Understanding coping with cancer: how can qualitative research help?

'Only to reconcile with it'. The coping experience amongst middle-aged and older cancer survivors: A qualitative study

BACKGROUND

Cancer threat is relevant to age, and the threat of a foreshortened life coupled with a lengthy treatment process negatively affects middle-aged and older adults. Understanding the coping throughout the cancer experience in middle-aged and older cancer survivors will help develop supportive care to promote their physiological and psychological coping effects.

OBJECTIVES

To explore the cancer coping experiences of middle-aged adults aged 40-59 and older adults over 60.

DESIGN

A descriptive phenomenological study was employed.

METHODS

Face-to-face, in-depth, semistructured interviews were conducted with 22 oncology patients in a tertiary university hospital aged 40 or above from August to October 2023. The interview data were analyzed using thematic analysis procedures.

RESULTS

Five themes and 13 subthemes were formed through analysis: acceptance of cancer (considering cancer as chronic, believing in fate and attributing cancer to karma); having different information needs (desired to be truthfully informed, information-seeking behaviour, information avoidance behaviour); getting families involved (developing dependent behaviours, feeling emotional support, family members suffering worse); striving to maintain positive psychological state (positive thinking, seeking peer support) and negative experience (undesirable, low self-esteem).

CONCLUSION

Our study reveals that cancer survivors' attitudes towards having cancer have changed from a death sentence to a more positive perception of a chronic disease. Supportive programmes for developing coping strategies should consider the cultural traditions and religious beliefs, different information needs, involvement of family and promoting a positive psychological state while avoiding negative factors.

PATIENT OR PUBLIC CONTRIBUTION

Participants with experience of coping with cancer were involved in the semistructured interview.

Colorectal cancer: a qualitative study of coping strategies used by survivors, with associated social determinants

BACKGROUND

Colorectal cancer survivors have to develop coping strategies during the diagnosis and survivorship period. This study aims to identify coping strategies in patients with colorectal cancer, in particular the differences between coping strategies during the disease and throughout survival. It also aims to investigate the impact of some social determinants on coping strategies and critically reflect on the influence of positive psychology.

METHODS

Qualitative study with in-depth interviews of a purposive sample of 21 colorectal cancer survivors in Majorca (Spain), developed between 2017-2019. Data was analysed using interpretive thematic analysis.

RESULTS

We observed different coping strategies during the stages of disease and survival. However, striving toward acceptance and adaptation when facing difficulties and uncertainty, predominate in both stages. Confrontational attitudes are also considered important, as well as encouraging positive rather than negative feelings, which are considered unhelpful and to be avoided.

CONCLUSIONS

Although coping during illness and survival can be classified into common categories (problem and emotion-centred strategies), the challenges of these stages are faced differently. Age, gender and the cultural influence of positive psychology strongly influence both stages and strategies.

Recovery of Health and Wellbeing in Rural Cancer Survivors Following Primary Treatment: Analysis of UK Qualitative Interview Data

Purpose: Rural cancer survivors have poorer experiences and health outcomes compared to their urban counterparts. There is limited research on the post-treatment experiences of UK cancer survivors residing in rural areas. This study aimed to provide an understanding of the specific challenges and opportunities faced by rural cancer survivors and to provide insight into how rurality influences experiences post-primary treatment, ultimately to inform service provision. Methods: A secondary analysis of in-depth interview transcripts (n = 16) from a wider study on self-management in cancer survivors was conducted. An adapted version of Foster and Fenlon’s recovery of health and wellbeing in cancer survivorship framework informed the data coding. Results: Health and wellbeing were interrupted by a variety of problem incidents, and the subsequent steps to recovery were influenced by pre-existing, personal, environmental, and healthcare factors. A prominent theme was support, both from local communities and family as well as from healthcare professionals, with many survivors feeling that their rural setting had a positive influence on their health and wellbeing. Close relationships with local GPs were seen as fundamental to supporting recovery. Access to healthcare was frequently mentioned as a challenge with an emphasis on lengthy travel times and limited bespoke support in rural areas. Conclusions: This study is novel in that it applied a well-established theoretical framework to a rich qualitative dataset on the lived experiences of rural cancer survivors. Rural residency influenced recovery from cancer both positively and negatively. Implications for Cancer Survivors: Future practitioners and policy makers should consider working with local communities to tailor interventions to the specific characteristics of the rural environment.

Self-compassion and healthcare chaplaincy: a need for integration into clinical pastoral education

Clinical chaplains are exposed to varying degrees of suffering and are not exempt from suffering themselves. This study took a phenomenological approach to examining self-compassion among 11 clinical chaplains, all of which had suffered from personal and/or professional hardships while providing spiritual care to medical staff, patients, and families. The three elements of self-compassion are mindfulness, self-kindness, and common humanity. Results showed that clinical chaplains' understanding of the aspects of self-compassion are limited or non-existent. Participants in this study ardently shared their experiences as they related to self-care activities during times of personal hardship. However, the intentional implementation of self-compassion practice was not displayed in these narratives. The need for education in this area would prove to enhance self-awareness and overall self-care within the profession of clinical chaplaincy.

Beneficios de un programa grupal de tratamiento no farmacológico en el afrontamiento del cáncer en mujeres españolas. Una síntesis cualitativa

Resumen En el presente trabajo se analizan los beneficios de un programa grupal de tratamiento no farmacológico realizado por la Asociación Española contra el Cáncer en Galicia (España). Se analizaron 14 ediciones del programa en las que participaron 361 mujeres con cáncer de edades comprendidas entre los 33 y los 82 años. Se adoptó un diseño descriptivo de carácter etnográfico triangulando las técnicas de análisis y las fuentes de recogida de datos por medio de un cuestionario de satisfacción, 32 entrevistas en profundidad y un grupo de discusión con profesionales. Los resultados apoyan la idea de que el programa grupal analizado ha conseguido un elevado grado de satisfacción entre las mujeres participantes en todas las ediciones, ha favorecido la aceptación y el afrontamiento positivo de la enfermedad, aumentado los conocimientos y las habilidades para resolver los problemas relacionados con el proceso, así como promovido las relaciones sociales, la participación en la comunidad y el apoyo social. Desde el punto de vista práctico y profesional, nuestro estudio evidencia la importancia de diseñar e implementar programas grupales desde el ámbito psicosocial y con carácter interdisciplinar que permitan mejorar las estrategias de afrontamiento y el apoyo en poblaciones de mujeres diagnosticadas de cáncer.

Assessment of Pain Management, Acceptance of Illness, and Adjustment to Life with Cancer in Patients with Nonmuscle Invasive Bladder Cancer

PURPOSE

According to the European Association of Urology bladder cancer is the seventh most commonly diagnosed malignancy in the world's male population. Despite its high incidence, papers evaluating psychological state in those patients' group are lacking. The purpose of the study was to evaluate pain management, disease acceptance, and adjustment to cancer in homogenous group of patients diagnosed with nonmuscle-invasive bladder cancer (NMIBC).

METHODS

Group of 252 male patients who were scheduled for NMIBC treatment were prospectively evaluated. Patients fulfilled Acceptance of Illness Scale (AIS), Mini-Mental Adjustment to Cancer (Mini-MAC) and Coping Strategies (CSQ) questionnaires before treatment introduction.

RESULTS

Highest CSQ score was achieved by the coping self-statements subscale (mean=18,37). The catastrophizing subscale score was the lowest (mean=11,24). Place of residence affected results of CSQ statement about pain control. Catastrophizing and coping self-statements strategies were associated with matrimonial status. In the Mini-MAC questionnaire the fighting spirit way of coping had the highest (21,73) and the helplessness-hopelessness subscale had the lowest mean value (13,3). Matrimonial status was strongly associated with anxious preoccupation, fighting spirit, and helplessness - hopelessness way of coping. The mean AIS test score was 28.8. AIS result was influenced by patient's marital status, yet not by education, place of residence, nor any clinical factor.

CONCLUSIONS

In the examined group, the level of acceptance of the disease reached values that were slightly higher than the average. It indicated a fairly good adaptation to cancer. Among the methods of coping with cancer, the constructive style is definitely dominant with a high intensity of the fighting spirit strategy. The destructive style of cancer coping reached low values with a low intensity of helplessness/hopelessness strategy. From pain coping strategies, self-statements and praying/hoping were the most commonly chosen ways, whereas catastrophizing was the rarest. Many associations between various questioners' results were also observed.

Coping Well with Advanced Cancer: A Serial Qualitative Interview Study with Patients and Family Carers

OBJECTIVES

To understand successful strategies used by people to cope well when living with advanced cancer; to explore how professionals can support effective coping strategies; to understand how to support development of effective coping strategies for patients and family carers.

DESIGN

Qualitative serial (4-12 week intervals) interview study with people with advanced cancer and their informal carers followed by focus groups. The iterative design had a novel focus on positive coping strategies. Interview analysis focused on patients and carers as individuals and pairs, exploring multiple dimensions of their coping experiences. Focus group analysis explored strategies for intervention development.

PARTICIPANTS

26 people with advanced (stage 3-4) breast, prostate, lung or colorectal cancer, or in receipt of palliative care, and 24 paired nominated informal/family carers.

SETTING

Participants recruited through outpatient clinics at two tertiary cancer centres in Merseyside and Manchester, UK, between June 2012 and July 2013.

RESULTS

45 patient and 41 carer interviews were conducted plus 4 focus groups (16 participants). People with advanced cancer and their informal/family carers develop coping strategies which enable effective management of psychological wellbeing. People draw from pre-diagnosis coping strategies, but these develop through responding to the experience of living with advanced cancer. Strategies include being realistic, indulgence, support, and learning from others, which enabled participants to regain a sense of wellbeing after emotional challenge. Learning from peers emerged as particularly important in promoting psychological wellbeing through the development of effective 'everyday', non-clinical coping strategies.

CONCLUSIONS

Our findings challenge current models of providing psychological support for those with advanced cancer which focus on professional intervention. It is important to recognise, enable and support peoples' own resources and coping strategies. Peer support may have potential, and could be a patient-centred, cost effective way of managing the needs of a growing population of those living with advanced cancer.