Understanding the cancer-related distress and coping of men from provincial New Zealand : 'bullet proof' meets radical prostatectomy : a thesis presented in partial fulfilment of requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Manawatū, New Zealand

Abstract

Men suffer inequities regarding their health which may largely be attributed to masculine culture. The present study sought to better meet men's needs for psycho-oncological care by describing men's cancer-related distress and coping, and deriving from that knowledge suggestions for intervening more effectively to address their distress. The study used participant action research methodology. Twenty-one Pākehā and six Māori men from rural provinces of New Zealand with lower socio-economic statistics, were interviewed in depth about their cancer-related distress and coping using a semi-structured format. Interviews were recorded, transcribed, and thematically analysed, producing preliminary descriptions of distress, coping, and a distress processing metaphor. These were discussed with small teams drawn from the original participants for verification and adjustment. Suggestions for intervention consistent with the findings were also discussed with these men. The description of distress summarises a wide range of matters under superordinate themes of: distress featuring a lack of control; anxiety or despondency at anticipated or actual loss; 'black' feelings (degradation, anger, self-pity, guilt and regret); and empathic distress. It includes the reporting of 'no distress' and ambiguous reporting. Dynamics associated with each of these groupings is discussed, notably the association of traditional masculine norms with 'no distress' reporting and with more sources of distress, and the wide range of distress associated with sexual dysfunction as a side-effect of cancer treatment. The description of coping lists four widely used coping strengths, namely: a positive attitude; an active and practical orientation; rationality and control; and social support/helping others. Use of social support varied with ethnicity and allegiance to traditional masculine norms. The processing metaphor describes a trajectory of suddenly losing and then gradually regaining control, which is likened to being overwhelmed by a rogue wave while paddling at the beach. Common to both descriptions and highlighted by the metaphor is the significance of control, which is underpinned by information. Accordingly, a new paradigm regarding the provision of information as part of standard treatment pathways is suggested. This features relevant, timely, and accessible information orienting men to the disease, its treatment and side-effects, the medical system, and social services.