Stigma-related experiences in non-communicable respiratory diseases: A systematic review

Our plain-English summary of Stigma-related experiences in non-communicable respiratory diseases: A systematic review, by S. Rose, C. Paul, A. Boyes, et al (Chronic Respiratory Disease, 2017).

The study

• Authors: S. Rose, C. Paul, A. Boyes, B. Kelly, D. Roach
• Journal: Chronic Respiratory Disease
• Published: 2017;14(3):199-216
• Type of article: Systematic review
• Cited by: 64 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The stigma of non-communicable respiratory diseases (NCRDs), whether perceived or otherwise, can be an important element of a patient's experience of his/her illness and a contributing factor to poor psychosocial, treatment and clinical outcomes. This systematic review examines the evidence regarding the associations between stigma-related experiences and patient outcomes, comparing findings across a range of common NCRDs. Electronic databases and manual searches were conducted to identify original quantitative research published to December 2015. Articles focussing on adult patient samples diagnosed with asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, lung cancer or mesothelioma, and included a measurement of stigma-related experience (i.e. perceived stigma, shame, blame or guilt), were eligible for inclusion. Included articles were described for study characteristics, outcome scores, correlates between stigma-related experiences and patient outcomes and methodological rigor. Twenty-five articles were eligible for this review, with most ( n = 20) related to lung cancer. No articles for cystic fibrosis were identified. Twenty unique scales were used, with low to moderate stigma-related experiences reported overall. The stigma-related experiences significantly correlated with all six patient-related domains explored (psychosocial, quality of life, behavioral, physical, treatment and work), which were investigated more widely in COPD and lung cancer samples. No studies adequately met all criteria for methodological rigor. The inter-connectedness of stigma-related experiences to other aspects of patient experiences highlight that an integrated approach is needed to address this important issue. Future studies should adopt more rigorous methodology, including streamlining measures, to provide robust evidence.

In plain English

This was a systematic review of quantitative studies, published up to December 2015, on stigma-related experiences in adults with asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, lung cancer or mesothelioma. Stigma-related experiences meant perceived stigma, shame, blame or guilt. The review did not study asbestos exposure. Twenty-five articles were included. Most involved lung cancer, and none involved cystic fibrosis. Mesothelioma appeared in only one study, which combined people with lung cancer and mesothelioma; in that study 10% reported shame as a barrier to attending support groups, and the association was not statistically tested. Overall, most samples reported low to moderate stigma-related scores. Stigma-related experiences showed significant associations with outcomes in all six areas examined: psychosocial, quality of life, behavior, physical health, treatment and work. No study met all of the quality criteria. The authors concluded that more rigorous studies are needed. They noted that only English-language quantitative articles were included, that most included studies were cross-sectional so causation cannot be established, and that their low, moderate and high score categories need validation.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Systematic review of original quantitative research (peer-reviewed and grey literature), conducted using the PRISMA statement
• Who was studied: 25 articles on adult (18 years or older) patients with asthma, COPD, lung cancer or mesothelioma, found in searches run in December 2015. Most concerned lung cancer, mesothelioma appeared in one article (Devitt et al.), and no article concerned cystic fibrosis.
• Exposure: Stigma-related experiences (perceived stigma, shame, blame and guilt) measured in patients. No asbestos or fiber exposure was studied.
• Main results:
  • Across the included studies, most samples reported low to moderate stigma-related scores, as categorized by the review authors.
  • Stigma-related experiences were significantly associated with outcomes in all six domains examined.
  • Perceived stigma and depression was the most frequently investigated association, and every study that examined it found a significant positive relationship.
  • In lung cancer patients, higher perceived stigma predicted longer delays between symptom onset and seeking medical help.
  • For mesothelioma, only one study was available: Devitt et al., with a combined sample of 100 people with lung cancer and mesothelioma. Only behavior was examined. In that sample, 10% reported shame as a barrier to support group attendance, and the association was investigated but not statistically tested.
  • No article met all seven quality criteria. Three met six of the seven criteria.
• The authors' conclusion: The authors concluded that patients with these respiratory diseases report low to moderate stigma-related scores, but that more rigorous studies are needed to determine this more accurately and comprehensively.
• Limitations the authors state:
  • Only quantitative, English-language articles were included, so some relevant articles may have been missed.
  • Only part of the screening was checked by a second coder.
  • The aims of the included studies were not reported, and stigma may not have been the main focus of some of them.
  • The review's own low, moderate and high categorization of scale scores requires validation.
  • Most included studies were cross-sectional, so causation cannot be established.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Systematic Review, COPD, Fibrosis, Lung Cancer, Mesothelioma, Quality of Life.

Related studies

• Electronic Nose Technology in Respiratory Diseases — S. Dragonieri, G. Pennazza, et al. (2017)
• Dendritic Cells in Human Lung Disease: Recent Advances — J.W. Upham, Y. Xi (2017)
• Occupational risk factors for chronic respiratory disease in a New Zealand population using lifetime occupational history — A. Hansell, R.E. Ghosh, et al. (2014)
• Vapor, dust, and smoke exposure in relation to adult-onset asthma and chronic respiratory symptoms: the Singapore Chinese Health Study — T.D. LeVan, W.P. Koh, et al. (2006)
• Exercise training to improve exercise capacity and quality of life in people with non-malignant dust-related respiratory diseases — M.T. Dale, Z.J. McKeough, et al. (2015)
• IgG4-related lung disease in a worker occupationally exposed to asbestos — M. Toyoshima, K. Chida, et al. (2010)

Browse return to medical research.