Shame, Guilt, and Communication in Lung Cancer Patients and Their Partners

Abstract

Lung cancer patients report the highest distress levels of all cancer groups. In addition to poor prognosis, the self-blame and stigma associated with smoking might partially account for that distress and prevent patients from requesting help and communicating with their partners. The present study used innovative methods to investigate potential links of shame and guilt in lung cancer recovery with distress and marital adjustment. A specific emphasis was an examination of the impact of shame on partner communication. Lung cancer patients (n = 8) and their partners (n = 8) completed questionnaires and interviews that were videotaped. We report descriptive statistics and Spearman correlations between shame and guilt, relationship talk, marital satisfaction, distress, and smoking status. We coded the interviews for nonverbal expressions of shame. Greater self-reported shame was associated with decreased relationship-talk frequency and marital satisfaction, and with increased depression and smoking behaviour. Nonverbal shame behaviour also correlated with higher depression and increased smoking behaviour. Guilt results were more mixed. More recent smoking behaviour also correlated with higher depression. At a time when lung cancer patients often do not request help for distress, possibly because of shame, our preliminary study suggests that shame can also disrupt important partner relationships and might prevent patients from disclosing to physicians their need for psychosocial intervention and might increase their social isolation. Even if patients cannot verbally disclose their distress, nonverbal cues could potentially give clinicians an opportunity to intervene.

The relationship between coping strategies, quality of life, and mood in patients with incurable cancer

“…29,30 We also demonstrated that patients with a more extensive smoking history and those with a lung cancer diagnosis were more likely to report high utilization of self-blame, and this adds to the literature suggesting that these patients experience more guilt and shame related to their cancer diagnosis. [31][32][33] By highlighting the different coping strategies commonly used across specific subgroups of patients, these findings may help clinicians anticipate the needs of their patients and identify those at risk for maladaptive coping and higher psychological distress.…”

Depressive symptoms among patients with COPD according to smoking status: a Danish nationwide case�control study of 21 184 patients

“…Further, continued smoking may be associated with guilt and shame and may thus lead to depression [16] However, all the above-mentioned studies were performed in highly selected patients, and a possible history of COPD was not considered. Whether smoking cessation in COPD patients affects the occurrence of depressive symptoms is unknown and has to our knowledge not previously been described.…”

Stigmatic and Sympathetic Attitudes Toward Cancer Patients Who Smoke: A Qualitative Analysis of an Online Discussion Board Forum

“…Indeed, greater negative affect is associated with nicotine dependence and potentially greater smoking among cancer patients. 68 Smokers consistently report that smoking helps them cope with emotional distress, that negative affect reduction is a primary smoking motive, and that they use cigarettes to manage negative emotions. As a result, increases in negative affect are one of the most powerful contributors to smoking relapse, as smokers turn back to cigarettes to manage negative emotions that come up during a quit attempt.…”