부산대학교 도서관

Introduction: Cancer directly touches the lives of many women. This raises the question, how do women diagnosed with cancer cope with their diagnosis? One such positive adaptation is resilience. Resilience is an individual's ability to bounce back from a negative experience. The study aimed to explore the lived experiences of adult female cancer survivors' to discover common protective resilience factors that helped them to cope with the cancer experience and to identify the barriers to resilience. Based on the findings, a Resilience tool for cancer survivorship was developed. Methods: A Mixed approach using sequential exploratory design was used which was conducted in 2 phases. Qualitative approach with Phenomenology design (Phase 1) and development and validation of a Resilience tool for cancer survivorship (Phase 2). Purposive and maximum variety sampling was used and 14 breast cancer survivors were selected between the age of 18 to 70 years till data saturation. Those with metastasis were excluded. An in-depth interview was conducted with open ended questions at the home of the participants. The audio taped data was transcribed, coding was done and emerging themes were identified. Results : The mean age of the participants was 57.07 years and the mean age at diagnosis was 55.5 with a range of 40 to 67 years, 9 of them were married, 8 underwent breast conservation surgery and 6 mastectomy, 11 of them chemotherapy and 13 had radiation therapy and 6 of them were on anastrozole and 8 were triple negative. Protective resilience factors are the factors which helped the survivors to accept, withstand, fight back and overcome the adversity they faced, and to move in life with an optimistic attitude. The emerged themes for protective resilience factors are as follows: Theme 1: Personal strengths: What it takes to be to be an "overcomer" The initially reaction to the diagnosis of cancer is that of, unexpectedness, shock, dread and disbelief, but an optimistic attitude is required to face the disease and the challenges related to treatment. But one thing I want to tell everyone who suffers from cancer, you should not get scared of cancer, your mindset should be strong, it's how you think, we should think positive. I don't mind talking to anyone who has cancer to encourage them, as I was a victim, I don't want them to get scared of the disease.P10 Theme 2: Social security: Family, friends, Health care personnel and social media. Family support plays a pivotal role in the speedy recovery of patients. When a person is diagnosed with cancer family cohesion happens instantaneously. Survivors feel safe and secure because of the stable affectionate bond of family and close secure attachments especially with the spouse. My husband, mother-in-law and family were very supportive, that gave me strength to fight day by day and to move on, my children too.P6 Theme 3: Spiritual factors- Unshakeable Faith in God. They believed that God is the Healer and He is the one that works through people. Sharing all their troubles and pain with the Almighty brought a sense of comfort and reassurance to them. It has made me more closer to God. I have strengthened my prayer life. P3 I used to pray, read books and listen to music, which helped me overcome my feelings of worry, I did become closer to God, it was God who had saved me through this experience. P5 Theme 4 : Speedy Perioperative period. Self advocacy plays a key role in speedy recovery. I got admitted Friday I had surgery and Monday I got discharged they said. P11 Theme 5 Physical factors -surfing through the waves of ' chemo'. Tolerating chemotherapy was a major area concern and fear. The common side effects of chemotherapy was seen in them, but it was more individualized in nature. I didn't have much side effects. I didn't get any mouth ulcers only tiredness', ate only home food, sometimes they used to ask what I eat, I ate bland food not pungent food. I had hair fall, I wore a scarf, the nurses they used teased me, sister all this white hair will fall and you will get black hair( laughing). P3 Theme 6 :The Transition -Celebrating 'new life' Celebrating new life and being glad that the whole episode was over is what many of them expressed in different ways. They accepted things with a positive attitude, followed the medical advice; were regular with the follow up and had a strong determination to move on with life. In my mind, I accepted everything, I am celebrating life, I get back to work, be pray full and enjoy life, I plan to go to Dubai and enjoy and come back fresh and get back to work.P10 Theme 7: Psychological and emotional factors-Coping strategies. Acceptance of the fact that one has cancer, getting treated, getting rid of the part and moving on with life. It is okay to cry as it releases all of one's worries and pains through tears and after that one feels lighter. I cried when I got the news and I prayed. I wept and said give me the strength and grace to bear, I felt lots of support and energy. I said I will face it the best way I can. I am not going to lament. P3 We should not get scared, we should be happy, more you are happy the more you laugh, humor is important, we should not sit and brood, it will eat you up, you should eat the right type of food, and be happy and have faith in God, that's' what I think. P10 I learnt yoga, It helps, not regularly, during treatment also I did, I also read quite a lot and listened to music and did some meditation. I also used to read a lot. I also spoke to many of my community.P3 Theme 8: Financial security Not having to worry about financial issues is one of the major protective resilience factors which would have otherwise been a major barrier. I put in my group, I did not know my class mates would help me, I have cancer and I have no money, I didn't say how much, they all sent and it's all in the bank, with that only I managed. Some said they will pray for me, some sent me money and others encouraging messages.P1 Barriers to Resilience The major themes that emerged from the cluster of themes and significant statements were as follows Theme 1: Neglecting ones health The first barrier seen in three of the participants was the delay in seeking medical help, as it is common with women of lower socio economic status and Indian women in general. Women do not take care of health issues unless it becomes troublesome to them or unless it affects their health. I thought it is a small growth and I left it for a year, they showed on TV too, I just neglected it, if I had known earlier I would have treated it with medication.P1 Theme 2: Dreadful word 'cancer' Although there are immense scientific and technological advancements in the field of medicine and more specifically oncology, when the word cancer is suspected and diagnosed, it creates a lot of fear, apprehension and a dreadful feeling in anyone be it medical persons or lay people. The reason behind it is the fear of fatality, fear of death, fear of chemo, fear of recurrence and many more. I was afraid, will I live or not? It has come to me what to do I have to face it, my daughter said many have had it removed and they are fine (P1) Theme 3: Biological/medical Barriers Delay on the part of the family doctors in giving the correct advice, delay in diagnosis and referrals to other tertiary hospitals or oncologists resulted in identification at later stages of cancer. No clear communication from the doctors also results in delay in treatment. Casual attitude and insensitiveness of some family doctors in providing correct advice and referrals to patients resulted in delay of treatment. I felt a lump I showed one Doctor they said that is nothing so I left it like that. I had a doubt so I showed it to another doctor he said I will give you a letter of reference you need to go and get it tested and show it to me. I went to St John's, they did all the tests, they took a piece of tissue for testing and they said that it is a growth. P1 Miscued diagnosis and contradicting pathology reports cause stress and delay in treatment. I went to these good path labs, she checked me and said are you getting pain, keep it monitored, its benign. By touch they (Dr) said it was benign, no they did not do FNAC, I don't know this Dr was so experienced, anyway that is over.P8 Theme 4: Financial barrier Finance was a major concern for some of them as they did not get financial support from spouse or children. But my son takes care. They take to hospital but I have to pay the money. I still I have credit to pay. No support from spouse or children, I have credit still to pay back. P1 Theme 5: Physical Barriers Physical barriers were expressed in terms surgery, chemotherapy and radiation therapy. Most participants had physical barriers related to the inability to tolerate and mange the side effects of chemotherapy. I had quite bad vomiting, twice it was very bad I had got admitted for it, no mouth ulcers, within first cycle there was hair fall, I had long thick hair, I cut it as only front hair was falling, P4 Denial and avoidance of chemotherapy, by compensating with changes in lifestyle especially in food patterns. I know that I don't need chemo, I know that nothing is in me, everything is gone, its' all in the mind, my food should be changed, It is mainly lack of B17 you need to eat the food which has B17, I got this Himalayan salt. I add this salt with orange juice a school too, then I have black tea. P10 Theme 6: Social barrier Social barriers were mainly in terms of stigma towards cancer, family issues and pitiful attitude by co-workers. Survivors expressed they would like to be independent as soon as possible and not be a burden to anyone. I left it, did not tell anyone, even if neighbors asked I used to just say I had some leg pain and go to hospital" P1 Theme 7: Psychological Barriers The psychological barriers identified were loneliness, inability to ventilate feelings, wanting to forget the bitter experience and move on, depression, disturbance in body image and losing interest in family roles. In the evenings I used to get depressed P2 I Don't want to discuss bitterness, on groups we will send messages in the group and forget the bitter experience, I don't want to think..P7 Theme 8: Impending Fear of Recurrence Fear of recurrence is one of the main psychological barriers.. As the date for follow up approached or time for scans there was lot of apprehension, fear and anxiety not knowing what the result would be like. We have to be careful, I feel I will not get.P7 Conclusion : The findings of this study will better inform individuals diagnosed with cancer, their families and the medical community to develop more effective ways to intervene to assist female cancer survivors to successfully cope with the various aspects of their cancer experience. Based on the protective resilience factors and barriers to resilience, a fundamental structure was created and a resilience tool for cancer survivorship was developed by the researcher. Mary Walton. [ABSTRACT FROM AUTHOR]