published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

As breast cancer incidence and survival rates increase, there is an urgent need to make appropriate psychosocial support available to all women with breast cancer. In this qualitative study, narrative inquiry was used to examine how women with breast cancer used visual creative expression (art therapy and/or independent art making) to address psychosocial needs that arose for them after their diagnoses. Seventeen women, aged 37-82, participated in this investigation. Data analysis of in-depth interviews with these women focused on narratives they constructed about why they turned to art therapy and/or independent art making and how it helped to be involved in these activities. Particular attention was given to the issue of meaning making. Four storylines emerged from the analysis. "Art and art therapy as a haven" came from narratives about using art making or art therapy for comfort and affirmation. The narratives that comprised "getting a clearer view" were about using visual creative expression to create a clear picture of emotional experience. "Clearing the way emotionally" came from narratives about self-expression and about processing difficult emotions. The narratives that yielded "expanding and enlivening the self were about the women fortifying and energizing themselves through visual creative expression. Two minor themes related to the role of the art therapist and negative experiences with art therapy also emerged. In their narratives, the women portrayed visual creative expression as flexible, compelling, and powerful means of addressing multiple psychosocial needs simultaneously. Above all, the storylines show that the women valued visual creative expression as a way to reduce the feeling of threat to existence, to affirm present existence, and to promote the ongoing existence of both their psyches and their bodies. The results of this study contribute to the field of psycho-oncology by extending understandings of meaning making in relation to breast cancer, supplying detailed explanations from the perspectives of women with breast cancer of how visual creative expression can be helpful, and providing valuable insight into how psychosocial support services based on visual creative expression might meet needs of women with breast cancer that would not be met through other types of services.

The use of quality of life instruments to evaluate the effects of cancer and its treatments on patients has increased, but understanding the roles that fatigue and depression play on quality of life is still complicated. Earlier studies have examined the individual effects on the quality of life of cancer patients. The purpose of this study was to investigate whether gender is related to the effects of fatigue and depression on quality of life. This study also examined the interactional effects of fatigue and depression on quality of life. The current study found no significant differences on reports of quality of life between genders. Additionally, this study found that depression and fatigue were moderately correlated. Depression and fatigue were also found to account for a proportion of the variance in the quality of life domains of physical, functional, and emotional wellbeing. However, the interaction effects were minimal, but were significant predictors of total quality of life in females, but not male, cancer patients. / Department of Counseling Psychology and Guidance Services

As the development of medical treatments and the increase in longevity of human life interface with the rising cost of medical care, the issue of quality of life appears to be coming to the forefront in understanding how health care decisions will best be realized for patients. Ethical questions relating to matters such as cost-effective economics, physician-assisted suicide, and quantity of life versus quality of life make the construct of quality of life even more important to ascertain.Quality of life can be an elusive construct to define as well as a difficult one to measure; however, recent literature has shown promising trends. Many quality-of-life measures have been developed in recent years. Initially these measures focused on life satisfaction in general. Then instruments for healthrelated concerns were developed. In the last decade such measures have become more specific as several have emerged to identify the quality-of-life experience regarding a particular illness, such as cancer. The current step is the development of measures for specific populations in oncology. Another trend is the move from objective to subjective measures of assessment. A third trend is movement toward a multidimensional perspective, with the latest addition being the inclusion of a spiritual domain.This project explored the unique experience of cancer patients with recurrent or metastatic disease by utilizing qualitative methodology to describe common themes which emerged from the data. Focus group sessions centered around defining quality of life and discussing the factors that diminish or enhance a meaningful quality of life. A unique contribution of this study was the involvement of the participants as co-researchers in the analysis of the data. Thirteen central themes were identified: control, attitude, humor, death, gratitude, faith, fear, pain, social comparison, social support, financial concerns, information and knowledge, and the focus group experience. The findings confirmed the recent trends in quality-of-life research--multidimensionality, subjectivity, and the uniqueness of a specific cancer population, those with recurrent or metastatic disease. With this elicitative data, future research could include the development of a quality-of-life instrument for this population of oncology patients with more advanced cancer. / Department of Counseling Psychology and Guidance Services

The purpose of this study was to investigate the influence of gender, time since diagnosis, and the family environment on the psychosocial adaptation of cancer patients. This study was important because there is a deficit in the literature investigating the effects of the family environment on psychosocial adaptation in male and female cancer patients with diverse diagnoses. This study measured psychosocial adaptation by the patient's ability to adjust to cancer-related stressors in the areas of social relationships, involvement in health care, psychological well-being, household and work related duties, and family relationships. The family environment was measured by the patient's perceived level of cohesion, expressiveness, and conflict in the family.The study's sample consisted of 149 stage I or II cancer patients over the age of 50 with no prior cancer diagnosis, recurrence, or metastases. Participants completed a set of questionnaires, including the Psychosocial Adjustment to Illness Scale and the Family Relationship Index. The combination of gender, time since diagnosis, and the family environment, with demographic variables held constant, was significant and accounted for nearly one-third (27 %) of the variance in cancer patients' psychosocial adaptation. Results showed that the family environment is a significant predictor of psychosocial adaptation in cancer patients. Gender and time since diagnosis were not significantly related to psychosocial adaptation. Implications from this study are offered. / Department of Counseling Psychology and Guidance Services

The purpose of this study was to explore the marital adjustment of older adult couples with breast cancer, prostate cancer, and couples who have experienced neither. Participants were 64 couples in which at least one of the spouses was over 55 years of age, including 19 breast cancer couples, 20 prostate cancer couples, 25 couples who had experienced neither of these cancers. Most participants were young-old, Protestant, Caucasians from a high socioeconomic class. The breast cancer and prostate cancer participants had completed treatment an average of 39.5 months prior to participation. The methodology was a mail survey. Participants completed a demographic questionnaire, the Marital Satisfaction Questionnaire for Older Adults (MSQFOP) (Haynes et al., 1992), Primary Communication Inventory (PCI) (Navran, 1967), Miller Social Intimacy Scale (MSIS) (Miller & Lefcourt, 1982), and the Index of Sexual Satisfaction (ISS) (Hudson et al., 1981).There were no differences in the amount of discordance between the couples groups' level of marital satisfaction, communication, intimacy, and sexual satisfaction. In addition, there were no differences in the level of marital satisfaction, communication, intimacy, and sexual satisfaction between the participant groups. There was a significantly greater correlation between the prostate cancer couples' scores on the ISS than the correlation between the breast cancer couples' scores and the scores of the couples who had not experienced breast cancer or prostate cancer.The level of marital satisfaction, communication, intimacy, and sexual satisfaction reported was similar to that of the normative samples. There was no difference between the marital adjustment of the cancer couples and older couples who had experienced neither type of cancer. These results are good news for breast and prostate cancer survivors, and professionals. Older adults may be better able to incorporate the experience of cancer into their lives or are better prepared for chronic illness through anticipatory socialization. The high degree of agreement between the prostate cancer spouses on the ISS may be related to the sexual dysfunction that frequently accompanies treatment for this cancer. Future research should be qualitative and longitudinal and continue to explore the psychosocial implications of prostate cancer. / Center for Gerontology

There is no abstract available for this dissertation. / Department of Counseling Psychology and Guidance Services

Typescript (Photocopy) / Includes two papers co-authored by the author as appendix D. / Bibliography: leaves 397-425 / xvii, 425 leaves ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--Dept. of Psychology, University of Adelaide, 1991

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