A famÃlia à uma unidade integrada e dinÃmica. Diante do diagnÃstico de cÃncer, estudos apontam para o surgimento de crises neste grupo primÃrio, que passa por uma reestruturaÃÃo. Este estudo teve como objetivo compreender a dinÃmica familiar do paciente oncolÃgico, a partir da revelaÃÃo do diagnÃstico e da atuaÃÃo da famÃlia no contexto da doenÃa. Foram analisadas as repercussÃes do diagnÃstico de cÃncer nos papÃis familiares, nos vÃnculos afetivos, nos estilos de comunicaÃÃo interpessoal. Realizou-se um estudo qualitativo de quatro casos de pacientes com cÃncer. O atendimento desses pacientes foi realizado no Instituto do CÃncer do Cearà e na Casa Vida, localizados em Fortaleza-CearÃ, onde se realizou a coleta de dados. Inicialmente, foi analisado o prontuÃrio dos pacientes prÃ-selecionados. Em seguida, foi dado o consentimento informado e foram realizadas entrevistas a partir de um roteiro semi-estruturado com os pacientes e seus membros familiares. Paralelamente, foi elaborado um diÃrio de campo para complementaÃÃo das informaÃÃes. As entrevistas foram gravadas e transcritas na Ãntegra. O conteÃdo das entrevistas permitiu identificar as unidades de significaÃÃes atribuÃdas à vivÃncia da doenÃa pelo paciente e os componentes das famÃlias entrevistados, assim como identificar as mudanÃas nos papÃis dos membros familiais, os vÃnculos afetivos e as formas de comunicaÃÃo reveladoras das repercussÃes do diagnÃstico do cÃncer. As narrativas indicam mudanÃa nos papÃis e, em alguns casos, a inclusÃo de outras pessoas no contexto familiar. Observou-se afastamento de alguns membros da famÃlia e aproximaÃÃo de outros componentes mais afastados, indicando alteraÃÃo nos vÃnculos afetivos, nas formas de comunicaÃÃo, transformando a dinÃmica familiar diante do diagnÃstico. Foi observado tambÃm que nem sempre a famÃlia consegue dar apoio emocional ao paciente, pois à ele quem dà o suporte emocional aos seus. O estudo indica que a dinÃmica familiar envolve dimensÃes fÃsicas, psicolÃgicas, sociais, ambientais e culturais. A famÃlia, junto ao paciente, tambÃm adoece, cada membro ao seu modo, tornando-se necessÃrio que seja capacitada para lidar melhor com a trajetÃria da doenÃa de que o paciente padece, assim favorecendo a diminuiÃÃo do estresse provocado pelo cÃncer. Quanto aos papÃis familiares, o estudo aponta para uma transformaÃÃo pelo menos momentÃnea. Os vÃnculos afetivos podem ser fortalecidos ou enfraquecidos. Os estilos de comunicaÃÃo interpessoal tambÃm se transformam em ditos e nÃo-ditos ou segredos. / The family unit is an integrated and dynamic. Once the diagnosis of cancer, studies point to the emergence of crises in the primary group, which undergoes a restructuring. This study aimed to understand the family dynamics of cancer patients from the disclosure of diagnosis and the role of family in the context of the disease. We analyzed the impact of cancer diagnosis in family roles, the emotional bonds, in the styles of interpersonal communication. We conducted a qualitative study of four cases of patients with cancer. The care of these patients was conducted at the Cancer Institute of Cearà and Life House, located in Fortaleza, Ceara, where he performed the data collection. Initially, we analyzed the records of patients pre-selected. Then was given informed consent and were interviewed from a semi-structured with patients and their family members. In parallel, we designed a field journal to complement the information. The interviews were taped and transcribed. The content of the interviews identified the units of meanings attributed to the experience of illness by the patient and the components of the families interviewed, as well as identify changes in familial roles of members, the emotional ties and ways of communication revealing the impact of cancer diagnosis . The narratives indicate changes in roles and in some cases, the inclusion of others in the family context. There was the expulsion of some members of the family and approach of other components further apart, indicating changes in the affective bonds, forms of communication, transforming the family dynamics before the diagnosis. It was also observed that the family can not always give emotional support to patients, it is he who gives emotional support to their. The study indicates that family dynamics dimensions involves physical, psychological, social, environmental and cultural. The family, along with the patient, too ill, each member in his own way, making it necessary to be able to deal better with the trajectory of the disease that the patient suffers, thus favoring the reduction of the stress caused by cancer. With regard to family roles, the study points to a transformation at least momentarily. The emotional ties can be strengthened or weakened. The styles of interpersonal communication also become sayings and unspoken or secrets.

Doctorat en sciences psychologiques / info:eu-repo/semantics/nonPublished

Submitted in fulfilment of the requirements for the Degree Philosophiae Doctor in Health Sciences, Durban University of Technology, 2017. / Background Cancer is a global concern because it affects and kills millions of people worldwide. In South Africa, patients frequently move between traditional health practitioners and radiation oncologists to seek cure of cancer, yet these health practitioners do not communicate with each other. Consequently, the treatment is often disrupted and imcomplete therefore compromising the survival of patients. The future of the health system in effective treatment of patients with cancer is dependent on health practitioners’ changing fundamentally in their co-operative practice. The aim of this study was to explore the practice of traditional health practitioners in the treatment of patients with cancer in order to describe a viable co-operative practice between them and radiation oncologists and ultimately develop traditional health practitioners as a component in the health system in the treatment of patients with cancer. Methods An exploratory descriptive qualitative study using an interpretive phenomenological approach was employed to collect data from 28 traditional health practitioners and four radiation oncologists in KwaZulu-Natal utilising snowball and stratified purposive samplings for the former and latter, respectively. Semi-structured face-to-face and group interviews were employed to collect primary data from traditional health practitioners and data from the radiation oncologists were collected through face-to-face and email interviews. Data were transcribed verbatim and analysed using framework analysis. Results It emerged that the referral of patients, in addition to external conditions, individual attributes, trusting attitudes of participants as well as organisational dynamics and philosophy of practice, were the main categories used by participants in their understanding of co-operative practice in KwaZulu-Natal. The patient is the main player in the co-operation between parties, and coordinates the health practitioners’ activities during treatment. Effective co-operative practice is time consuming and requires commitment, co-operation and training of the participants. Conclusion Considering the problems associated with treatment of cancer when patients move freely between the traditional health practitioners and radiation oncologists, resulting in interruptions in treatment, co-operative practice between the two health practitioners is paramount. The development of traditional health practitioners could result in extending their role in the management of cancer and therefore increasing the accessibility of cancer services. It follows that a workable practice between traditional health practitioners and radiation oncologists in the treatment of patients with cancer could be an inclusive health system where the parties work in parallel with the patient being the main actor in the collaboration. There should be a healthy relationship between all those involved in the collaboration in order to facilitate referral of patients between the health practitioners. / D

M.A. / It is well known that high levels of anxiety and/or depression often accompany the diagnosis and treatment of breast cancer. Literature from various sources, but in particular from the fairly new field of research, Psychoneuroimmunology, also provides ample evidence that excessive anxiety and/or depression can be immunosuppressive. It makes sense, therefore, that any intervention restoring balance to the immuno-regulatory system, thereby allowing the body’s innate healing processes to focus on eliminating cancer, is highly desirable. In line with current thinking based on the mind-body connection as well as cognitive behavioural techniques utilised in many therapeutic settings, various psychological interventions have been found to help the patient gain a better sense of control over distressing symptoms and side-effects of cancer. Some of these include: basic cognitive restructuring, hypnotherapy, relaxation-meditation techniques, art and music therapy, and guided imagery. Substantial international research was found illustrating the beneficial affect that the psychological intervention, guided imagery, provided in such diverse settings including work, sport and health. In this regard, it was decided to run a pilot study to ascertain whether a specifically designed tape recording with relaxing music and dialogue aimed at helping patients manage and cope with negative symptoms of cancer, could significantly reduce anxiety and/or depression levels in women with breast cancer. To operationalise the above, 40 women, aged between 30 and 60, with Stages 1, 2 or 3 breast cancer, who are about to commence adjunctive chemotherapy, were randomly selected to a treatment and a control group. A quasi-experimental design was applied to this study whereby the treatment group was subjected to pre- and post chemotherapy Hospital Anxiety & Depression (HAD) Scale and blood pressure measurements on their 1st, 3rd and final cycle of treatments. The HAD Scale is a well-researched and respected, quick, self-diagnostic assessment utilised abroad and in this country. The measurement of a person’s blood pressure is provided as a physiological backup to the psychometric assessment of the individual’s anxiety levels. For the intervention, each participant was supplied with her own copy of Healing Imagery for Cancer CD or audiotape, produced by a South African medical doctor, specialising in the “wellness” field. The participant was requested to listen to this tape as often as possible, but particularly during her chemotherapy treatments. The control group was tested pre-1st cycle of chemotherapy and post-6th cycle of chemotherapy. The main hypothesis of this pilot study was that there would be statistically significant decreases in levels of anxiety and depression as a result of the intervention of guided imagery tape recording in women with breast cancer undergoing adjuvant chemotherapy. Statistical analysis of the data revealed that the guided imagery intervention correlated with a decrease in blood pressure (systolic and diastolic) measurements, as well as depression and anxiety over a six-cycle period of chemotherapy. The most significant decrease was correlated with the anxiety variable. This pilot study revealed some methodological weaknesses but at the same time results are sufficiently encouraging to warrant further in-depth research regarding the use of guided imagery as a cost-effective, relatively easy method for individuals with cancer to learn and utilise as part of their integrative treatment regimen.

D.Litt. et Phil. (Sociology) / Reid and Walker (2005) suggest that black South African men are ‘behaving differently’. Added to this Budlender (2008) has found that South African men are more likely to engage in unpaid community care work than conventional wisdom suggests. Part of this community work involves black men acting as AIDS caregivers. It is imperative to gain knowledge about masculine caregivers as the informal health care sector bears the brunt of the HIV pandemic. The fragmented and over-burdened public health system simply cannot absorb the 15-20% of HIV infected South Africans. Coovadia et.al. (2009) point to a lacuna in the scholarship regarding community health workers (CHW) in South Africa. My study of black masculine caregivers, located in the world of informal AIDS care, hopes to fill this gap. Yet, I do something more for I tackle the conventional wisdom that suggests South African men are different and exceptional if they conduct feminised care work. The emotions involved in care processes are the basis upon which society may feminise care work. My argument is also premised upon forging links between the past and the present. As such, I focus upon determining the extent to which emotional labour that may be exhibited by historical and contemporary black men. I make use of W.E.B. Du Bois’ (1903) notion of double-consciousness to show how the normalising society, surrounding masculine care, impacts this category of black men. In so doing, I not only forge links between past and present by means of doubleconsciousness, but I perform an intersectional analysis of emotional labour, and the context, in which it occurs. In so doing, I show how double-consciousness is an intersectionally-forged mechanism for Foucault’s (1978) biopower, and one that has become reinvented in present day South Africa. In this way I augment the works of Du Bois (1903) and Foucault (1978) for both did not give primacy to gender as a construct. It is essentially this view of black men, involved in AIDS care that contributes to the originality of this work. This historical-sociological investigation relied upon the linking of cases. I conducted historical research upon two cases: ‘houseboys’ in colonial Natal (1850 – 1928) and mine hospital ‘ward boys’ (1931 – 1959). Contemporary cases were constructed to reflect the world of AIDS and cancer care. The 13 original cases were compressed into seven case categories and based on triangulated survey and interview data (29 AIDS and 18 cancer caregivers were interviewed; while 195 community workers involved in AIDS care were surveyed in 2005/6; follow-up interviews were conducted with 11 caregivers across all case categories in 2010).

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. / Graduate and Postdoctoral Studies / Graduate

This interpretive descriptive study explored the meaning and lived experience of breast cancer for 5 mothers and their 5 adolescent daughters, and for these mother-daughter relationships. Mothers had been diagnosed with breast cancer between 2 and 6 years ago, and their daughters were between 11 and 13 years old at the time of the diagnosis. A series of six in-depth interviews with mothers and daughters, conducted both jointly and separately, afforded a view of aspects of experience that were shared and privately held. Interview data were supplemented with participants' drawings of their experience, and the researcher's observations. The interpretive descriptive framework employed was augmented with the lens of portraiture in the conduct of study, data analysis, and composition of the product of inquiry. Portraiture utilizes five essential features: voice, relationship, context, emergent themes, and aesthetic whole. Individual and relational experience and meaning were described in four themes: (a) Inhabiting Another Landscape, (b) Intending and Acting, (c) Acquiring Wisdom, and (d) Enduring Mother-Daughter Relationships. The theme of Inhabiting Another Landscape described a trajectory of experience and meaning that began with diagnosis, persisted through prolonged effects of treatment, and continued in the present and into imagined futures. Mothers and daughters had privately held concerns about the mothers' breast cancer and the possibility that breast cancer might one day visit daughters as well. The most prominent reminder of vulnerability was recurrence among friends in the social networks of breast cancer. The theme of Intending and Acting described the mutual caring and protectiveness of these mothers and daughters. Mothers and daughters described actions and strategies to minimize the threat of breast cancer for themselves and for the other person. Actions included attempts by both persons to create and maintain a sense of normalcy. Conversations between mothers and daughters on the experience of breast cancer were limited, in particular around prognosis and the possibility of death. The theme of Acquiring Wisdom described personal growth and change after the diagnosis of breast cancer. For both persons, realizations of mortality brought a new perspective on what was important in life. Mothers passed on the wisdom gained from their experience either directly in what was said to daughters or indirectly in the attitudes and behaviours they modelled. The theme of Enduring Mother-Daughter Relationships described the quality of mother-daughter relationships and the import of breast cancer for these relationships. Mothers and daughters described their relationships as close. Daughters described their relationships as closer than most, in part because of their experience with breast cancer. Parenting and being parented was in some cases complicated by breast cancer. Friction between mothers and daughters was described as par for the course during the teen years, but one source of friction was the unexpected and prolonged effects of treatment. The findings in this study indicate the value in attending to the voices of teenage daughters, which remain largely absent in the literature. Mothers and daughters have needs for information and support that are not being met. The emotional landscape of breast cancer, which entails prolonged uncertainty for both mothers and daughters, deserves further study. Personal growth described by both mothers and daughters provides an alternative view of the largely problem-focused perspective in the literature of the meaning and experience of breast cancer. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

Familial caregivers are providing increasing amounts of care to advanced cancer patients. Increased understanding of caregivers' needs is vital in providing necessary support to lessen caregiver burden and comorbidity. This study examines particular information needs across a variety of specific events in the advanced cancer disease trajectory. A cross-sectional sample of 107 familial caregivers (24 current and 83 bereaved) of people with advanced cancer completed a needs assessment survey along with a measure of health information-seeking behavior. Analyses extend current research by including more specific disease-related events along the advanced cancer trajectory through bereavement. In all information categories, endorsement of wanted information differed across broad stages of Cancer Progression, Treatment, End of Life, and Post-Patient Death. For all information categories, except Dying and Spirituality, greatest information was wanted at the Cancer Progression stage. Information need also differed across specific events within broad stages. The categories of Disease/Medical and Relating to the Patient were the most endorsed at events involving patient care. Spirituality was least endorsed. At patient death, Caregiver Well-being has the highest endorsement. For events thereafter, information on Caregiver Well-being, Spirituality, Future Outlook, and Family and Close Others was most endorsed. Information needs did not differ based on age or education. Whether or not a caregiver had experienced a given event on the cancer trajectory impacted some categories of information desired at the events of leaving the hospital for home, going into hospice, patient death, immediately after death, and bereavement. In all cases, those who had experienced the event wanted more information. In comparing current to bereaved caregivers, no differences in information endorsement occurred for events of the Cancer progression or Treatment stages. This study also involved the validation and factor analysis the Health Information-Seeking Behavior Survey. Two factors, Health Information-Seeking and Health Information-Avoiding, emerged. Health Information-Seeking correlates positively with some of the information categories at some of the stages. Increased understanding of caregiver needs at specific key events in the advanced cancer illness trajectory can now be used to inform the development of effective familial caregiver education interventions.

Behavior analysts who study verbal behavior theorize that people derive relationships between stimuli - forming stimulus classes such that psychological functions transfer among stimuli and therefore affect behavior. Verbal processes are thought to play a role in cancer patients' behavioral flexibility. The current study examined if an analogue intervention produced changes in relations between health-relevant stimuli from pre- to post-test in patient and student samples. A matching-to-sample (MTS) task required participants to form three 4-member classes that included health, treatment, or neutral terms. Participants next listened to either an acceptance-based or a control-based rationale and therapy exercise, or a distracter task. Then, they were re-exposed to the MTS task. Latencies and accuracies for learning each class as well as between condition differences were examined. Finally, changes in ratings of stimuli from pre to post analogues were measured. Differences in stimuli ratings were seen in the student sample, reflecting transfer of function and some reduction in responsiveness to stimuli following intervention, but overall no learning performances are found. Discussion explores the consistency of the findings with acceptance and commitment therapy (ACT) theory in light of the seemingly lack of findings.

The study explored whether certain factors might be used to distinguish between people with cancer who do or do not want detailed information about their disease progress, do or do not want to be informed if their disease is no longer considered curable, and who do or do not want an estimation of life expectancy if their disease is no longer considered curable. The factors included whether an individual has an internal versus external locus of control, uses an active coping strategy or a planning coping strategy, the level of spirituality, and age. Participants consisted of 51 people with cancer from a cancer center in the state of Washington. Results indicated that 98% wanted detailed information about their disease progress, 94% wanted to be informed if their disease was no longer considered curable, and 78% wanted an estimation of life expectancy if their disease was no longer considered curable. Due to the majority of the participants endorsing the need for prognostic information none of the factors (e.g. coping strategies, locus of control, spirituality) were able to predict the information needs of the patients with cancer. Clinical implications of this study suggest that physicians have an ongoing, open dialogue with their patients about their prognostic information needs. The dialogue might be especially important for patients undergoing active treatment for cancer, since it could affect treatment decisions.