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LOW-INCOME, MINORITY CANCER PATIENTS WHO DROP OUT OF DEPRESSION
TREATMENT
by
Anjanette A. Wells
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(SOCIAL WORK)
May 2009
Copyright 2009 Anjanette A. Wells
Object Description
| Title | Low-income, minority cancer patients who drop out of depression treatment |
| Author | Wells, Anjanette A. |
| Author email | aawells@usc.edu; awells@gwbmail.wustl.edu |
| Degree | Doctor of Philosophy |
| Document type | Dissertation |
| Degree program | Social Work |
| School | School of Social Work |
| Date defended/completed | 2009-02-23 |
| Date submitted | 2009 |
| Restricted until | Unrestricted |
| Date published | 2009-05-13 |
| Advisor (committee chair) | Palinkas, Lawrence A. |
| Advisor (committee member) |
Ell, Kathleen R. Cruz, Tess B. |
| Abstract | Depression is one of the most common symptoms of cancer, having a profound impact on patients' quality of life, immune response, morbidity, adherence to treatment, and even mortality. Although medication and counseling are effective in reducing depressive symptoms in cancer patients, there is an increasing need to understand factors that contribute to dropout (and retention) of low-income, minority cancer patients to depression treatment.; The aim of this study was to explore and understand the barriers and enablers contributing to low-income minority cancer survivors' participation and completion of depression treatment, within the context of an effectiveness treatment trial (ADAPt-C study). Such perspectives were gained through in-depth, telephone interviews with 20 patients who had dropped out of treatment, compared to 10 similar patients' who had completed depression treatment. Additional understanding about the dropout barriers were gained through secondary analysis of provider clinical notes. Face-to-face and telephone interviews with providers offered a list of strategies to retain patients to treatment.; Findings revealed that patients who dropped out of treatment perceived and described key barriers which interfered with their treatment completion: cancer-related, depression treatment-related, informational, instrumental, cultural, and systems-related. Taken together, dropouts often described "multiple confounding barriers." Completers experienced equally as many "multiple confounding barriers", however were able to continue and complete treatment. Potential explanations for this discrepancy can be found within some of the discrete barriers and associated narratives themselves. Analyses of dropout clinical notes from providers help reveal that additional barriers contributed to dropout: Enabling Family factors and Additional Enabling Psychological Coping factors. Provider interviews indicated that providers can provide feasible strategies which address some of the various patient-identified barriers: 1) Depression treatment strategies; 2) Informational strategies, 3) Instrumental strategies; 4) Recruitment strategies; 5) Cultural strategies; and 6) Systems' strategies. These results point to implications in the following areas: theoretical, research study design, clinical social work, community-based, and further research in the areas of health behavior decision-making, the influence of motivation, and self-efficacy. This adherence study of low-income, minority depressed cancer patients is especially important to future research and real-world depression care among cancer patients, particularly those from hard-to-reach populations. |
| Keyword | adherence; cancer; depression; disparities; low-income; minority |
| Language | English |
| Part of collection | University of Southern California dissertations and theses |
| Publisher (of the original version) | University of Southern California |
| Place of publication (of the original version) | Los Angeles, California |
| Publisher (of the digital version) | University of Southern California. Libraries |
| Provenance | Electronically uploaded by the author |
| Type | texts |
| Legacy record ID | usctheses-m2253 |
| Contributing entity | University of Southern California |
| Rights | Wells, Anjanette A. |
| Repository name | Libraries, University of Southern California |
| Repository address | Los Angeles, California |
| Repository email | cisadmin@lib.usc.edu |
| Filename | etd-Wells-2693 |
| Archival file | uscthesesreloadpub_Volume32/etd-Wells-2693.pdf |
Description
| Title | Page 1 |
| Contributing entity | University of Southern California |
| Repository email | cisadmin@lib.usc.edu |
| Full text | LOW-INCOME, MINORITY CANCER PATIENTS WHO DROP OUT OF DEPRESSION TREATMENT by Anjanette A. Wells A Dissertation Presented to the FACULTY OF THE GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY (SOCIAL WORK) May 2009 Copyright 2009 Anjanette A. Wells |
