Indiana University-Purdue University Indianapolis (IUPUI) / Loneliness is a known risk factor for poor mental and physical health outcomes in the general population, and preliminary research suggests that loneliness is linked to poorer health in cancer patients as well. Various aspects of the cancer experience (e.g., heightened existential concerns) lend themselves to making patients feel alone and misunderstood. Furthermore, loneliness theory suggests that negative social expectations, which may specifically relate to the cancer experience, precipitate and sustain loneliness. Thus, loneliness interventions in cancer should be tailored to address illness-related social conditions and negative social expectations. Prior to the development of loneliness interventions for cancer populations, cancer-specific tools are needed to assess: (1) loneliness attributed to cancer (i.e., cancer-related loneliness), and (2) negative social expectations related to cancer. In the current project I developed measures of cancer-related loneliness and cancer-related negative social expectations for use in future theory-based loneliness research. A mixed-methods study design was employed. First, I developed items for the measure of cancer-related loneliness (i.e., the Cancer Loneliness Scale) based on theory, prior research, and expert feedback. Second, I conducted a clinic-based qualitative study (n=15) to: (1) obtain cancer patient feedback on the Cancer Loneliness Scale items, and (2) inform development of the item pool for the measure of negative social expectations (i.e., the Cancer-related Negative Social Expectations Scale). Interviews were audiotaped, transcribed verbatim, and then transferred to Atlas.ti for analysis. Content analysis was used to analyze data regarding patient feedback and theoretical thematic analysis was used to analyze data regarding negative social expectations. Overall, patients said they liked the Cancer Loneliness Scale and no changes were made to the items based on patient feedback. Based on results, I also created five content domains of negative social expectations that were represented in the item pool for the Cancer-related Negative Social Expectations Scale. Third, I conducted a telephone and mail-based quantitative study (n=186) to assess psychometric properties of the two new measures. Dimensionality was determined using confirmatory factor analysis. Reliability was assessed by examining internal consistency coefficients and construct validity was assessed by examining theoretical relationships between the Cancer Loneliness Scale, the Cancer-related Negative Social Expectations Scale, and existing reliable and valid measures of health and social well-being. The final products of the project included a 7-item unidimensional Cancer Loneliness Scale and 5-item unidimensional Cancer-related Negative Social Expectations Scale. Excellent evidence for reliability and validity was found for both measures. The resulting measures have both clinical and research utility.

Thesis (M. Tech.) - Central University of Technology, Free State, 2009

The purpose of the research was to explore the challenges faced by both employer and employee when the later undergoes active cancer treatment from a systemic perspective. A qualitative research was conducted using a case study of six sessions with both employer and employee. The study revealed that the employer and employee defined their relationship and boundaries as a system. The research project made a great impact on the researchers’ map regarding cancer or any other symptom, the person with cancer and the employer. In the researcher’s old map, before the research project, cancer implied a very threatening disease which rendered both the employer and the employee helpless and powerless. Through the research project the researcher discovered the significance of not having preconceived ideas as according to this study both the employer and employee had the freedom to punctuate their challenges in relation to the latter undergoing active treatment. / Social Work / M. A. (Social Science (Mental Health))

This study addresses the importance of studies of human psychoneuroimmunology in understanding the role of psychological factors in cancer. Research trends in psychosocial aspects of cancer are reviewed, exploring the role of distress and the support group as an intervention which potentially reduces distress through enhancing interpersonal relationships, emotional adjustment and communication with health professionals, in these ways helping the patient to cope with the symptoms of treatment. In South Africa, most hospitals which treat cancer patients medically do not simultaneously have support groups for the newly diagnosed patient to join in order to discuss immediate fears and acquire more knowledge about their particular disease. Following an experimental cancer support group involving patients who had recently undergone a bone marrow transplant (some considerable time after their first cancer diagnosis) in Cape Town's Groote Schuur Hospital, the researcher, as one of the participants in the fortnightly meetings convened to dicuss psychosocial issues related to each patient's experience of the cancer and transplant process, transferred the themes, concepts and questions that arose in that scenario, to a cancer clinic in Pretoria where recently diagnosed patients were asked to volunteer to participate in such a group. It was felt that these patients would derive some benefit early in their treatment programme. Psychosocial concerns are left to the individual patient to seek therapy should it be required. Presently, it is reported in the body of knowledge about cancer, that interventions aimed at alleviating the psychosocial distress of cancer patients highlight hypnosis, guided imagery and relaxation therapy. It is contended that a more appropriate intervention for the majority of people with cancer in South Africa would entail a fellow-patient support group meeting on a regular basis. / Psychology / (M.A. (Psychology)

The word "cancer" has different meanings for different people. In general, it is synonymous with fatality, either imminent or in the forseeable future. How each person perceives and attributes meaning to this personal experience, varies according to idiosyncratic factors. These factors are constituted by each individual's unique internal make up and by external influences and it is the combination of the multiplicity of factors that bring about the personal attributions of meaning for each individual. The thesis examines the attributions of meaning of a sample of 42 women with breast cancer, through administration of a semi-structured interview and questionnaire, with follow up interviews. The theoretical concepts which are explored, examine the shift away from the traditional, Newtonian, linear-causal, neutral observer model (as in the traditional medical model), towards an ecosystemic, a-causal, contextual, holistic stance. Ecosystemic thinking is utilised in this research work, and this way of thinking is applied to the findings. In addition, a qualitative, descriptive approach is adopted, so that an in depth emphasis rather than a quantitative, empirical view of the patients in the sample, is undertaken. The applied questionaire focuses on the patient's experience of cancer diagnosis, with more specific reference to the side effects of the chemotherapy. The emphasis is towards the issue of anticipatory nausea and emesis and the possible use of hypnosis in relation to these effects. Each patient's attribution of meaning to these aspects forms the core of the thesis. The study discloses the wide variety of attributions of meaning held by different women in a similar predicament towards different aspects of that predicament. Concomitantly, the study highlights the limitations of the traditional, medical model which contribute to diminishing the personal understanding of each patient, and the impact of this on both treatment and outcome for each patient. / Psychology / D.Phil. (Psychology)

Thesis (MA (Psychology))--Stellenbosch University, 2005. / Family resilience is an increasingly visible concept in the field of family psychology. The aim of the present study was to identify family resilience qualities associated with the successful adaptation of families with a husband diagnosed with prostate cancer. The Resiliency Model of Family Stress, Adjustment and Adaptation (McCubbin & Thompson, 1991) served as the theoretical framework in the design and the execution of the research. Both qualitative and quantitative measures were used in this cross-sectional survey research design. Twenty-one husbands and their spouses independently completed seven questionnaires, a biographical questionnaire and answered an open-ended question. Qualitative findings revealed the importance of intrafamilial support, spiritual/religious beliefs and professional support and knowledge in families coping with prostate cancer. Quantitative results indicated that family adaptation to prostate cancer was fostered by family hardiness (the family's internal strengths and durability), affirmative communication and social support.

Thesis (MTh)--Stellenbosch University, 1993 / ENGLISH ABSTRACT: Seeing that breast cancer is the most common cancer in women and that it has such a high incidence that every woman should be aware of it, time has come for the theology, and especially for pastoral care, to provide some answers on the possible problems that accompany the illness. Treatment of breast cancer almost always include a degree of surgical intervention through which part of or a whole breast, and in extreme cases even the underlying tissue, is being removed. This procedure, to some extent, influences a woman's experience of her physique which in turn has an effect on the intimate space of her marriage. The mastectomy patient may experience that the operation, with all the psychological affects it has, disturbs her inner life rythm and that results in her relationships also being pressurised. The crisis of a mastectomy should be handled as a relationship crisis within a marriage, in which the husband can play an important therapeutic role. The husbands contribution will be greatly effected by: a) His commitment to the relationship and b) The correlation between his male identity, his sexuality and his perceptions of the female physique. Within the crisis of mastectomy, the woman's body-image should not be separated from her faith identity and the quality of her marriage - there exists a dynamic interaction between these three, which means that the handling of the crisis of a mastectomy is directly dependent on the quality if her loving relationship and on the way in which she experiences her faith. The faith factor plays an important role in the handling of the crisis, by creating a distance between the trauma of the loss and the way in which she experiences her identity. Pastoral care can play a vital role in the handling of the crisis of a mastectomy by means of guidance and support, as it proclaims the active presence of God through the marrid body of Jesus Christ. The husband of the mastectomy patient can, in his therapeutic role, be guided to be much more sensitive for the emotional needs of his wife, in regard to aspect of sexuality. This would give her the support she needs and work constructively towards the goal of healing. / AFRIKAANSE OPSOMMING: Aangesien borskanker die algemeenste kanker onder vroue is en dit sulke geweldige afmetings aangeneem het dat elke vrou daarmee moet rekening hou, het dit tyd geword dat die teologie, en met name die pastoraat, ditself ook ten opsigte van die moontlike problematiek wat daarmee saamgaan, moet verantwoord. Die behandeling van borskanker behels in die meerderheid van gevalle 'n mate van chirurgiese ingrepe waardeur 'n deel van of die hele bors, en in ekstreme gevalle ook die onderliggende weefsel, verwyder word. Hierdie prosedure oefen, in 'n mindere of meerdere mate, 'n invloed op die vrou se belewing van haar liggaamlikheid uit wat weer na die intieme band van die huwelik kan deurwerk. Die mastektomiepasiënt kan ervaar dat die operasie, met al die sielkundige effekte wat dit inhou, haar innerlike lewensritme versteur sodat die verhoudinge waarin sy leef ook onder druk geplaas word. Binne die huwelik sou 'n mens dan die krisis van 'n mastektomie as 'n verhoudingskrisis moet hanteer, waarin die eggenoot 'n belangrike terapeutiese funksie kan vervul. Die man se bydrae word egter deurslaggewend bepaal deur: a) Sy verbintenis aan die verhouding en b) Die korrelasie tussen sy manlike identiteit, seksualiteit en die persepsies met betrekking tot die liggaamlikheid van die vrou. Binne die krisis van 'n mastektomie kan die vrou se liggaamsbeeld nie van haar geloofsidentiteit en die kwaliteit van haar huwelik losgemaak word nie - hierdie drie staan in 'n interdinamiese verband en beteken dat die verwerking van die krisis van 'n mastektomie direk van die kwaliteit van die liefdesverhouding en die ervaring van geloof, afhang. In die verwerking van die krisis vervul die geloofsfaktor 'n deurslaggewende rol om afstand tussen die emosionele trauma van die verlies en die ervaring van identiteit te skep. Die pastoraat kan 'n belangrike funksie vervul ten opsigte van begeleiding en ondersteuning in die verwerking van die krisis van 'n mastektomie deurdat dit God se aktiewe betrokkenheid by die situasie, aan die hand van die liggaamlikheid van Jesus Christus, verkondig. As terapeut kan die eggenoot begelei word om, op die gebied van die seksuele, baie sterker op die emosionele behoeftes van die mastektomiepasiënt ingestel te wees, om haar sodoende te ondersteun en in die proses van heling mee te werk.

Thesis (MMed)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Background: Sputum is a non-invasive, economic investigation whereby bronchogenic carcinoma can be identified. Manual cytological screening is labour intensive, time-consuming and requires a continuous high level of alertness. Automation has recently been successfully introduced in gynaecological cytology. Since sputum samples are similar to cervical smears, the question arises as to whether they are also suitable for automated screening. Objective: This study presented with various objectives: 1) To test automated sputum screening using the BD FocalPoint™ Slide Profiler (FP) and compare with manual sputum screening. 2) To determine the sensitivity and specificity of sputum in identification of bronchogenic carcinoma. 3) To ascertain if any clinical, radiological or bronchoscopy findings would be predictors for bronchogenic carcinoma. 4) To determine the significance of adequacy. Method: Sputum samples were collected prospectively from patients attending the Division of Pulmonology at Tygerberg hospital for a transbronchial fine needle aspiration biopsy (TBNA) or a transthoracic fine needle aspiration biopsy (TTNA) for the period from 2010 to 2012. A pre-bronchoscopy sputum was collected and submitted for processing. Stained slides were put through the FP for automated screening. After slides were qualified, sputum slides were put back in the routine screening pool. Correlation was done using the TBNA/TTNA result as the standard to evaluate the sputum results. Results: 108 sputum samples were included in this study. Of the 84.3% malignant (n=91) and 15.7% benign (n=17) cases confirmed with a diagnostic procedure, sputum cytology had a sensitivity of 38.5% (35/91 malignant cases), and a specificity of 100% (17/17 benign cases). Automated screening had a better sensitivity of 94.3% (33/35 positive sputum cases), while manual screening showed a sensitivity of 74.3% (26/35 positive sputum cases) when compared to the final sputum result. Individual parameters with a significant association with positive sputum included the presence of an endobronchial tumour, partial airway obstruction / stenosis, round mass, spiculated mass (negative association), loss of weight (negative association) and squamous cell carcinoma as the histological subtype. Adequacy was not as significant as hypothesised since 85.3% of true positive sputum, but also 65.5% of false negative sputum, had large numbers of alveolar macrophages present. Conclusion: Sputum cytology remains an important part of the screening programme for bronchogenic carcinoma in the public health sector of South Africa. Results confirm that sputum cytology is very specific, and automated screening improves sensitivity. Automated screening proved to be more time efficient, resulting in 83.1% reduction (p<0.0001) in the screening time spent per case by a cytotechnologist. Results confirm that the quantity of alveolar macrophages is not directly proprtional to pathology representation. Positive sputum results did however improve with sputum adequacy, but had no significant association. Recommendations from this study include adopting automated sputum screening. / AFRIKAANSE OPSOMMING: Agtergrond: Die verkryging van ‘n sputummonster is ‘n nie-indringende, ekonomiese ondersoek waardeur bronguskarsinoom identifiseer kan word. Nie-geoutomatiseerde sitologiese ondersoek is arbeidsintensief, tydrowend en vereis ‘n deurlopende hoë vlak van konsentrasie en fokus. Outomatisering is onlangs suksesvol geïmplementeer in ginekologiese sitologie-ondersoeke. Aangesien sputummonsters soortgelyk aan servikale monsters is, het die vraag ontstaan of sputummonsters ook geskik sou wees vir geoutomatiseerde sifting. Doelwit: Hierdie studie het verskeie doelwitte gehad: 1) Om geoutomatiseerde sifting van sputummonsters te toets deur gebruik te maak van BD Focal Point ™ Slide Profiler (FP), en te vergelyk met nie-geoutomatiseerde sputum sifting. 2) Om die sensitiwiteit en spesifisiteit van sputum in die identifikasie van bronguskarsinoom te bepaal. 3) Om vas te stel of enige kliniese, radiologiese of brongoskopiese bevindings bronguskarsinoom sou kon voorspel. 4) Om die belang van ‘n verteenwoordigende monster te bepaal. Metode: ‘n Prospektiewe studie van die pasiënte wat die Divisie van Pulmonologie by Tygerberg Hospitaal vir transbrongiale nodale aspirasie (TBNA) of ‘n transtorakale aspirasie (TTNA) vanaf Julie 2010 tot Mei 2012 bygewoon het, is gedoen. ‘n Prebrongoskopiese sputum is geneem en gestuur vir prosessering. Die gekleurde skuifies is deur die FP gestuur vir geoutomatiseerde ondersoek. Indien die sputumskuifies gekwalifiseer het vir geoutomatiseerde sifting, is hulle in die groep vir ondersoek ingesluit. ‘n Korrelasiestudie, om die sputumresultate te evalueer, is uitgevoer deur die TBNA/TTNA bevindings as standaard te gebruik. Resultate: Vir hierdie studie is 108 sputummonsters ingesluit. Vanuit die 84.3% maligne (n=91) en 15.7% benigne (n=17) gevalle, bevestig deur ‘n diagnostiese prosedure, het sputumsitologie ‘n sensitiwiteit van 38.5% (35/91 maligne gevalle) en ‘n spesifisiteit van 100.0% (17/17 benigne gevalle), getoon. Geoutomatiseerde sifting het ‘n beter sensitiwiteit met 94.3% (33/35 maligne gevalle), terwyl nie-geoutomatiseerde (ondersoek) ‘n sensitiwiteit van 74.3% (26/35 maligne gevalle) wanneer met die finale resultaat vergelyk, gevind. Individuele parameters met ‘n betekenisvolle assosiasie het die teenwoordigheid van ‘n endobrongiale tumor, gedeeltelike lugwegobstruksie / stenose, ronde massa, ‘n spekuleerde massa (negatiewe assosiasie), gewigsverlies (negatiewe assosiasie) en plaveiselkarsinoom as die histologiese subtipe, ingesluit. Geskiktheid van die monster was nie so betekenisvol as wat in die hipotese gestel is nie: aangesien 85.3% van ware positief gediagnoseerde sputummonsters, maar ook 65.5% van die vals negatiewe sputummonsters, groot hoeveelhede alveolêre makrofae ingesluit het. Gevolgtrekking: Sputumsitologie bly steeds ‘n belangrike deel van die siftingsprogram vir bronguskarsinoom in die openbare gesondheidssektor in Suid-Afrika. Resultate van hierdie studie bevestig dat sputumsitologie baie spesifiek is en dat geoutomatiseerde sifting die sensitiwiteit verbeter. Ge-outomatiseerde sifting het bewys dat dit meer tydsbesparend is, met ‘n 83.1% vermindering (p<0.0001) in die siftingstyd wat deur een sitotegnoloog per geval bestee word. Resultate het bevestig dat die hoeveelheid alveolêre makrofae nie direk proporsioneel verwant is tot die patologie nie. Hoe meer verteenwoordigend die sputummonster was, hoe groter was die kanse om ‘n akkurate positiewe diagnose te maak. Die assosiasie van die geskiktheid van die sputummonster en die positiewe resultate het egter nie ‘n statisties betekenisvolle resultaat getoon nie. Aanbevelings vir hierdie studie sluit in die aanwending van geoutomatiseerde sputumondersoeke.

published_or_final_version / Social Work / Master / Master of Social Work

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