title: A systematic review of the impact of stigma and nihilism on lung cancer outcomes.
abstract: BACKGROUND
  This study systematically reviewed the evidence on the influence of stigma and nihilism on lung cancer patterns of care; patients' psychosocial and quality of life (QOL) outcomes; and how this may link to public health programs.
  
  
  METHODS
  Medline, EMBASE, ProQuest, CINAHL, PsycINFO databases were searched. Inclusion criteria were: included lung cancer patients and/or partners or caregivers and/or health professionals (either at least 80% of participants had lung cancer or were partners or caregivers of lung cancer patients, or there was a lung cancer specific sub-group focus or analysis), assessed stigma or nihilism with respect to lung cancer and published in English between 1st January 1999 and 31st January 2011. Trial quality and levels of evidence were assessed.
  
  
  RESULTS
  Eighteen articles describing 15 studies met inclusion criteria. The seven qualitative studies were high quality with regard to data collection, analysis and reporting; however most lacked a clear theoretical framework; did not address interviewer bias; or provide a rationale for sample size. The eight quantitative studies were generally of low quality with highly selected samples, non-comparable groups and low participation rates and employed divergent theoretical and measurement approaches. Stigma about lung cancer was reported by patients and health professionals and was related to poorer QOL and higher psychological distress in patients. Clear empirical explorations of nihilism were not evident. There is qualitative evidence that from the patients' perspectives public health programs contribute to stigma about lung cancer and this was supported by published commentary.
  
  
  CONCLUSIONS
  Health-related stigma presents as a part of the lung cancer experience however there are clear limitations in the research to date. Future longitudinal and multi-level research is needed and this should be more clearly linked to relevant theory.
authors.affiliation: Griffith Health Institute, Griffith University, Brisbane, Australia. suzanne.chambers@griffith.edu.au
authors.forename: Suzanne K
authors.initials: SK
authors.lastname: Chambers
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Dunn
authors.forename: Stefano
authors.initials: S
authors.lastname: Occhipinti
authors.forename: Suzanne
authors.initials: S
authors.lastname: Hughes
authors.forename: Peter
authors.initials: P
authors.lastname: Baade
authors.forename: Sue
authors.initials: S
authors.lastname: Sinclair
authors.forename: Joanne
authors.initials: J
authors.lastname: Aitken
authors.forename: Pip
authors.initials: P
authors.lastname: Youl
authors.forename: Dianne L
authors.initials: DL
authors.lastname: O'Connell
mesh_terms: D001291:Attitude of Health Personnel; D017028:Caregivers; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008175:Lung Neoplasms / Q000523:psychology* / Q000628:therapy*; D011788:Quality of Life; D057545:Social Stigma