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Cancer Control Research

Abstract

DESCRIPTION (provided by applicant): African Americans (AA) have the highest incidence and death rates from all cancers in the U.S. Adequate assessment and treatment of depression in AA cancer patients is essential to reduce this unequal burden of cancer and health disparity. Current knowledge of AA cancer patients' depression is extremely limited. A few existing studies suggest inadequate recognition of the extent of depression in this population. Currently no available instrument has been validated for screening depression of AA cancer patients, despite increasing evidence of cultural insensitivity of depression measures for African Americans. It is imperative to develop a culturally sensitive screening instrument for AA cancer patients' depression, in order to provide adequate referral and needed care. The development of this instrument would require a deep understanding of AA depressive experience. This application is the first study of the lived experience of depression in AA cancer patients. It is significant because of the large size of AA cancer population, the need to combat cancer disparity, and its implication for quality of life and long-term survival of AA cancer patients. Using a mixed design, the study will provide baseline knowledge of AA depressive experience and identify AA depressive symptoms as an initial step of the instrument construction. The specific aims are as follows: 1) Describe the meaning and structure of AA depressive experience in the context of living with cancer; 2) Compare depressed and nondepressed AA cancer patients to identify beliefs and attitudes about having cancer, which are associated with depression; and 3) Identify manifestations of AA depression and create a symptom catalogue that can be developed into a culturally sensitive screening instrument for assessing AA cancer patient's depression in a future study. The interview sample will consist of 80 cancer patients-20 patients in each of four groups: 3 AA groups and a white group consisting of two subgroups, varying by degree of depression. The group members will be further stratified by age and cancer diagnosis for an unstructured individual interview that will be audiotaped, transcribed, and analyzed verbatim. In the validation phase, an additional 10 AA cancer patients will be recruited to determine the credibility of study outcomes. Qualitative data analysis using the NUDIST software will identify themes and their relationships to describe: 1) meanings and structure of the lived depressive experience of AA cancer patients; 2) beliefs and attitudes about having cancer; and 3) self- explanations of depressive experiences. The mixed method analysis using statistical and qualitative methods will be used to identify AA depressive symptoms. Consequently, a symptom catalogue that inventories the identified AA depressive symptoms will be constructed so that a culturally sensitive screening instrument for assessing depression in AA cancer patients can be developed in a future study.