Advertisement

Patient perspectives on adapting meaning-centered psychotherapy in advanced cancer for the Chinese immigrant population

  • Jennifer LengEmail author
  • Florence Lui
  • Xiaoxiao Huang
  • William Breitbart
  • Francesca Gany
Original Article
  • 39 Downloads

Abstract

The Chinese immigrant community faces multiple obstacles to effective cancer support and psychosocial care post diagnosis. Meaning-centered psychotherapy (MCP) is an empirically based treatment (EBT) that has been found to significantly reduce psychological distress while increasing spiritual well-being and a sense of meaning and purpose in life in patients with advanced cancer. However, it has not yet been adapted for Chinese immigrants who have unique linguistic and cultural needs. This study presents a community needs assessment to inform the cultural adaptation of MCP for Chinese patients with advanced cancer using Bernal et al.’s ecological validity model and the cultural adaptation process model of Domenech-Rodriquez and Weiling. Interviews were conducted until saturation with 12 Chinese immigrants with advanced cancer to determine the community’s needs and preferences regarding the MCP intervention. Transcripts were translated and analyzed using Atlas.ti and six frequently occurring themes were identified: Coping; End of Life; Family; Culture, Religion, and Language; Immigration; and Specific Adaptations to MCP. Sociocultural values, beliefs, and practices such as filial piety and the use of Traditional Chinese Medicine (TCM) should be considered when adapting EBTs for Chinese immigrant cancer patients.

Keywords

Chinese immigrants Advanced cancer Psycho-oncology Meaning-centered psychotherapy Cultural adaptation Spiritual well-being 

Notes

Compliance with ethical standards

Conflict of interest

This study was funded by the National Institutes of Health Research Project Grant Program (3R01CA128134-05S1) and the National Institutes of Health Small Grant Program (R03CA178124-01A1). The authors have full control of all primary data and agree to allow the journal to review the data if requested.

References

  1. 1.
    Lopez G, Cillufo A, Patten E. Chinese in the U.S. fact sheet. Pew Research Center: Social & Demographic Trends Web site. http://www.pewsocialtrends.org/fact-sheet/asian-americans-chinese-in-the-u-s/. Published September 8 2017. Updated 2018. Accessed 6 June 2018
  2. 2.
    NYC Department of City Planning (2017) Info brief: NYC’s foreign-born, 2000 to 2015. 2017; March 2017Google Scholar
  3. 3.
    Chen MS Jr (2005) Cancer health disparities among Asian Americans: what we know and what we need to do. Cancer 104(S12):2895–2902CrossRefGoogle Scholar
  4. 4.
    McCracken M, Olsen M, Chen MS et al (2007) Cancer incidence, mortality, and associated risk factors among Asian Americans of Chinese, Filipino, Vietnamese, Korean, and Japanese ethnicities. CA Cancer J Clin 57(4):190–205CrossRefGoogle Scholar
  5. 5.
    Guidry JJ, Torrence W, Herbelin S (2005) Closing the divide: diverse populations and cancer survivorship. Cancer 104(S11):2577–2583CrossRefGoogle Scholar
  6. 6.
    Lam WW, Fielding R (2003) The evolving experience of illness for Chinese women with breast cancer: a qualitative study. Psycho-Oncology 12(2):127–140CrossRefGoogle Scholar
  7. 7.
    Ngo-Metzger Q, Massagli MP, Clarridge BR, Manocchia M, Davis RB, Iezzoni LI, Phillips RS (2003) Linguistic and cultural barriers to care. J Gen Intern Med 18(1):44–52CrossRefGoogle Scholar
  8. 8.
    Liang W, Wang JH, Chen M et al (2008) Developing and validating a measure of Chinese cultural views of health and cancer. Health Educ Behav 35(3):361–375CrossRefGoogle Scholar
  9. 9.
    Mui AC, Kang S, Kang D, Domanski MD (2007) English language proficiency and health-related quality of life among Chinese and Korean immigrant elders. Health Soc Work 32(2):119–127CrossRefGoogle Scholar
  10. 10.
    Yu MY, Hong OS, Seetoo AD (2003) Uncovering factors contributing to under-utilization of breast cancer screening by Chinese and Korean women living in the United States. Ethn Dis 13(2):213–219PubMedGoogle Scholar
  11. 11.
    Surbone A (2008) Cultural aspects of communication in cancer care. Support Care Cancer 16(3):235–240CrossRefGoogle Scholar
  12. 12.
    Thorne SE, Hislop TG, Armstrong E, Oglov V (2008) Cancer care communication: the power to harm and the power to heal? Patient Educ Couns 71(1):34–40CrossRefGoogle Scholar
  13. 13.
    Castillo-Page L (2010) Diversity in the physician workforce: facts and figures 2010. Association of American Medical Colleges. (Summer 2010)Google Scholar
  14. 14.
    Reeves T, Bennett CE (2004) We the people: Asians in the United States. Vol 17. US Department of Commerce, Economic and Statistics Administration, US Census BureauGoogle Scholar
  15. 15.
    MLA Language Map Data Center (2008) Data center resultsGoogle Scholar
  16. 16.
    Hsiao S, Gau M, Ingleton C, Ryan T, Shih F (2011) An exploration of spiritual needs of Taiwanese patients with advanced cancer during the therapeutic processes. J Clin Nurs 20(7–8):950–959CrossRefGoogle Scholar
  17. 17.
    Lin JS, Finlay A, Tu A, Gany FM (2005) Understanding immigrant Chinese Americans’ participation in cancer screening and clinical trials. J Community Health 30(6):451–466CrossRefGoogle Scholar
  18. 18.
    Breitbart W, Rosenfeld B, Gibson C, Pessin H, Poppito S, Nelson C, Tomarken A, Timm AK, Berg A, Jacobson C, Sorger B, Abbey J, Olden M (2010) Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial. Psycho-Oncology 19(1):21–28CrossRefGoogle Scholar
  19. 19.
    Breitbart W (2002) Spirituality and meaning in supportive care: spirituality-and meaning-centered group psychotherapy interventions in advanced cancer. Support Care Cancer 10(4):272–280CrossRefGoogle Scholar
  20. 20.
    Breitbart W, Rosenfeld B, Pessin H, Applebaum A, Kulikowski J, Lichtenthal WG (2015) Meaning-centered group psychotherapy: an effective intervention for improving psychological well-being in patients with advanced cancer. J Clin Oncol 33(7):749–754CrossRefGoogle Scholar
  21. 21.
    Breitbart W, Poppito S, Rosenfeld B, Vickers AJ, Li Y, Abbey J, Olden M, Pessin H, Lichtenthal W, Sjoberg D, Cassileth BR (2012) Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer. J Clin Oncol 30(12):1304–1309CrossRefGoogle Scholar
  22. 22.
    Breitbart W, Poppito SR (2014) Meaning-centered group psychotherapy for patients with advanced cancer: a treatment manual. Oxford University Press, USAGoogle Scholar
  23. 23.
    Breitbart WS, Poppito SR (2014) Individual meaning-centered psychotherapy for patients with advanced cancer: a treatment manual. Oxford University Press, USACrossRefGoogle Scholar
  24. 24.
    Hall GC, Hong JJ, Zane NW, Meyer OL (2011) Culturally competent treatments for Asian Americans: the relevance of mindfulness and acceptance-based psychotherapies. Clin Psychol Sci Pract 18(3):215–231CrossRefGoogle Scholar
  25. 25.
    Leng J, Lui F, Chen A, Huang X, Breitbart W, Gany F (2018) Adapting meaning-centered psychotherapy in advanced cancer for the Chinese immigrant population. J Immigr Minor Health 20(3):680–686CrossRefGoogle Scholar
  26. 26.
    Domenech-Rodríguez M, Wieling E (2004) Developing culturally appropriate evidence based treatments for interventions with ethnic minority populations. In: Rastogi M, Wieling E (eds) Voices of color: first person accounts of ethnic minority therapists. Sage Publications, Thousand Oaks, pp 313–333Google Scholar
  27. 27.
    Bernal G, Bonilla J, Bellido C (1995) Ecological validity and cultural sensitivity for outcome research: issues for the cultural adaptation and development of psychosocial treatments with Hispanics. J Abnorm Child Psychol 23(1):67–82CrossRefGoogle Scholar
  28. 28.
    Strauss A, Corbin JM (1990) Basics of qualitative research: grounded theory procedures and techniques. Sage Publications, Inc, Thousand OaksGoogle Scholar
  29. 29.
    ATLAS.ti: The qualitative data analysis & research software (2012). http://www.atlasti.com/index.html. Accessed Jan 2018
  30. 30.
    Thomas DR (2006) A general inductive approach for analyzing qualitative evaluation data. Am J Eval 27(2):237–246CrossRefGoogle Scholar
  31. 31.
    Takeuchi DT, Sue S, Yeh M (1995) Return rates and outcomes from ethnicity-specific mental health programs in Los Angeles. Am J Public Health 85(5):638–643CrossRefGoogle Scholar
  32. 32.
    Yeh M, Takeuchi DT, Sue S (1994) Asian-American children treated in the mental health system: a comparison of parallel and mainstream outpatient service centers. J Clin Child Psychol 23(1):5–12CrossRefGoogle Scholar
  33. 33.
    Betancourt JR (2003) Cross-cultural medical education: conceptual approaches and frameworks for evaluation. Acad Med 78(6):560–569CrossRefGoogle Scholar
  34. 34.
    Betancourt JR, Green AR, Carrillo JE, Ananeh-Firempong O 2nd (2003) Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep 118(4):293–302CrossRefGoogle Scholar
  35. 35.
    Kagawa-Singer M, Kassim-Lakha S (2003) A strategy to reduce cross-cultural miscommunication and increase the likelihood of improving health outcomes. Acad Med 78(6):577–587CrossRefGoogle Scholar
  36. 36.
    Kearney MK, Weininger RB, Vachon ML, Harrison RL, Mount BM (2009) Self-care of physicians caring for patients at the end of life: “Being connected... a key to my survival”. JAMA 301(11):1155–1164CrossRefGoogle Scholar
  37. 37.
    Lin T, Tardiff K, Donetz G, Goresky W (1978) Ethnicity and patterns of help-seeking. Cult Med Psychiatry 2(1):3–13CrossRefGoogle Scholar
  38. 38.
    Sue D, Sue S (1987) Cultural factors in the clinical assessment of Asian Americans. J Consult Clin Psychol 55(4):479–487CrossRefGoogle Scholar
  39. 39.
    Sue S (1977) Psychological theory and implications for Asian Americans. J Couns Dev 55(7):381–389Google Scholar
  40. 40.
    Hwang W (2006) The psychotherapy adaptation and modification framework: application to Asian Americans. Am Psychol 61(7):702–715CrossRefGoogle Scholar
  41. 41.
    Tervalon M, Murray-Garcia J (1998) Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved 9(2):117–125CrossRefGoogle Scholar
  42. 42.
    Vasquez MJ (2007) Cultural difference and the therapeutic alliance: an evidence-based analysis. Am Psychol. 62(8):878–885CrossRefGoogle Scholar
  43. 43.
    Chen SW, Davenport DS (2005) Cognitive-behavioral therapy with Chinese American clients: cautions and modifications. Psychother Theory Res Pract Train 42(1):101–110CrossRefGoogle Scholar
  44. 44.
    Lorence DP, Park H, Fox S (2006) Racial disparities in health information access: resilience of the digital divide. J Med Syst 30(4):241–249CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Immigrant Health and Cancer Disparities Center, Department of Psychiatry and Behavioral SciencesMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkUSA
  3. 3.Department of Healthcare Policy and ResearchWeill Cornell Medical CollegeNew YorkUSA
  4. 4.Department of Clinical PsychologyThe City College of New YorkNew YorkUSA
  5. 5.Department of Psychiatry and Behavioral SciencesMemorial Sloan Kettering Cancer CenterNew YorkUSA
  6. 6.Department of MedicineWeill Cornell Medical CollegeNew YorkUSA

Personalised recommendations