Coping Strategies Among Cancer Patients: A Qualitative Study Using Grounded Theory

Social Relationships and QoL among Cancer Patients

Question:

Discuss about the Research Proposal for Assessment of Psychological.

Social relationships are one of the most studied factors that contribute to quality of life (QoL) among cancer patients. It is a well recognised fact that cancer diagnosis and its exhaustive treatment are stressful events and create extreme emotional burden on the patient the family members. Recent studies have focused on the different psychosocial characteristics of cancer. Psycho-oncology has shown rapid developments in the past two decades and has led to the creation of a model that associates oncology with the psychological domain (Crist & Grunfeld, 2013). Being diagnosed with cancer is likely to create severe physical and emotional stress. Research studies predominantly focus on individual coping mechanisms such as inhibition and fighting spirit. Coping is therefore considered as the response to a perceived self-threat, such as life-threatening diseases like cancer. Coping involves several strategies that focus on the problem such as seeking instrumental support and planning, and targets the emotional distress caused due to the illness. Strategies like searching for emotional support and acceptance also work to reduce the distress. These coping techniques lead to the establishment of positive outcomes among cancer patients and enhance their overall well-being and quality of life (Schmidt et al., 2012). This research proposal aims to develop a qualitative study based on the grounded theory that will help to assess how cancer patients cope with their health status.

Coping with cancer diagnosis and its treatment is therefore characterized as a dyadic affair. Several notable researches have been done to evaluate the mechanisms by which cancer patients cope in their life and the subsequent effects on their quality of life. The PICO framework was utilized to find clinically relevant evidences (Cooke, Smith & Booth, 2012). For this literature review, electronic databases like SCOPUS, MEDLINE and Cochrane Library were used. The review includes peer reviewed journals that were published in English and contained information on coping strategies among cancer patients. The journals with date of publishing not before 2012 were selected. Exclusion criteria contained journals that were published prior to 2012, non-English articles, and dissertations and published abstracts. The search terms were ‘cancer’, ‘coping’, ‘quality of life’, ‘psychosocial’, ‘grounded theory’, and ‘coping strategies’. One study investigated the coping strategies that were utilized by young adults diagnosed with advanced cancer and also examined the relationship between psychological distress and the identified coping strategies. 53 YA participants were recruited and their informed consent was taken prior to starting the research. On statistical analysis of the Brief COPE 24 item scale and the Prolonged Grief Disorder Scale (PG-12), it was found that 6 coping factors were associated with the factor analysis. The factors identified were proactive coping, distancing, support seeking, respite seeking, acceptance and negative expressions. On the other hand, physical wellbeing and dependent children were found to be confounding variables that predicted grief among such patients. Physical wellbeing showed negative correlation with respite seeking and grief (r_s=-0.33, p<0.05).  Thus, the study successfully identified the most effective coping strategies related to cancer among young adults. Support-seeking, acceptance coping and proactive coping were found to be the most frequently used coping strategies (Trevino et al., 2012).

Individual Coping Mechanisms among Cancer Patients

Another study illustrated the grounded theory with respect to survivorship among breast cancer patients. The electronic mailing list software, LISTSERV was used to make an announcement, which was posted on the SHARE Web site. The primary aim of this announcement was to recruit women who were known to be diagnosed with breast cancer and were presently undergoing treatment. 15 respondents were recruited for the study. The experiences and perceptions of the enrolled women revealed that diagnosis of breast cancer acted as a turning point in their life. They recognized breast cancer as a part of their lives, learned to live with the disease and gradually worked towards creating a new life in the long run. Results showed that survivorship in breast cancer was marked by time, support and coming to terms with the associated trauma and treatment aftermath. Self-healing, developing new perspectives, creating new mindset and experiencing wellbeing and growth through all adversities enhanced the survivorship (Sherman, Rosedale & Haber, 2012).

Evidences from a meta-analysis and systematic review, which measured the psychosocial interventions among couples coping with cancer, showed that couple-based interventions play a significant role in improving quality of life aspects in both patients and their partners. A total of 43 randomized controlled trial studies were used. Couple-based interventions were found to create beneficial effects on the patients who had been diagnosed with cancer (Badr & Krebs, 2013). Another study was conducted to inquire about the social context of communication and lived experiences of cancer patients, based on the grounded theory. Potential participants were made to complete an interview that would assess their suitability for the study. All participants were aged 18-74 years and did not have any intellectual disabilities. The Mini-International Neuropsychiatric interview was used to measure Axis 1, which provided a description of the distress nature and level among the respondents. Results from the studies revealed that the Axis 1 diagnostic criteria were met by 50 participants. Three models were obtained from the research; the first model described the ways of quality of care evaluation by patients. On the other hand, the remaining 2 models referred to cancer-coping process where coping attempts via communication and the associated loss or distress were described. It created avenues for further research on cancer interventions (Knott et al., 2012).

Another meta-analytic review was conducted that focused on measuring self-efficacy coping strategies and evaluated their association with psychosocial outcomes among cancer patients. The CBI scale was used to measure the distress level. It was found that self-efficacy was negatively correlated with distress outcomes.  Positive correlations were displayed by between coping with cancer and self-efficacy. Therefore, the study helped in establishing the fact that people with high efficacy showed less anxiety and was better able to adjust to stressful situations upon diagnosis of cancer (Chirico et al., 2017). Results from another qualitative interview, conducted among patients with lung, prostate and breast cancer showed that people suffering from advanced cancer and their family members develop coping strategies that help them to effectively manage the psychological wellbeing. The major coping strategies that contribute to wellbeing of the individuals are support, indulgence and learning from peers (Walshe et al., 2017).

Beneficial Effects of Couple-Based Interventions to Improve QoL among Cancer Patients

The aims of this research are as follows:

• What strategies are adopted by people to cope with their life at an advanced stage of cancer?
• What are the psychological impacts of cancer on the patient and the family members?
• When are these coping strategies thought to be effective and why?

The grounded theory principles will be used to conduct the research. It refers to a series of systematic inductive methods that are used to conduct qualitative research, which is aimed towards development of the theory. The methodological strategies that are involved in this theory aim to develop middle-level theories from the obtained results directly. Strong empirical foundations are used to build the power of the analyses. A focused, conceptual and abstract theory will be obtained to explain the empirical phenomena being studied (Charmaz & Belgrave, 2012). This theory has been used by several other research studies to explore how family members utilize coping strategies during cancer diagnosis and treatment. The grounded theory will be used owing to its significance in providing sequential guidelines that will help to conduct the research (Wolfswinkel, Furtmueller & Wilderom, 2013). Moreover, the theory will offer strategies to handle the inquiry phases; will assist in streamlining data collection and analysis. The research will also get legitimized on application of this theory.

3 cancer hospitals in Queensland, Australia will be selected as the research site. Site selection plays a significant role in successful conduction of clinical or qualitative research. Improper selection of the research site can lead to compromise of the results that the research aims to achieve.  On matching the criteria for research site selection to the specific requirements and features of the proposal, the likelihood of efficient conduction of the research study will increase. Moreover, it will lead to availability of sufficient amount of superior quality data to achieve the study outcomes. 3 cancer hospitals will be selected as the site owing to the huge prevalence of cancer in Australia. Cancer was the leading cause of death in Australia (Torre et al., 2015). It was reported to be the second leading death cause in the year 2014. The hospitals that provide screening and treatment facilities for breast, bowel and prostate cancer will be selected due to greater incidence of these 3 cancer types in Australia.

Detailed sheets that contained information on the proposed study will be distributed at the waiting areas and to oncologists practicing at each of the 3 selected hospitals. All potential participants will be screened for meeting the eligibility criteria before being recruited for the study. The participants should meet the following criteria:

• They should be aged above 18 years. There will be no upper age limit.
• They should have received a diagnosis for breast, prostate or bowel cancer.
• They should be able to speak fluent English.
• There should be no intellectual impairment in the participants.
• They should be residents of Queensland.
• They should be available for undergoing psychological treatments on a weekly basis if required.

The exclusion criteria would include:

• Physically unwell patients.
• Those with DSM-IV psychotic disorder.

Informed consent will be taken separately from each participant before commencing the study. A moderator trained in the qualitative research methods will carry out structured interviews for individual participants. They will be welcomed by the moderator and their permission will be taken before audio recording their responses to the interview questions. They will then be asked to respond to the questions without any apprehensions. The interview transcript will be coded, using the NVivo 10 software, to make the study more sensitive theoretically (AlYahmady & Alabri, 2013). The interview would contain several questions, some of which are stated below:

• How long have you been diagnosed with cancer?
• What were your immediate reactions?
• Do you know how the cancer developed?
• What did you find about your illness?
• What makes you feel that you had a good day?
• How do you manage to make terms with the illness?
• How do you communicate with your friends and family after the diagnosis?
• Does the oncologist effectively communicate with you?
• Are your family and friends supportive?
• Do you feel pessimistic ever since the disease has been detected?
• Are you happy with the treatment?

The Role of Self-Efficacy Coping Strategies and Its Association with Psychosocial Outcomes among Cancer Patients

The obtained results will be analysed using Glaser’s framework of grounded theory. The limited codes obtained during the interview phase would be collected and applied to a larger data (Kolb, 2012). This will be followed by a comparison of the coded data with the larger set. This constant comparison method would lead to continuous verification of the responses and will lead to the formation of a rich and detailed theory on the psychological effects on cancer patients (Thornberg & Charmaz, 2014).

Some major ethical concerns that should be taken into account before carrying out the research are: confidentiality, anonymity and informed consent of the participants. No personal information of the patients should be shared or revealed. All possible efforts should be taken to reduce intrusion into patient autonomy (Damianakis & Woodford, 2012). Moreover, it is of utmost importance to taken informed consent of the participants prior to data collection. They should be given a detailed explanation of the nature of the research, their role, the objectives of the study and how the results would be published and utilized.

Conclusion

Thus, it can be concluded that people who suffer from cancer often find the physical, social and emotional effects of the disease to be extremely stressful. Patients who successfully attempt to manage this stress with indulgence into behaviors or those who start following sedentary lifestyle, after cancer treatment often report poor quality of life. In contrast, people who efficiently utilize coping strategies such as relaxation, emotional support and acceptance display positive health and psychological outcomes. This report therefore aimed to propose a study that would evaluate the psychological impacts on cancer patients with respect to the coping strategies they follow, using the grounded theory approach.

References

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