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1.  Psychosocial predictors of depression among older African American cancer patients 
Oncology nursing forum  2013;40(4):394-402.
To determine whether psychosocial factors predict depression among older African American cancer patients.
A descriptive correlational study.
Outpatient oncology clinic of NCI designated Cancer Center in Southeastern U.S.
African American cancer patients aged 50 and over.
Fisher’s 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 Variables
Religiosity, emotional support, collectivism, perceived stigma and depression.
African American cancer patients (n=77) were on average a median age of 58 years (IQR = 55–65), a majority were well-educated, insured, religiously affiliated, and currently in treatment. Participants in the lowest income category, not married, and male gender 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.
Psychosocial factors are important predictors of depression. For these participants, emotional support and organized religious activities may represent protective factors against depression, while collectivism may increase their risk.
Nurses need to be especially aware of the potential psychological strain for patients with collectivist values, experienced stigma, disruptions in church attendance and lack of emotional support. Further, these 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 the needs for support of the African American cancer patient.
PMCID: PMC3753674  PMID: 23803271
depression; stigma; religion; collectivism; social support; African American cancer patients
2.  Coping Profiles Common to Older African American Cancer Survivors: Relationships to Quality of Life 
Cancer survivors employ distinct sets of coping behaviors that vary in their associations with psychological health and quality of life. However, existing research has largely focused on white and middle class subjects.
This study explores whether clusters with differing coping profiles could be identified among older African American cancer survivors and whether these profiles varied on cultural factors and physical, psychological, and relationship well-being.
Four hundred forty-nine older African American cancer survivors recruited from outpatient oncology clinics completed a questionnaire booklet containing the Ways of Helping Questionnaire (WHQ), the Brief Index of Race-Related Stress (IRRS), the Religious Involvement Scale, Mutuality Scale, and the Short Form 12 Health Survey Questionnaire (SF-12). A k-means cluster analysis was conducted using the WHQ.
Four distinct coping profiles were identified and labeled High Coping, Low Encouraging Healthy Behaviors, Low Coping and Strong/Distracting Behaviors. Coping profiles were associated with participant’s gender, age, and living alone. Controlling for these demographic differences, coping profiles were associated with religiosity, experiences with racism, and physical, psychological and relationship well-being.
The findings from this study lend support for examining coping profiles and health outcomes among African American cancer survivors. This research also suggests that these profiles vary on cultural factors. This information should prove useful to researchers as they develop culturally appropriate interventions for this underserved population.
PMCID: PMC3029503  PMID: 20832984
cancer; African Americans; coping profiles; cluster analysis; religious involvement; experienced racism; quality of life
3.  Reliability and Validity of the Perspectives of Support From God Scale 
Nursing research  2010;59(2):102-109.
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.
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.
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.
The Perceived Support From God Scale consists of 15 items in two subscales (Support From God and God’s Purpose for Me). The two subscales explained 59% of the variance. Cronbach’s α coefficients were .94 and .86 for the Support From God and God’s Purpose for Me subscales, respectively. Test–retest correlations were strong, supporting the temporal stability of the instrument. Pearson’s correlations to an existing religious involvement and beliefs scale were moderate to strong. Subscale scores on Support From God were negatively correlated to depression.
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.
PMCID: PMC2867661  PMID: 20216012
African Americans; cancer; spiritual support
4.  Predictors of Depression Among Older African American Cancer Patients 
Cancer nursing  2010;33(2):156-163.
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.
This study explores the demographic and illness-related risk factors in older African American cancer patients.
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.
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.
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.
PMCID: PMC2844350  PMID: 20142741
African Americans; Cancer; Depression
5.  Development of the Ways of Helping Questionnaire: A Measure of Preferred Coping Strategies for Older African American Cancer Survivors 
Research in nursing & health  2009;32(3):243-259.
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 WHQ’s content coverage makes it especially relevant for older African American cancer survivors.
PMCID: PMC2752043  PMID: 19259991
coping; social support; African Americans; cancer; instrument development
6.  Psychological symptoms and end-of-life decision making confidencein surrogate decision-makers of dialysis patients 
This cross-sectional descriptive study explored surrogate decision-makers' psychological symptoms and their own assessment of decision-making abilities before actual involvement in end-of-life decision-making for their loved ones. One hundred-twenty dialysis patients' surrogates (79 African Americans and 41 Caucasians) completed scales measuring decision-making confidence, anxiety and depression, Post-Traumatic Symptoms (PTSS), and a sociodemographic questionnaire. Forty-two (35%) and 14 (11.7%) surrogates showed abnormal scores on anxiety and depression, respectively. Seven (5.8%) surrogates showed abnormal scores on PTSS. While surrogates decision making confidence was high (M=17.70, SD=2.88), there was no association between decision-making confidence and the three psychological variables. Surrogates' confidence was associated only with the quality of relationship with patient (r=0.33, p=0.001).
PMCID: PMC4169048  PMID: 25242897
7.  Living the Golden Rule: Reciprocal Exchanges Among African Americans With Cancer 
Qualitative health research  2003;13(5):656-674.
Giving is receiving, and receiving is giving. This is the key finding from interviews conducted with 28 African American women and men with cancer who were active participants in dynamic relationships characterized by both giving and receiving. These participants engaged in reciprocal relationships varying in the number of persons involved, types of resources exchanged, and timing of exchange. Findings suggest the need to reconceptualize social support as caregiving and caregiving as social support. This study also points to the need to redesign intervention studies to be more inclusive of components that allow the elderly in illness-related situations to maintain their status as givers in their social networks.
PMCID: PMC2972546  PMID: 12756686
African Americans; cancer; caregiving; social exchanges; social support
8.  Perceptions of Support Among Older African American Cancer Survivors 
Oncology nursing forum  2010;37(4):484-493.
To explore the perceived social support needs among older adult African American cancer survivors.
Research Approach
Qualitative design using grounded theory techniques.
Outpatient oncology clinics in the southeastern United States.
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.
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.
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.
Early identification of the factors that influence social support can facilitate strategies to improve outcomes and decrease health disparities among this population.
PMCID: PMC2948788  PMID: 20591808

Results 1-8 (8)