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    Survivors of cancer : a phenomenological study : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 2005) Miller, Janet
    This paper explores the experiences of survivors of cancer. Eight participants, who were all diagnosed with cancer and had undergone various treatments, were interviewed. These participants had all survived the prognosis and treatment for cancer and continue to live as survivors. Their stories of survival were transcribed and analysed using a phenomenological approach. Initially, the research question was aimed at the type of personal qualities these survivors have; for example, a fighting spirit, positive attitude, or internal locus of control, and whether they attributed their survival to a change in life-style or behaviour through, for example, meditation, diet, prayer, or beliefs. However, during the interview and transcribing process it became clear that, while their stories of survival were exceptional, the participants themselves did not attribute their survival to anything outstanding. They did not necessarily have exceptional personal qualities and were not highly motivated at the time of their diagnoses to change their lifestyle or way of being. None of them had remarkable reasons that they could attribute their survival to. Some attributed their survival to luck. This is consistent with the research by Killoran, Schlitz and Lewis (2002) who found that long-term survivors framed their recoveries as "being largely unremarkable". What was very apparent in all of the survivors stories was that, with survival comes a whole new and different way of being and it poses new psychological issues that have to be faced daily, for the rest of their lives. While each participant's story was one of amazing courage, strength, hope and positiveness, it was also found that surviving cancer can and does have a dark side. Fear of recurrence is always in the forefront of the survivor's mind. Depression and mal-adaptive coping strategies occur in some survivor's lives. Changes in body image, employment, abilities, stress on relationships and ongoing health problems can render a person incapable of coping. Therefore, the research question changed from one of looking at the personalities and life styles of survivors, to that of "what is it like to live as a survivor of cancer?" As a phenomenological study, this shift in focus was significant and necessary. The interviews were analysed and data was formulated into four main clusters; "Why me?": cause, effect & making meaning & sense out of it all; "I just want life to be normal again": the issue of normality, redefining oneself and the physical legacy of surviving treatment; "I've been told that canccr will eventually get me": remission or cure? Living with uncertainty, fear of recurrence and "Keeping busy and my mind off of it helps": coping styles, control and attitude.
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    Cancer survivorship : exploring the relationships among gender, religion, spirituality, health behaviours and the quality of life of cancer survivors : a thesis presented in partial fulfilment of the requirements for the Master of Arts in Psychology at Massey University, Palmerston North, New Zealand
    (Massey University, 2012) Cleaver, Bridget
    More people are surviving cancer now than ever before and research with cancer survivors has grown considerably. International research has identified that the cancer experience does not end when treatment ends, but instead is a journey that can continue to weave a complex and multifaceted path that can collide with numerous domains of an individual’s life. Many factors have been identified within the cancer experience that can impact on an individual’s quality of life for the rest of their life. Factors such as, type and stage at diagnosis of cancer, treatment, social support, ethnicity, socioeconomic status, employment, health behaviours, gender and religious and spiritual beliefs. The purpose of this study was to investigate the factors that can influence the quality of life of those who have had cancer in the New Zealand population. The particular focus was the differences between males and females and those who identify as Religious or Spiritual, the health behaviours of cancer survivors were also investigated. The study analysed data from the Health Work and Retirement 2006, 2008 and 2010 surveys, which collected data from over 6000 New Zealanders aged from 55 to 75 years. This group was seen to provide a good representation of those who have had cancer in their lifetime. Results from this study were varied, supporting as well as contradicting overseas research. No differences in gender and quality of life were identified, however males were found to consume more alcohol and exercise more frequently. Females reported to be more religious and spiritual than males. Religion did not impact on quality of life however spiritual activities impacted negatively on physical health. Over time religion and spirituality contributed to improved mental health. A mediating relationship was identified with those who participate in more spiritual activities consuming less alcohol and in turn have poorer quality of life
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    Experiences of gynaecological cancer and treatment of female survivors : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Health Psychology with endorsement at Massey University, Palmerston North, New Zealand
    (Massey University, 2011) Smit, Adele; Smit, Adele
    Until recently, clinical management of gynaecological cancer focussed almost exclusively on prolonging life. This resulted in improved diagnostic and treatment regimes that increased survival. Unfortunately, this comes at the price of various side effects that can have a vast impact on women’s personal and social lives by introducing a variety of challenges and changes that necessitate adjustment. This qualitative study was carried out to gain insight into the challenges faced by women following gynaecological cancer diagnosis, treatment and effects as well as the changes implemented by them as a result of altered circumstances and perceptions. Purposive sampling was used to recruit women diagnosed with gynaecological cancer and who had undergone various treatments. Interviews revealed a range of shared experiences of the gynaecological cancer and highlighted the importance women placed on identity re-evaluation and reconstruction. Four themes emerged from the data: women’s sense of female identity following gynaecological cancer treatment, threats to the identity experienced, protection mechanisms adopted by women to protect the self or identity as well as reconstruction of a new identity as a result of changed circumstances that was induced by cancer. While some of the findings were consistent with results of previous research conducted on identity re-evaluation and reconstruction of cancer survivors, it became clear that women with gynaecological cancer have to endure many unique challenges to their identity that needs to be addressed in future to lessen suffering endured.
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    An investigation of the outcomes of psycho-oncology interventions : a thesis presented as partial fulfilment of the requirements for the degree of Doctorate in Clinical Psychology at Massey University, Wellington, New Zealand
    (Massey University, 2010) Croy, Philippa
    Cancer can have a significant psychological impact on those diagnosed, and their families. The ability of psychotherapy to reduce this impact has been extensively studied internationally. However, New Zealand-based research in this area remains limited. The present study aimed to investigate the effectiveness of psycho-oncology interventions, provided by a New Zealand psycho-oncology service, in reducing distress and improving quality of life for cancer patients and their families/whanau. Eighteen clients (patients/family members) of the service (intervention group) were recruited and matched for initial distress and wellbeing with patients/family members located in an area without a psycho-oncology service (control group). Wellbeing, wairua (spirituality), distress, impact and coping were measured pre- and posttherapy, and at follow-up. In addition, eight intervention group participants were interviewed to examine their experiences of cancer and the psychooncology service. Possible key factors influencing the effectiveness of service interventions were also investigated. The results showed that participants who had access to the psycho-oncology service showed significant improvements in all outcome measures by the end of therapy. The majority of these were maintained 3 months later. Improvements were also observed in the control group. Reasons for accessing therapy centred on diagnosis/prognosis concerns, communication with family, and talking to a non-family member about their worries. Although clients had no specific expectations prior to therapy, previous psychotherapy experiences influenced their perceptions of its potential effectiveness. Therapists’ personal and professional qualities were also viewed as crucial. Five key themes were identified as most beneficial - receiving individualised support, talking to someone who was not family, receiving expert/professional support, regaining a sense of control, and service availability/flexibility. Overall, psycho-oncology interventions had a significantly positive impact on clients’ lives, and were viewed as being extremely beneficial for those experiencing cancer-related distress. This research provides a unique contribution to the limited psycho-oncology research in New Zealand.
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    Cognitive determinants of treatment choice among cancer patients : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University
    (Massey University, 2001) Haddon, Glen Leonard
    Decisions about whether or not to include non-conventional therapies in a cancer treatment regimen are potentially critical. An illness such as cancer, perceived to be life-threatening, inevitably raises existential questions which, in the present study, were posited to underlie the cognitive approach to treatment choice for cancer patients. The hypotheses tested in the study were that those who use non-conventional medicine will be more knowledgeable and have a more positive belief system about cancer, will be more interested in and motivated about health matters, will desire more personal control and assume more responsibility for their health and its treatment, and will be more intrinsically oriented in terms of meaning in illness and life. It was further hypothesised that the differences between those who use only conventional treatments and those who include non-conventional treatments will become more marked as the boundary between the two is altered to incorporate more non-conventional treatments in the conventional category, suggesting that patients' perceptions of the distinction varies from the medical establishment's view. An important underlying objective of the study included the exploration of the conceptualisation of meaning in life and its events in terms of intrinsic and extrinsic orientations. 212 adult participants, all having been diagnosed with any form of cancer for at least three months, volunteered and completed a postal survey. Overall, the results indicated that the conceptualisation of meaning as intrinsically or extrinsically oriented was an appropriate basis for exploring the role of existential issues in treatment decision making. The combination of constructs in the study was also confirmed as appropriate. In terms of the specific hypotheses, the expectation that users of non-conventional medicine would be more knowledgeable and more positive in their beliefs about cancer was supported only when conventional treatment was deemed to include certain physical and natural types of treatment usually labelled as non-conventional. Users of non-conventional medicine were found to be more interested in and more motivated to be involved in health matters than those who used only conventional medicine. They were also found to be those who desired more personal control over their health and its treatment and were also prepared to assume more responsibility. The results also supported the hypothesised difference between conventional only and non-conventional users in terms of intrinsic life meaning, but results for extrinsic life meaning only partially supported the expectation that this would be associated with conventional medicine use. These were discussed in terms of measurement issues and the reconceptualisation of the religious, spiritual and philosophical derivations of extrinsic meaning. No difference was found between users of conventional only and users of non-conventional medicine in terms of illness meaning, suggesting that conceptualisation in intrinsic and extrinsic terms was inappropriate for this sub-construct. There was also support for the view that treatments are viewed by many as being on a continuum from conventional to non-conventional, rather than being in defined dichotomous groups. Multivariate results (from a series of 2-group discriminant analyses) confirmed that health interest and motivation, attributions of control, responsibility and blame, and intrinsic and extrinsic meaning in life were the most important contributors to discrimination. Internal control attributions were consistently the most important relative discriminator. These results also showed that the influence of the discriminating variables in combination, including sociodemographic control variables, explained variances ranging from 25.4% to 33.6% across the altered groupings of treatment type. The results are discussed in relation to the conceptualisation of meaning and attributions of control and responsibility as pivotal concepts, and in relation to the indication that the greatest separation between conventional and non-conventional use was found when certain physical and natural treatments were classified as conventional rather than non-conventional. Psychometric, and conceptual limitations of the study are discussed, suggestions for future research are made, and some applications of the findings for health professionals are offered.
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    Cancer survivorship : understanding the issues faced by cancer survivors : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Palmeston North, New Zealand
    (Massey University, 2010) Hayward, Penelope Anne
    International research on cancer survivorship has started to identify a range of issues that affect cancer survivors physically, mentally, emotionally and spiritually. These issues can be present at any time, from diagnosis, throughout treatment and for the rest of the individual’s lives. The quality of life and well-being cancer survivors depends on many interacting factors including the type of cancer they are diagnosed with, the type of treatment provided, healthcare utilisation, social support availability and use, employment status, locus of control, ethnicity and socio-economic status. The objective of this study was to investigate the influence of these factors on cancer survivor’s quality of life, health outcomes and support needs within the New Zealand population. Of particular interest is whether ethnicity might affect outcomes. It is hoped that the information provided by this study will help to inform future policy and interventions for cancer survivors. This study analysed and discussed data from the 2008 Health Work and Retirement Survey. The Health and Work Retirement Survey collected information from over 3000 participants, ranging in age from 57-72 years. This age group has an increased likelihood of cancer diagnosis but also potentially has several more years of active participation in society. Results from this study were consistent with overseas research and indicates that New Zealand cancer survivors share similar issues to those overseas. Of all the factors, socioeconomic status was found to be the largest contributor to a poorer quality of life in cancer survivors.
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    Meta-analysis of moderators of psycho-oncology therapy effectiveness : "it's the sick who need a doctor" : a thesis presented in partial fulfillment of the requirements for the degree of Master of Arts in Psychology at Massey University, Palmerston North, New Zealand
    (Massey University, 2009) Heron, Heather Adele
    Reviews conflict regarding the effectiveness of psycho-oncological therapies at reducing patient anxiety, depression and general distress, suggesting that unknown factors are moderating trial results. This meta-analysis investigates the moderating impact of a large range of socio-demographic, psychological, medical and therapy factors using published and unpublished data from 146 prospective controlled trials, including non-random designs. Preliminary analyses of trial design quality features exposed 2 moderators: recruit screening for psychological distress or history, and the nature of the control condition. These structured a 2 x 2 matrix used to conduct substantive analyses. Admitting only recruits with established baseline distress was found to predict greater effect size, as was excluding patients with a history of distress. Main effects for patients with baseline distress compared with untreated controls, were medium-strong at g = 0.52 - 0.70. Evidence of varying strengths indicated that patients who were older, of lower income, male, single, or suffering from cancer sited elsewhere than breast produced higher effect sizes. Data also highlighted particular stages in the cancer journey: re-entry to normal life at the end of medical treatment, recurrence, and distant disease spread. Findings suggest that risk and distress screening should be employed by both clinicians and researchers. Researchers should also re-direct attention away from unscreened middle class early stage breast cancer patients, towards more vulnerable socio-demographic and medical groups. The potential of using survivors and indirect therapies to effectively and efficiently reach vulnerable groups deserves exploration. Reviewers need to take into account the 2 trial design moderators discovered, and should include non-random controlled trials which may have more access to particularly vulnerable groups because some past conclusions were confounded by the co-variation of study design with sampling characteristics.
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    Qualitative description of the adult patient experience of cancer-related cachexia (CRC) : a pilot study : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing, Massey University, Palmerston North, New Zealand
    (Massey University, 2008) Stubbs, Marika Jane
    This thesis explores the experience of living with cancer-related cachexia (CRC) from the patient perspective. Critique of the literature indicates few examples where patients have had the opportunity to speak. Following a challenging recruitment process, six people living with the syndrome were interviewed to elicit their narrative. Their stories were examined and themes identified relating to their personal feelings and how these affected social interactions. Thematic analysis was applied to produce what is a rich qualitative description of the experience from this small sample. Living with CRC requires development of strategies to survive. Emergent themes included the loss of sense of self and a changing relationship to the social world, social isolation and dissatisfaction with truth-telling by health professionals. Recommendations are made to mitigate the suffering of patients by empowering them through better information and acknowledgement of their condition. The balance between nutrition and wellbeing is re-examined, calling for a reorientation of perspective from a focus on intake towards a focus on quality of life. This clearly falls within the nurse-as patient-advocate paradigm and the relevance and meaning of this research to the nursing profession is explored. Potential areas for further research in regards to both patient experience and nursing practice are extrapolated.