The existing literature on adaptation to childhood cancer is integrated within the stress and coping paradigm (Lazarus & Folkman, 1984) to demonstrate its functional utility. The coping resources (i.e. psychological and social resources) and coping efforts of 21 children (9 male, 12 female) diagnosed with cancer were assessed and compared with standardized norms. Within-group differences were explored as the cancer sample was subdivided by stage of therapy (i) newly diagnosed, (ii) currently in treatment, and (iii) off treatment. Results suggest that children with cancer differed significantly from typical children on measures of coping effort (Coping Inventory) in that they demonstrated relatively more adaptive and efficient coping behavior as compared to their normative peers. Children with cancer differed slightly from typical children on measures of psychological resources (Assessment of Coping Style) such that they utilized a slightly more restrictive style of coping. Children with cancer did not differ significantly from normative children on measures of social resources (Social Support Scale for Children). The data are analyzed and discussed with reference to mediating factors including developmental stage, gender, and stage of illness.

From the time women suspect that they have breast cancer they may be faced with many decisions about themselves, their treatment, their relationship and their lives. Previous research in this area has focused largely on describing the different ways that patients behave when making decisions about treatment, and women's perspectives of making those decisions after the initial diagnosis of early breast cancer. However, there are no studies that provide an understanding of the range of decisions that women are likely to face and what the experience of making these decisions is like. The aims of this study were to describe the types of decisions women make during early breast cancer and to provide an in-depth understanding of the phenomenon of making decisions during the experience of early breast cancer. Health professionals may be able to use this understanding to improve their relationships with patients and further assist women to make decisions during their experience of early breast cancer.

Thesis (Ph.D.)--University of Nebraska-Lincoln, 2008. / Title from title screen (site viewed Feb. 17, 2009). PDF text: iv, 173 p. ; 687 K. UMI publication number: AAT 3325857. Includes bibliographical references. Also available in microfilm and microfiche formats.

D.Cur. / Hospitalisation can be very traumatic for children – and this is especially true for the child admitted to a haematology-oncology unit. These children are subjected to an environment which they do not understand, nor have any control over, they are faced with many unfamiliar sights, sounds and smells and they have to undergo frightening and often painful procedures. In South Africa, there are no associations responsible for monitoring the environment that children are subjected to in hospital; neither does any Child Life Specialists, Hospital Play Therapists or scientifically based programs exist that can ensure that the psychosocial needs of children in hospital are met. The purpose of this study was to develop and describe a model for the facilitation of support for children through the mobilisation of resources according to their needs in a haematology-oncology unit in the private healthcare sector of South Africa. The following research questions were asked: • What are the needs of children in a haematology-oncology unit? • What are the resources that can be mobilised so that the needs of these children can be met? • How can support be facilitated for children in a haematology-oncology unit? During this study a theory generating, sequential explanatory (consisting of a quantitative field study followed by qualitative model development), explorative, descriptive as well as contextual research design was used. A model was developed according to the method of theory generation as explained by Chinn and Kramer (1995:77-102) and involved the following steps: Concept analysis (which includes concept identification as well as concept definition and –classification); description of the links and relationships between the concepts and a description and evaluation of the model. It became evident that children in a haematology-oncology unit are robbed of all feelings of control and choice in the situation, resulting in a sense of powerlessness. For this reason, the focus point of the model was changed to include the empowerment of children in a haematology-oncology unit as the main focus of the model. The final model aims at the facilitation of support in order to empower children in a haematology-oncology unit in the private healthcare sector of South Africa.

The purpose of this study was to understand the meaning of transformation in surviving terminal cancer. An existential-phenomenological approach was used to interview five participants who had lived at least five years beyond the diagnosis of widely metastatic or terminal cancer. Review of the literature which addressed the issue of transformation suggested that life-threatening illness is an opportunity for growth. There are many cross-cultural accounts of transformation, and many studies of survivorship qualities, but little research into the transformation process as it is experienced by cancer survivors. Participants told the story of their recovery from cancer and how it changed their lives. Cochran's (1986) dramaturgical approach provided the model for capturing the meaning of this experience in story form. Each interview lasted from 2½to 5 hours. Interviews were audio-recorded and transcribed. Analysis of the interviews followed Colaizzi's (1978) method. Significant statements were extracted from the protocols, themes were formulated, and a description of the experience was written. Other sources of data were used in addition to interviews. An autobiography and a series of articles were collected from two participants. This written material was analyzed in the same way as the interviews. The experience of the researcher also served as data, and was analyzed through reflective and descriptive methods. Conducting interviews, soliciting written descriptions and including the researcher's experience allowed the data to be more broadly supported. Results of the study were validated by the participants in a second interview. They confirmed that the 38 themes and the common pattern of transformation derived from the five participants accurately reflected their own experience. The results indicated that psychological transformation in survivors of terminal cancer is a spiritual journey. In allowing a life-threatening disease to become an opportunity for personal awareness and growth, people can transform their illness into a spiritual teaching. Serious illness can teach people about the meaning of life., and give their own lives purpose and direction. Through this affirmation of life, and by following their purpose and path, healing can occur. This healing not only moves people toward wholeness, but it holds the potential for transforming and healing the problems of others. This pattern of transformation has practical implications for the nature of support useful for people experiencing a health crisis, and has implications for the designing of effective psychosocial support for cancer patients. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

Accurate assessment of educational needs is central to the planning of effective patient education programs. Adult learning theory holds that the more agreement that exists in the educator's and the learner's assessment of learning needs, the higher the probability that effective learning will occur. This descriptive survey was carried out to compare the learning needs of cancer patients receiving chemotherapy as perceived by three groups involved in patient education: nurses, physicians, and patients themselves. Using the Assessment of Learning Needs Questionnaire (ALNQ) developed by Lauer, Murphy, and Powers (1982) and demographic data questionnaires developed by the researcher, the perceptions of patients' learning needs held by a convenience sample of 20 lymphoma patients, 24 nurses, and ten physicians were studied. Responses to the rating and ranking scales of the ALNQ were analyzed using nonparametric statistical techniques to determine the existence and location of differences in perceptions among the three groups. General comments about patient education and the ALNQ were gathered from the patient group in an interview setting and from the two care giver groups through responses to two open-ended questionnaire items. Findings revealed that the learning needs of patients undergoing chemotherapy tend to focus on concerns related to the treatment experience, and the knowledge and skills required to cope with the impact of the disease and treatment on their lives. Patients described themselves as most knowledgeable in areas relating to life experience, rather than disease or treatment related areas, and were oriented to survival in their learning needs. The three groups demonstrated considerable similarity in their perceptions of areas problematic to patients and areas in which patients have the most knowledge. However, despite presumed knowledge and expertise in dealing with the concerns of chemotherapy patients, nurses' and physicians' perceptions of patients' learning needs differed from those held by patients. The care givers perceived patients to be more concerned with learning needs related to activities of daily living than patients reported. Implications for nursing practice and education are suggested, and recommendations made for further study. / Applied Science, Faculty of / Nursing, School of / Graduate

Much has been written on guiding children through trauma and life crises. Most sources focus on trauma such as violence, abuse, terminal illness or death, experienced by the children themselves. However, little has been published about a parent’s illness, especially the effects of a mother having breast cancer on her children. This research starts off by investigating the high prevalence of breast cancer in South Africa. Based on this evidence, it was argued that many families are affected, and it seems that little care, in terms of support, is given to the children of women with breast cancer. The aim of this research study was to analyse and describe the experiences and the meaning three children made whose mother was being treated with breast cancer. In the literature review, social constructionism, narrative therapy, and generally used approaches to supporting children during their parents’ illnesses were scrutinized. Thereafter, the research paradigm and design applicable to this study were examined. The emphasis was on the qualitative research paradigm, the exploratory case study design, the purposeful sample, as well as the methods used for data collection and data analysis. The data gathered during the research (therapeutic sessions with the three children), were analysed and documented. Each child’s data analysis started with a description of the child, after which a visual illustration of the analysis process and their experiences and meaning-making were discussed. According to the findings of this study, children explore their experiences and meaning-making freely in a narrative therapy approach. The experiences and the meanings they made, were unique and very different from each other. Developmental age and language usage played a role in their expression and sharing of meaning. Consequently, it would not be possible to use predetermined therapeutic ‘recipes’ or impose expert meaning onto children, since this would hinder the unique process of meaning-making and re-authoring. / Prof. J. Byrne

Thesis (M.S.)--Boston University, 1956 / This thesis represents one part of a group study conducted jointly by four Boston University social work students. The purpose of this group study is to examine first same of the social and emotional factors that affect the rehabilitation of cancer patients, and second, the role of social service in this rehabilitation. The study is based on the cases comprising the Harvard Medical School project.

No description available.

Il existe une forte prévalence d'incontinence urinaire (IU) chez les femmes ayant été traitées pour un cancer de l'endomètre (CE). Les connaissances actuelles sur les effets d'un programme de réadaptation pour réduire la sévérité de l'IU pour cette population sont rares. L'objectif principal de cette thèse était de vérifier les effets d'un programme de réadaptation à distance, comprenant l'utilisation d'une technologie mobile, pour réduire la sévérité de l'IU chez des survivantes d'un CE. Les objectifs secondaires visés par les travaux de cette thèse étaient de 1) décrire l'étendue des connaissances actuelles concernant l'utilisation des technologies mobiles pour le traitement de l'IU, 2) faire une synthèse des évidences sur les indices de sensibilité au changement des questionnaires auto-administrés qui mesurent l'impact de l'IU sur la qualité de vie lors d'une intervention conservatrice, et 3) déterminer la fidélité intra et inter-évaluateurs des mesures échographiques pour des mesures morphologiques et fonctionnelles de la vessie, de l'urètre et des muscles du plancher pelvien (MPPs) chez des femmes ayant été traitées avec de la radiothérapie pelvienne. Quatre études ont été réalisées pour rencontrer ces objectifs. La première étude était un examen systématique de la portée des connaissances sur l'utilisation des technologies mobiles pour le traitement conservateur de l'IU. Les résultats ont permis de démontrer que les technologies mobiles étudiées pour le traitement de l'IU présentent plusieurs fonctionnalités et paramètres recommandés pour les soins de santé. Également, les évidences recensées indiquent que l'utilisation des technologies mobiles peut être bénéfique en matière de réduction de la sévérité de l'IU, de satisfaction, de l'adhérence au traitement et des coûts. La deuxième étude était une revue systématique dans laquelle ont été recensées les évidences sur les indices de sensibilité au changement des questionnaires auto-administrés qui mesurent l'impact de l'IU sur la qualité de vie dans un contexte d'intervention conservatrice. Les résultats ont permis de mettre en lumière que le questionnaire bref International Consultation on Incontinence pour l'IU (ICIQ-UI SF) présente la sensibilité interne au changement la plus élevée dans un contexte d'intervention conservatrice. Les résultats indiquent également que l'étude avec la plus haute qualité méthodologique démontrait que c'est le questionnaire PRAFAB qui avait l'indice de sensibilité au changement externe le plus élevé. La troisième étude réalisée a permis de déterminer la fidélité des mesures échographiques transpérinéales de morphologie et de fonction des muscles du plancher pelvien auprès de femmes ayant eu de la radiothérapie pour traiter un cancer pelvien. Les résultats démontrent qu'il existe une très bonne fidélité intra-évaluateur pour mesurer la longueur de la plaque des releveurs au repos (LP-R), lors d'une contraction maximale des MPPs (LP-MVC) et lors d'une manœuvre maximale de Valsalva (LP-MVM), ainsi que pour la longueur de l'urètre (UL). La fidélité inter-évaluateurs est jugée très bonne pour LP-R, et bonne pour LP-MVC, LP-MVM et UL. Cependant, la fidélité intra- et inter-évaluateurs est jugée pauvre pour la mesure de l'épaisseur du mur de la vessie (BWT). Enfin, la quatrième étude était une étude d'intervention qui a été réalisée à l'aide d'un devis expérimental à cas unique avec réplications. Le programme de réadaptation comprenait des exercices des MPPs effectués avec la technologie mobile Elvie, une rééducation vésicale et de l'éducation sur les habitudes de vie favorisant la continence urinaire. Le programme s'est déroulé à distance et était supervisé téléphoniquement par une physiothérapeute. Les résultats indiquent que 7 femmes sur 8 ont amélioré la sévérité de leur IU à la suite du programme de réadaptation selon la mesure principale, le Pad Test d'une heure. De plus, les résultats découlant de l'analyse de groupe démontrent une réduction significative du nombre de fuites urinaires et d'urgences urinaires au journal urinaire de trois jours, ainsi que du score au ICIQ-UI SF. Ainsi, les résultats présentés dans cette thèse soutiennent qu'une approche de réadaptation à domicile, comprenant l'utilisation d'une technologie mobile et une supervision à distance par une physiothérapeute, peut réduire l'IU chez les survivantes d'un CE. / There is a high prevalence of urinary incontinence (UI) in women who have been treated for endometrial cancer (CE). Current knowledge on the effects of a rehabilitation program to reduce the severity of UI for this population is scarce. The main objective of this thesis was to verify the effects of an in-home rehabilitation program, including the use of a mobile technology, in reducing the severity of UI in CE survivors. The secondary objectives of the works of this thesis were to 1) describe the extent of current knowledge on the use of mobile technologies for the treatment of UI, 2) to synthesize the evidence on the responsiveness of patient-reported outcome measures (PROMs) questionnaires that measure the impact of UI on quality of life in the context of a conservative intervention, and 3) to determine the intra and inter-rater reliability of ultrasound measurements for morphological and functional measurements of the bladder, urethra, and pelvic floor muscles (PFMs) in women who have been treated with pelvic radiotherapy. Four studies were carried out to meet these objectives. The first study was a systematic scoping review on the use of mobile technologies for the conservative management of UI. The results demonstrated that the mobile technologies studied for the treatment of UI have several important features that are recommended for healthcare. Evidence also indicates that the use of mobile technologies can be beneficial in reducing UI severity, for satisfaction, for treatment adherence and for treatment-related costs. The second study was a systematic review that synthesized the responsiveness indices from recommended PROMs questionnaires that measure the impact of UI on quality of life in the context of conservative intervention. The results established that the International Consultation on Incontinence for UI (ICIQ-UI SF) questionnaire presented the highest internal responsiveness index in a conservative intervention setting. In addition, the results established that the study with the highest methodological quality indicated that the PRAFAB-Q questionnaire was the one with the highest external responsiveness index. The third study carried out made it possible to determine the reliability of transperineal ultrasound measurements of the morphology and function of the pelvic floor muscles in women who have been treated with pelvic radiotherapy. The results demonstrate that there is very good intra-rater reliability for measuring the length of the levator plate at rest (LP-R), during maximal contraction of the PFMs (LP-MVC) during a maximal Valsalva maneuver (LP-MVM), as well as for the length of the urethra (UL). Results established that inter-rater reliability is very good for LP-R, and good for LP-MVC, LP-MVM and UL. However, intra- and inter-rater reliability are considered poor for the measurement of bladder wall thickness (BWT). Finally, the fourth study was an interventional study which was carried out using a single-case experimental design with replications. The rehabilitation program included PFM exercises performed with the Elvie mobile technology, bladder training and education on lifestyle to favor urinary continence. The program was conducted remotely (in-home) and was supervised by a physiotherapist through telephone follow-ups. The results indicate that 7 out of 8 women improved the severity of their UI measured by the main outcome, the one-hour Pad Test, after the rehabilitation program. In addition, the results from the group analysis demonstrate a significant reduction in the number of urine leaks and urinary urgency episodes on a three day bladder diary, as well as in the ICIQ-UI SF score, were found after the rehabilitation program. Thus, the results presented in this thesis support that an in-home rehabilitation program, including the use of a mobile technology and remote supervision by a physiotherapist, can reduce UI in CE survivors.