the CASS scale being shortened the internal reliability was lowered. Their final reported limitation was that due to this being a cross-sectional study there was no causality between cancer stigma and cancer screening attendance.

After reviewing all components of this quantitative research study I would consider this in support of the national practice problem. Overall I sought to find ways in which we can decrease the morbidity and mortality rates of cancer. If we are able to get people appropriately screened by changing the narrative surrounding cancer, through earlier diagnosis, this could potentially yield more positive outcomes for patients. At the completion of this investigation, my goal will be to find a way to incorporate simulation into the screening process to hopefully decrease the fear that also may influence the stigma regarding cancer.

Alcaraz, K. I., Wiedt, T. L., Daniels, E. C., Yabroff, K. R., Guerra, C. E., & Wender, R. C. (2019). Understanding and addressing social determinants to advance cancer health equity in the United States: A blueprint for practice, research, and policy. CA: A Cancer Journal for Clinicians, 70(1), 31–46. https://doi.org/10.3322/caac.21586

Badihian, S., Choi, E. ‐. K., Kim, I. ‐. R., Parnia, A., Manouchehri, N., Badihian, N., Tanha, J. M., Guallar, E., & Cho, J. (2017). Attitudes toward cancer and cancer patients in an urban Iranian population. The Oncologist, 22(8), 944–950. https://doi.org/10.1634/theoncologist.2017-0073

Kang, N. E., Kim, H. Y., Kim, J. Y., & Kim, S. R. (2020). Relationship between cancer stigma, social support, coping strategies and psychosocial adjustment among breast cancer survivors. Journal of Clinical Nursing, 29(21–22), 4368–4378. https://doi.org/10.1111/jocn.15475

Vrinten, C., Gallagher, A., Waller, J., & Marlow, L. (2019). Cancer stigma and cancer screening attendance: a population-based survey in England. BMC Cancer, 19(1), 1–10.

https://doi.org/10.1186/s12885-019-5787-x (Links to an external site.)

Cancer stigma and cancer screening attendance: a population-based survey in England (Links to an external site.)

Johns Hopkins Individual Evidence Summary Tool_Smith-2.docx