The results suggested both similarities and differences between the younger and older groups of patients with regard to disruption of life tasks in breast cancer. However, the younger group experienced, on average, significantly greater disturbances with regard to the following 'stress themes': interpersonal relationships.
ROGER GOULD’S THEORY OF THE EVOLUTION OF
Appraisal Process, Survival Schema and Coping Styles/
PSYCHOLOGICAL SEQUELAE OF DISRUPTIONS CAUSED
Biopsychosocial Sequelae of Cancer, Disruption of Develop-
DYNAMIC INTERACTION OF VARIABLES INVOLVED IN
METHOD OF DATA COLLECTION AND INTERVIEWING
Courtauld Emotional Control Scale (CECS) (Watson and
Ways of Coping Questionnaire (WCQ) (Folkman and
- Children and grandchildren 152
Mental Adjustment to Cancer Scale (MAC) (Watson, Greer
Courtauld Emotional Control Scale (CECS) (Watson and
Ways of Coping Questionnaire (WCQ) (Folkman and
- Dependent variables: Themes of stress 196 7.4.1.2 Dependent variables: Stress reactions 197
- Dependent variables: Stress reactions 220 7.6.1.2 Dependent variables: Psychological symptoms 226
HYPOTHESIS ONE AND TWO: THE IMPACT OF THE DIAGNOSIS AND TREATMENT OF BREAST CANCER ON
Impact of Demographic Variables, Themes of Stress, and
IMPLICATIONS OF THE STUDY FOR INTERVENTION 317
LIMITATIONS OF THE STUDY AND RECOMMENDATIONS
EXAMINE HYPOTHESES ONE THROUGH FIVE 128 TABLE 4 DEGREE OF STRENGTH OF CORRELATION 146 TABLE 5 FREQUENCIES AND PERCENTAGES FOR THE. Younger/Older/Total Group: 'Younger' group refers to the group of participants in the study with an age group of 26 – 52 years, which would generally be considered 'pre-menopausal' (Van Keep, 1983) in relation to development phase; 'older' group refers to the group of participants in the study with an age group of 53 – 79 years, which would generally be considered 'postmenopausal' (Van Keep, 1983) in relation to
Introduction
Psychosocial
Models of
Developmental
Research
Results
Discussion,
THE PROBLEM AND ITS SETTING
The incidence of breast cancer in sub-Saharan Africa is reported to be second only to cervical cancer (Garcia et al., 2007). For example, Fotopoulis and Cook (1980) found high levels of stress in older women with breast cancer.
OBJECTIVES OF THE STUDY
- Objective One
- Objective Two
- Objective Three
- Objective Four
To assess and delineate sources of stress and psychological morbidity in Indian South African women with breast cancer at different developmental stages of the life cycle to derive useful concepts for intervention and future research. To create and pilot a developmental stress questionnaire for South African women with serious/life-threatening illness.
HYPOTHESES TO BE TESTED
- Hypothesis One
- Hypothesis Two
- Hypothesis Three
- Hypothesis Four
- Hypothesis Five
The disruption of life tasks and subsequent themes of stress caused by breast cancer diagnosis and treatment are associated with stress-related reactions and psychological morbidity, which vary according to age/developmental stage. Different coping styles and strategies are associated with stress-related responses and psychological adjustment to breast cancer diagnosis and treatment, and these vary depending on age/stage of development.
CHAPTER OUTLINE
PSYCHOLOGICAL MORBIDITY AND QUALITY OF LIFE
- Psychological Adjustment
- Quality of Life
For example, Hunter et al. 1996) found that more than 20% of patients with primary breast cancer experienced high levels of coercion and avoidance. On the other hand, some studies comparing mastectomy with breast conservation found no significant differences (Fallowfield et al., 1986).
DEMOGRAPHIC VARIABLES MEDIATING PSYCHOSOCIAL ADAPTATION: AGE, RACE AND SOCIAL SUPPORT
- Age as a Mediating Variable
- Theoretical formulations of age as a mediating variable
- Race/Culture as a Mediating Variable
- Tradition and culture
- Race, coping and psychological adjustment
- Social Support as a Mediating Variable
- Social support, coping and psychological adjustment
- Definitions of social support
- Familial support and psychological adjustment
- Limitations of social support
- Ethnicity and social support
Empirical research suggests that lack of social support is strongly associated with increased psychological morbidity in breast cancer patients (Nosarti et al., 2002). Studies of social support and adjustment to breast cancer have examined support from multiple sources.
GENERAL OVERVIEW OF RESEARCH
- The Psychosocial Factors in the Initiation and Promotion of Cancer
- Behavioural factors and health Beliefs
- Life events
- Stress
- Personality
- Psychological Consequences of Cancer
- Emotional responses
- Cognitive responses
- The Alleviation of Symptoms
- Pain management
- Social support interventions
- Treating nausea and vomiting
- Body image counselling
- Cognitive adaptation strategies
- Psychological Factors in Longevity
- Life stress and disease-free interval
- Personality/coping style and longevity
In another study, Watson et al. 1991) found that a “fighting spirit” is negatively correlated with anxiety and fear. depression, while 'fatalism', 'helplessness' and 'anxious preoccupation' are related to depressed mood. Newer 'third wave' CBT techniques, such as mindfulness-based techniques, have been shown to improve immune function, quality of life and coping in women with breast cancer (Witek-Janusek et al., 2008). Tschuschke et al., 2001), while fatalism and avoidant coping styles are associated with disease progression and poorer prognosis (Brown et al., 2000).
STRESS AND CANCER
- Stress Concepts, Theories and Models
- Cannon’s fight or flight model
- Selye’s general adaptation syndrome (GAS)
- Life events theory
- The transactional model of stress and coping: Stress as a response to appraisal
- Stress and Illness
- Stress as an etiological factor
- Stress and illness progression
In relation to this model, the individual is conceptualized as passive and reacts automatically to the external stressor. In relation to this model, according to Lazarus and Folkman, a stress reaction is induced if a situation is assessed by the individual as being stressful. In relation to this model, this process of primary and secondary appraisal ultimately determines whether the individual exhibits a stress response or not.
COPING AND CANCER
- Coping Concepts, Theories and Models
- The psychoanalytic model of coping: Trait theories
- The transactional model of coping: Coping as process
- Crisis theory
- Cognitive adaptation theory
- An integrated cognitive behavioural model of coping and adaptation
Every shift in the human-environment relationship leads to a re-evaluation of what is happening, its significance and what can be done. It is to be expected that a patient with this coping style will deny the impact of the illness. This attitude would be accompanied by behavior that reduces the impact of the disease on the patient's life.
INTRODUCTION
The two major researchers and lifespan development theorists considered first are Erik Erikson and Robert J. Havighurst, whose theories were important precursors to the work of the two more contemporary researchers discussed here—Daniel Levinson and Roger Gould.
ERIK ERIKSON’S THEORY OF PSYCHOSOCIAL DEVELOPMENT
It is hypothesized that, in terms of this theory, disruption caused by a disease such as cancer at this stage of development may interfere/prevent the appropriate resolution of the developmental crisis inherent in this stage of development. Regarding the next developmental stage of 'Middle Age' (which begins around the age of 40), the developmental tasks include the fulfillment of goals that include family, career and society;. Failure to achieve the developmental tasks of this stage leads to personal bankruptcy, pseudo-intimacy, excessive dependence or premature disconnection from society.
ROBERT J. HAVIGHURST’S THEORY OF DEVELOPMENTAL TASKS
In terms of this theory, a disruption of development in early adulthood (19-30 years old) by a major life event, such as a serious illness, would affect the person's ability to form new and more mature relationships , and to get emotional in the right way. The person's ability to choose an occupation and pursue a career would also potentially be hampered by illness at this stage, further impacting the development of social identity and the development of independence and autonomy. As for the disruption in middle age (30–60 years), illness during this stage of development would potentially seriously hinder an individual's ability to start a family; become established and achieve success in a profession; and generally adapt to 'middle age' in terms of changes in body function, leisure and social activities.
DANIEL LEVINSON’S THEORY OF ADULT LIFE STRUCTURES
The midlife transition occurs between the ages of 40 and 45, during which time one questions all aspects of life and seeks balance among a number of choices, including desires, aspirations, talents, values, and different parts of oneself. An important aspect of this period is preparation for the next era of life, or a review and reworking of the past. As with the previously discussed theories, it is hypothesized that failure to achieve any of the aforementioned developmental "milestones" as a result of the illness may result in psychological distress and a diminished ability to cope with both the challenges posed by the illness, like. as well as those from everyday life in general.
ROGER GOULD’S THEORY OF THE EVOLUTION OF ADULT CONSCIOUSNESS
Developmental disturbances in this developmental phase inhibit the establishment of identity, putting the individual at risk of not developing a sense of agency and autonomy. Developmental disturbances in this stage of development potentially impede the achievement of goals, possibly affecting the individual's self-esteem and sense of self-efficacy. By the end of their 20s, the individual's sense of time incorporates their adult past as well as their future.
CRITIQUE OF ADULT DEVELOPMENTAL MODELS
The feminist literature is therefore critical of the dominant theories of adult human development for the underrepresentation of these gender-specific issues. Levinson's concept of the life structure captures the importance of a sense of integration and harmony at a particular time, in addition to the ability to confront and cope with change. Gould's focus on the need for adults to relinquish the illusion of absolute security derived from our childhood captures the importance of the need for a sense of self-determination – something that research has indicated is later for women ( mid 40s) is achieved it seems. to achieve identity and intimacy in reverse order of men (Sanguiliano, 1978; in Bee and Mitchell, 1980).
HOLLAND AND ROWLAND’S ADULT DEVELOPMENTAL ILLNESS MODEL: DISRUPTION OF DEVELOPMENTAL LIFE
- The Young Adult (19 – 30 years)
- Developmental tasks
- Disruptions of illness
- The Mature Adult (31 – 45 years)
- Developmental tasks
- Disruptions of illness
- The Older Adult (46 – 65 years)
- Developmental tasks
- Disruptions of illness
- The Ageing Adult (66 and older)
- Developmental tasks
- Disruptions of illness
Cancer at this stage of the life cycle has an extremely negative impact on young adults' ability to develop or maintain relationships. Normal concerns associated with this stage of development about changing sexual image and functioning may be. The aging adult's inability to maintain personal hygiene can be distressing to the patient, family, and staff alike.
SUMMARY AND CONCLUSION
INTRODUCTION
PROCESS OF APPRAISAL AND COPING
- Appraisal Process, Survival Schema and Coping Styles/Strategies
- Biopsychosocial Sequelae of Cancer, Disruption of Developmental Life Tasks and Psychological Symptoms
However, researchers such as Lazarus (1993) also warn against 'extreme contextualism' and recommend in the study of coping an investigation into the contextually-influenced, as well as stable relationships between the person and environment. The model discussed here therefore incorporates both coping styles and coping strategies into the coping process to emphasize the importance of both the patient's pre-existing 'psychological make-up' as well as the dynamic, mutually reciprocal, two-way relationship between the person and their environment that enables coping to ' to be a fluid and dynamic process. As with the threat of death, it is the appraisal of these effects of cancer that contributes to the person's emotional response.
DYNAMIC INTERACTION OF VARIABLES INVOLVED IN PROCESS OF PSYCHOLOGICAL ADJUSMENT
The aforementioned changes in mental and physical abilities, personal and social roles, and appearance are said to be influenced by contextual/systemic factors and. They are conceptualized as being in a two-way relationship with developmental life tasks, given that the consequences of these disorders can also cause changes in these areas, just as these changes can be viewed as potential disorders of developmental life tasks. good. The flexibility of an individual's coping styles/strategies is conceptualized as influencing psychological functioning (in terms of psychological symptoms and stress reactions), with psychological functioning viewed as potentially influential in a feedback loop on coping styles/strategies, which may require adaptation.
THE PRESENT STUDY
- Components of Model Highlighted by Present Study
- Components of Model Not Investigated by Present Study
INTRODUCTION
SAMPLE
- Method
- Size
CRITERIA FOR INCLUSION/EXCLUSION
SAMPLE GROUPS
- Younger Breast Oncology Group (n = 60)
- Older Breast Oncology Group (n = 56)
Although imprecise given the sample size and age distribution, this cutoff was considered to be the most appropriate given the aforementioned trend reported in the literature. In this way, the integrity of the theory is maintained in interpretations based on age-related factors, given the age delineations in this study. The sample was taken mainly from Addington Hospital, Durban and King Edward VIII Hospital, Durban, although a small proportion of the sample was also obtained from R.K.
POSSIBLE BIASES
- Sampling Biases
DESCRIPTION OF THE SAMPLE
- Participants
METHOD OF DATA COLLECTION AND INTERVIEWING PROCEDURE
- Procedure
- Data Collection
- Interviewing Procedure
Volunteers who met the necessary inclusion criteria were identified and provided with a brief formal letter of introduction and explanation of the study (Appendix A). After the introductory letter, participants received a brief explanation of the procedure and confidentiality was guaranteed. After the interview, all patients were formally thanked for their contribution to this study.
DESCRIPTION OF THE QUESTIONNAIRES
- Introduction
SUMMARY OF PSYCHOMETRIC INSTRUMENTS
- Demographic Questionnaire
- Developmental Stress Questionnaire (DSQ) (Selmer, 2000)
- Brief Symptom Inventory (BSI) (Derogatis and Spencer, 1982)
- Mental Adjustment to Cancer Scale (MAC) (Watson, Greer and Bliss, 1989)
- Courtauld Emotional Control Scale (CECS) (Watson and Greer, 1983)
- Ways of Coping Questionnaire (WCQ) (Folkman and Lazarus, 1985)
Other studies confirming the validity of the BSI are referenced in the manual (Derogatis, 1993). Separate scores are calculated for each subscale by summing the scores for each of the components that make up the subscale. The factor structure of the MAC scale was tested based on the intercorrelation between the subscales.
STATISTICAL ANALYSIS OF DATA
The low autocorrelations indicate that the use of problem-focused forms of coping is strongly influenced by the situational context. Positive reappraisal has the highest average autocorrelation (r = .47) suggesting that it was most influenced by personality.
DESCRIPTIVE STATISTICS: RESEARCH STATEMENTS
INFERENTIAL STATISTICS
The raw data were summarized and graphically presented in the form of frequency distribution graphs and tables. Cronbach's alpha statistics were calculated for each instrument subscore to determine whether the instruments used retained construct validity in this sample (Table 49, Appendix C).
UNIVARIATE ANALYSIS
- Pearson’s Chi-Square Test and Mann-Whitney U Test
- Correlations
The one-sample Kolmogorov-Smirnov test was used to determine which results followed a normal distribution (Table 50, Appendix C). It is used when the data do not meet the assumptions of normality, homoscedasticity and linearity and when one or both variables consist of ranks. Determining whether a relationship is reliably significant or not can be determined by the level of significance.
MULTIVARIATE ANALYSIS
- Multiple Regression Analysis
- Multivariate Analysis of Variance: Hoteling’s T
Multivariate analyzes of variance form linear combinations of the dependent variables that best distinguish between groups in the particular experimental design. Hotelling's t is a multivariate statistic used to compare two groups where multiple outcomes are observed; that is, a dichotomous independent variable and multiple dependent variables. F-tests for each variable are then examined to interpret the respective effect; that is, to identify the specific dependent variables that contributed to the overall effect.
INTRODUCTION
DESCRIPTVE ANALYSIS
- Demographic Data
- Home language
- Religion
- Marital status
- Children and grandchildren
- Level of education
- Employment status
- Gross household income
- History and current status of mental and physical health
- Premorbid history of traumatic events
- Time of diagnosis
- Type of treatment
The mother tongue of the majority of patients in the total sample was English. The majority of the total sample had children (86.2%), with this trend observed in both the younger and older patient groups. The majority of patients in the total sample (88.8%) were unemployed at the time of the study, with none of the patients in the older sample indicating that they were unemployed.
UNIVARIATE ANALYSIS
- Developmental Stress Questionnaire (DSQ) (Selmer, 2000)
- Stress Symptom Checklist (SSCL) (Schlebusch, 2000)
Frequencies and percentages for disruption of specific life tasks of the younger breast cancer cohort (n = 60). Frequencies and percentages for interruption of specific life tasks of the breast cancer group (n = 56). Means and SDs for the Stress, Psychological Functioning, and Coping Themes of the Younger (n = 60) and Older (n = 56) Breast Cancer Groups.
