Department of Psychology, University of Arizona, Tucson, Arizona; Department of Family and Community Medicine, University of Arizona, Tucson, Arizona.
Department of Psychology, University of Arizona, Tucson, Arizona.
J Thorac Oncol. 2018 Aug;13(8):1062-1075. doi: 10.1016/j.jtho.2018.05.014. Epub 2018 May 23.
The public health imperative to reduce the burden of lung cancer has seen unprecedented progress in recent years. Fully realizing the advances in lung cancer treatment and control requires attention to potential barriers in their momentum and implementation. In this analysis, we present and evaluate the argument that stigma is a highly significant barrier to fulfilling the clinical promise of advanced care and reduced lung cancer burden. This evaluation of the stigma of lung cancer is based on a multilevel perspective that incorporates the individual, persons in the individual's immediate environment, the health care system, and the larger societal structure that shapes perceptions and decisions. We also consider current interventions and interventional needs within and across aspects of the lung cancer continuum, including prevention, screening, diagnosis, treatment, and survivorship. Current evidence suggests that stigma detrimentally affects psychosocial, communication, and behavioral outcomes over the entire lung cancer control continuum and across multiple levels. Interventional efforts to alleviate stigma in the context of lung cancer show promise, yet more work is needed to evaluate their impact. Understanding and addressing the multilevel role of stigma is a crucial area for future study to realize the full benefits offered by lung cancer prevention, control, and treatment. Coordinated, interdisciplinary, and well-conceptualized efforts have the potential to reduce the barrier of stigma in the context of lung cancer and facilitate demonstrable improvements in clinical care and quality of life.
近年来，降低肺癌负担的公共卫生必要性使得肺癌治疗和控制方面取得了前所未有的进展。要充分实现肺癌治疗和控制方面的进步，就需要关注其发展势头和实施过程中可能存在的障碍。在本分析中，我们提出并评估了这样一种观点，即污名是实现先进护理和降低肺癌负担的临床承诺的一个重大障碍。对肺癌污名的这种评估是基于一个多层次的视角，该视角包含个人、个人的直接环境中的人、医疗保健系统以及塑造观念和决策的更大社会结构。我们还考虑了当前干预措施以及贯穿肺癌连续体各个方面（包括预防、筛查、诊断、治疗和生存）的干预需求。目前的证据表明，污名在整个肺癌控制连续体以及多个层面上对心理社会、沟通和行为结果产生不利影响。减轻肺癌背景下污名的干预措施显示出了希望，但仍需要更多的工作来评估其影响。了解和解决污名的多层次作用是未来研究的一个重要领域，这有助于充分实现肺癌预防、控制和治疗带来的好处。协调、跨学科和精心设计的努力有可能减少肺癌背景下污名的障碍，并促进临床护理和生活质量的明显改善。
