Publication Date

2014-07-23

Availability

Open access

Embargo Period

2014-07-23

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PHD)

Department

Psychology (Arts and Sciences)

Date of Defense

2014-04-15

First Committee Member

Michael H. Antoni

Second Committee Member

Youngmee Kim

Third Committee Member

Amy Weisman de Mamani

Fourth Committee Member

Jason R. Dahn

Fifth Committee Member

Frank J. Penedo

Abstract

Disparities in quality of life outcomes have been found among ethnically diverse prostate cancer survivors following prostate cancer treatment. Quality of life disparities have been traditionally explained by ethnic group membership and socioeconomic disadvantages. The examination of cultural vulnerability factors, such as cancer fatalism and medical mistrust, which are prevalent in minority ethnic groups, may offer a more comprehensive assessment of ethnic disparities as they have been found to negatively impact health beliefs and behaviors (e.g., poorer screening rates). However, few studies have examined the impact of these cultural values on quality of life following a prostate cancer diagnosis. The present study aimed to evaluate whether cultural vulnerability factors (i.e., cancer fatalism and medical mistrust) mediated the relationship between ethnic group membership and general quality of life indexes (i.e., physical and emotional well-being) among PC survivors prior to receiving PC-related treatment. Participants were 268 ethnically diverse men (30% African American, 29% Hispanic, and 41% non-Hispanic White) who were on average 63.42 years old (SD=7.83), had received a prostate cancer diagnosis, and had not initiated prostate cancer-related treatment. Path analysis was used to examine: 1) the relationship between ethnic group membership and pre-treatment quality of life; 2) the relationship between ethnic group membership and cultural vulnerability factors; 3) the relationship between cultural vulnerability factors and pre-treatment quality of life; and 4) whether cultural vulnerability factors mediated the relationship between ethnic group membership and pre-treatment quality of life. Results indicated that ethnic group membership was not significantly associated with physical and emotional well-being. Hispanic men did report greater levels of cancer fatalism compared to non-Hispanic White men (B= .15, p= .03), and both Hispanic (B= .19, p<.01) and African American (B= .20, p<.01) men reported greater levels of medical mistrust compared to non-Hispanic White men. Across the entire sample, cancer fatalism was not related to physical (B= -.12, p= .06) or emotional (B= -.10, p= .11) well-being. However, greater levels of medical mistrust were significantly associated with poorer physical (B= -.14, p= .03) and emotional (B= -.13, p= .04) well-being. In addition, a significant total indirect relationship between ethnicity and emotional well-being (B= -.04, p= .04) via greater levels of cancer fatalism and medical mistrust was found when comparing Hispanic and non-Hispanic White men. These associations held after controlling for relevant covariates (i.e., age, subjective social status, language preference, perceived support from the family, religious behavior, PSA level at diagnosis, time since diagnosis, and comorbid medical conditions). The results suggest a role for cancer fatalism and medical mistrust as they relate to pre-treatment quality of life, particularly emotional well-being. Identification of culturally relevant correlates of quality of life has implications for developing interventions that may promote adjustment in this population. Future studies should examine the relationship between ethnic group membership, cancer fatalism, medical mistrust, and emotional well-being in longitudinal designs.

Keywords

prostate cancer; quality of life; medical mistrust; cancer fatalism; ethnic group membership; pre-treatment

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