- Introduction
Cancer occurs among 1 in 3 individuals in the United States. 1 The disease extends among various races, socioeconomic classes, and families to produce feelings of hopelessness, loss of control, and psychological distress.2-5 Despite the prevalence of cancer among many populations, there still exists a negative stigma about the illness. It is this stigma, which creates barriers among families to discuss the diagnosis, treatment, and or quality of life for individuals living with cancer.4,6,7
- Body
Family cancer communication
Family cancer communication is essential given the presence of an increased risk of cancer in some families due to genetic mutations, behaviors, and environmental issues.1 The role of genetics and the ability to screen for various genes that are linked to cancer has become an increasingly pertinent topic in the field of medicine. Therefore, family members must be aware of the potential risk for developing cancer that has a history of occurring in their family. College students, which are young adults must also grapple with various health risks within their families while pursuing a degree. When faced with academic success or being knowledgeable of their risk for various cancers and other diseases it is not difficult to surmise college students will be inclined to choose academic success. Although undergraduate college students are gaining knowledge and life skills in an academic setting, one must not forget that the family is a significant influence regarding their behaviors and values.
Undergraduate College students
According to the National Center for Education Statistics within the U.S. Department of Education and the Institute of Education Sciences, the latest statistics for undergraduate students enrolled in postsecondary degree granting institutions was appropriately 16.9 million as of fall 2016.8 Inadequate knowledge of health topics can place college students at risk for various diseases that may be prevalent within their families. However, the families of college students may feel the need to shield them from a cancer diagnosis or other health issues due to their academic endeavors. When faced with academic success or being knowledgeable of their risk for various cancers and other diseases it is not difficult to surmise college students will be inclined to choose academic success. Although undergraduate college students are gaining knowledge and life skills in an academic setting, one must not forget that the family is a significant influence regarding their behaviors and values.
The objective of this study was to examine the results of the Family Cancer and Health Communication Questionnaire (FCHCQ), an electronically administered survey designed by the primary investigator, to measure cancer perception, comfort in communicating about cancer and health issues and topic avoidance within the families of college students.
METHODS
Design and Sample
The pilot study utilized a cross-sectional design and was implemented from November 2016 to April 2017. Participants in the study were undergraduate college students at a public university in the Southeast region of the U.S. Inclusion criteria for the study consisted of currently enrolled full or part-time undergraduate students, 18 years of age and older, able to speak and read English, and access to an electronic device with internet service. College students who were not undergraduate students, under the age of 18 years old, not enrolled as full or part-time students, or could not read or speak English were excluded from the study.
The impetus for the development of the FCHCQ was the lack of questionnaires that measured an individual’s comfort with discussing cancer and family health communication which impact an individual’s health. The concept of cancer communication avoidance within the family provides valuable information regarding barriers to communication. Previous questionnaires were based on avoidance of cancer communication, which served as a foundation for including this concept in items on the FCHCQ. Thus, the FCHCQ built upon topic avoidance of cancer communication within the families of college students. The concept of comfort in discussing cancer with family members was lacking from the previous questionnaires although it seemed to be a pertinent aspect for general communication as well as cancer and health communication. The FCHCQ fills a lack in the literature by combining aspects of the previously indicated questionnaires that were developed and validated to assess avoidance of cancer communication, family communication, and comfort with communicating about cancer. Furthermore, there are no questionnaires that measure the combination of previously mentioned concepts among college students. In addition, the questionnaire, is intended for use among individuals with or without a diagnosis of cancer.
After approval for the study was received from the University’s Human Subject Committee, an email for participation in the study was dispersed among the college students. Emails were sent randomly to undergraduate students who were 18 years of age and older via the University’s Survey Committee. The email contained a link for the online software program Qualtrics, which contained the consent for participation in the study and the FCHCQ.
III. Objectives
The objectives are: 1) Discuss topics of avoidance within family cancer and health communication; 2) Differentiate which family members college students are comfortable with sharing health and illnesses information; 3) Identify if college students are more comfortable sharing information regarding health and illness within or outside of the family.
IV Results
The participants consisted of 346 undergraduate college students who responded to the electronic questionnaire that was randomly emailed to students enrolled at a large public university in the Southeast U.S. Seventeen participants did not provide response to any of the questionnaire items and were therefore excluded from the analysis. The final sample, thus, consisted of 327 participants, 72 males (22%) and 255 females (78%), ranging in age from 18 to 45 with a mean of 20.37 years (SD=3.16). Most of the participants were White (81.3%) and non-Latino (78%), and the majority, (97%) were never married. English was the predominate native language for the participants, 90.5%. Lastly, 59.3% of the participants reported an annual family income of $50,000 or more.
The first item asked participants whom they felt they could talk and have a sense of comfort from a list that was provided. Results indicated that the option of “mother” was the common choice at 59.9%. Lastly, topic avoidance was analyzed wherein the option of “sex” was the most frequently selected, (63%), for avoidance in family discussions.
There were also three items that assessed the presence of family cancer and health communications regarding 1) openness for talking; 2) the lack of communicating about health issues with individuals outside of the family; 3) and comfort with talking to family about cancer. Responses for the items were summed to determine the overall score for the scale. Scores on the FCHCQ ranged from 4 to 15, with a mean score of 11.78 (SD = 2.35). Scale scores were negatively skewed (Skewness statistics = -.92, SE = .13), and the distribution of the scores were not normal (Kolmogorov-Smirnov Statistic = .16, df = 329, p< .001). The majority of the scores were above 10, which resulted in the negatively skewed distribution.
The item responses for perception of cancer were summed to determine the overall score for the scale. Scores ranged from 4 to 20, with a mean score of 11.67 (SD= 2.96). In addition, scores for the items had a slight positive skew as shown in Figure 4 (Skewness statistic = .42, SE = .13), and the distribution of the scores was not normal (Kolmogorov-Smirnov Statistic = .101, df = 329, p < .001).
The importance of communicating health issues is indicated in one of the Healthy People 2020 objectives, which aims to increase the proportion of individuals that can identify a family member or friend to discuss their health issues.9 A decrease and/or elimination of stigma surrounding cancer and discussing health communication must begin with the group that is often trusted the most, the family.