Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

published_or_final_version / abstract / Psychology / Master / Master of Philosophy

Suffering is a fundamental experience of the human condition. Whereas the arts and humanities have struggled to make sense of this condition, no concerted effort has taken place in nursing. Suffering is painfully absent within the cancer nursing research literature, a place where suffering should be conspicuous. The purpose of this study was to explore suffering inherent in the cancer experience. The concurrent use of Travelbee's Human-To-Human Relationship Model and narrative theory provided the conceptual underpinning for this prospective ethnography. Narratives of suffering were explored among seven patients diagnosed with cancer (breast, n = 4; brain; malignant melanoma; and ovarian cancer). Five women and two men were interviewed weekly (N = 89 interviews) for a period of up to five months. Participant observation supplemented the interview data. Seven richly textured narratives revealed the suffering endured in the living-of-cancer. The narratives also detailed the informant as person, the cancer trajectory, and explanatory models of cancer causation. A second level analysis of the narratives provided an intra-group comparison of suffering. "Cascade of losses" was the overarching theme. The undermining of personhood, and a loss of faith and trust in the medical system characterized this cascade of losses. Losses were further encountered: the dismissal of symptoms presented to physicians, the failure of treatment as cure, the death of other cancer patients, and the false reassurance that "cancer can be beaten". The remaining themes were "cancer as torture" and "the work of suffering--the beauty of cancer". The findings of this study suggest that nurses may not be capable of alleviating patient suffering. Patients' lives intersect at the suffering experience; their suffering is shaped by the past, present, and future. Nurses may influence these intersections of suffering to some extent, however, it is the individual who ultimately determines the living and outcome (if any) of their suffering. In the lives of the informants, it was the love of spouses and children, faith and trust in God, and satisfaction with life's accomplishments which permitted the endurance of suffering. Competent, comfort-care provided by compassionate nurses is needed by patients who suffer with cancer.

The use of quality of life instruments to evaluate the effect of cancer and its treatment on individuals has increased but the process by which the patient comes to make these quality of life evaluations has not been addressed. Earlier studies have shown the reporting of physical symptoms and the evaluation of one's health to be related to negative affect. The purpose of this study was to investigate whether the relationship between negative affect and the evaluation of ones health would remain the same in a group of cancer patients, when a major disease and treatment symptom, fatigue was controlled for. The current study found no relationship between negative affect and the evaluation of health once fatigue was controlled for. Negative affect and fatigue were found to be moderately correlated and fatigue accounted for a large proportion of the variance in the quality of life domains of physical, functional and emotional well-being. Both empirical and theoretical issues are discussed. / Department of Counseling Psychology and Guidance Services

Health Locus of Control (HLOC) and other predictors of Quality of Life (QL) were examined for women with an initial versus recurrent breast cancer diagnosis. Twenty-eight women with an initial breast cancer (IBC) diagnoses and twenty-eight women with recurrent breast cancer (RBC) diagnoses were recruited from doctors' offices and cancer support groups. Correlational analyses were used to assess the relationships between variables. No significant differences were found between women with IBC and RBC on Psychological QL. Doctor HLOC and Psychological QL were related for women with RBC (r = .481, p = .01) and marginally so for women with IBC (r = .329, p = .09). A positive correlation was also found between Doctor HLOC and Functional QL for both women with IBC (r = .464, p = .01) and women with RBC (r = .390, p = .04). After controlling for stage of cancer, women with RBC reported higher Functional QL than did women with IBC. Advanced (stages III or IV) versus early (stages I or II) cancer stage related to lower Functional QL, controlling for initial versus recurrent diagnosis (r = -.283, p = .01). A marginally significant relationship was also found for cancer stage, regardless of initial versus recurrent diagnosis, with higher Overall QL for women with early stages of breast cancer (r = -.157, p = .09). No significant differences in Optimism or Overall QL were found between women with IBC versus RBC. No differences were found between married and single women. This research begins to explore differences in Quality of Life for women with a new versus a recurrent breast cancer diagnosis.

This study tested the relationship between Social Support, Psychological Distress, and Illness Stress in individuals who report cancer as a health condition. This study was based on archival data obtained from the Wave 1 of the Health and Retirement Study (HRS). The HRS provides a nationally representative sample of individuals aged 51 to 61 in 1992 and their spouses. The study sample was limited to cancer patients with a spouse or partner (n = 503). A structural equation modeling analysis procedure was used to test the theoretical models. Measures of social support were limited to variables assessing the participant's satisfaction with social support. Evidence was found for the Stress Prevention and the Support Deterioration models. This is congruent with previous research using measures of social support perception. Both the Stress Prevention and the Support Deterioration models predict a negative relationship between Illness Stress and Social Support. In addition, a univariate analysis of variance was used to test the stress buffering model. Similarly to other studies measuring the individual's degree of integration, or its perception, in the social network, the present research supported the only the Main Effect model and not the Stress Buffering model.

This mixed methods sequential research study was performed to explore the role of identity in posttraumatic growth and psychological adjustment for adults with cancer. One hundred nineteen individuals participated in an online survey which included items from Brief COPE, Mini-Mental Adjustment to Cancer (Mini-MAC), Brief Illness Perception Questionnaire (BIPQ), Sense of Coherence Scale - 3 items (SOC-3), Posttraumatic Growth Inventory (PTGI), Illness Intrusiveness Ratings Scale (IIRS), and Centrality of Event Scale (CES). A two-step cluster analysis divided the sample into two clusters based on the integration of cancer into identity: High Cancer Identity Cluster (cancer identity scores above M) with strong cancer identity and Low Cancer Identity Cluster (scores below the M) with a weak or absent cancer identity. HCIC yielded positive and negative subgroups. A discriminant analysis revealed which variables are significant predictors of group membership: PTG factor New Possibilities (Wilks'l = .781, F (1, 119) = 32.834, p = .000), Psychological Adjustment factor Anxious Preoccupation (Wilks' l= .863, F (1, 119) = 18.612, p = .000), Illness Intrusiveness factor Intimate Relationships (Wilks' l= .794, F (1, 119) = 30.348, p = .000), and Illness Perception factor Perceived Life Impact of Cancer (Wilks' l= .783, F (1, 119) = 32.412, p = .000). From the sample, 17 individuals and spouses/partners were interviewed to obtain a deeper understanding of the lived experience of cancer. Qualitative themes of suffering, woundedness, and uncertainty were found. Narrative data corroborated the quantitative data and contributed depth to the analysis. A new Cancer Identity Process Model was offered in which assimilative and accommodative efforts are informed by identity structures. / Performing Normalcy is an assimilative process in which stressful life events such as cancer activate automatic behaviors guided by existing identity structures with the goal of reg As dissonance grows over the inability to re-establish valued former identities, negative affect and intrusive rumination prevails. Individuals then utilize accommodative strategies in a process of Constructing Survivorship to either regain valuable aspect of former identities or to create equally valued new ones. / by Barbara E. Abernathy. / Thesis (Ph.D.)--Florida Atlantic University, 2009. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2009. Mode of access: World Wide Web.

陳津利. / "2000年7月" / 論文 (哲學碩士)--香港中文大學, 2000. / 參考文獻 (leaves 138-151) / 附中英文摘要. / "2000 nian 7 yue" / Chen Jinli. / Lun wen (zhe xue shuo shi)--Xianggang Zhong wen da xue, 2000. / Can kao wen xian (leaves 138-151) / Fu Zhong Ying wen zhai yao. / Chapter 第一章 --- 緒論 --- p.1 / Chapter 第一節 --- 中國的乳腺癌患者 --- p.1 / Chapter 第二節 --- 中國內地的癌症自助團體 --- p.3 / Chapter 第三節 --- 硏究意義和主題 --- p.5 / Chapter 一、 --- 硏究意義 --- p.5 / Chapter 二、 --- 硏究主題 --- p.8 / Chapter 第二章 --- 文獻回顧 --- p.9 / Chapter 第一節 --- 乳腺癌和乳腺癌患者 --- p.9 / Chapter 一、 --- 乳腺癌和乳腺癌患者的定義 --- p.9 / Chapter 二、 --- 患者瀕死的心理反應 --- p.10 / Chapter 三、 --- 患者面臨的實際問題和情感需求 --- p.15 / Chapter 第二節 --- 支持的槪念和取向 --- p.21 / Chapter 一、 --- 社會支持的槪念 --- p.21 / Chapter 二、 --- 支持的類型 --- p.23 / Chapter 三、 --- 社會支持的功能 --- p.27 / Chapter 四、 --- 社會支持的測量和指標 --- p.31 / Chapter 第三節 --- 自助團體的定義及功能 --- p.36 / Chapter 一、 --- 自助團體的定義 --- p.36 / Chapter 二、 --- 自助團體作爲社會支持系統的組成部分 --- p.37 / Chapter 第三章 --- 硏究架構 --- p.46 / Chapter 第一節 --- 基本假設 --- p.46 / Chapter 第二節 --- 研究變量名詞的操作性定義 --- p.48 / Chapter 一、 --- 自助團體行爲認知 --- p.48 / Chapter 二、 --- 感受的情感支持 --- p.50 / Chapter 三、 --- 個人特徵 --- p.50 / Chapter 第四章 --- 硏究方法 --- p.51 / Chapter 第一節 --- 研究法的選擇 --- p.51 / Chapter 一、 --- 應用三角測量的思考 --- p.51 / Chapter 二、 --- 量化爲主、質性爲輔的主輔設計 --- p.51 / Chapter 三、 --- 同步三角測量法的采用 --- p.53 / Chapter 第二節 --- 問卷調查硏究設計 --- p.54 / Chapter 一、 --- 樣本策略_ --- p.54 / Chapter 二、 --- 測量工具 --- p.56 / Chapter 三、 --- 資料搜集方法 --- p.59 / Chapter 四、 --- 效度和信度 --- p.59 / Chapter 五、 --- 問卷調查的資料處理及數据分析 --- p.62 / Chapter 第三節 --- 質性硏究方案 --- p.63 / Chapter 一、 --- 硏究樣本及資料收集 --- p.63 / Chapter 二、 --- 資料分析 --- p.63 / Chapter 第四節 --- 硏究局限 --- p.65 / Chapter 第五章 --- 硏究結果 --- p.66 / Chapter 第一節 --- 中國乳腺癌患者的基本特徵 --- p.66 / Chapter 一、 --- 背景結構 --- p.66 / Chapter 二、 --- 身心狀況 --- p.72 / Chapter 三、 --- 病患情感特徵 --- p.77 / Chapter 第二節 --- 患者自助團體行爲認知 --- p.85 / Chapter 一、 --- 患者的自助團體活動參與程度(A1 ) --- p.85 / Chapter 二、 --- 患者的自助團體活動認知程度(A2 ) --- p.90 / Chapter 三、 --- 患者對自助團體的主觀認同(A3) --- p.91 / Chapter 四、 --- 個人基本特徵的作用 --- p.96 / Chapter 第三節 --- 患者自助團體中的情感支持感受(B) --- p.100 / Chapter 一、 --- 患者在自助團體中的情感支持感受 --- p.100 / Chapter 二、 --- 個人特徵對情感支持感受影響 --- p.108 / Chapter 第四節 --- 假設驗証：自助團體行爲認知與情感支持感受的 相關關係 --- p.114 / Chapter 一、 --- 活動參與程度(A1)與情感支持感受的相關關係 --- p.115 / Chapter 二、 --- 活動認知程度(A2)與情感支持感受的相關關係 --- p.119 / Chapter 三、 --- 主觀認同(A3)與情感支持感受的相關關係 --- p.120 / Chapter 四、 --- 個人基本特徵對行爲認知(A)與情感支持感受 關係的影響 --- p.122 / Chapter 五、 --- 小結 --- p.122 / Chapter 第六章 --- 結論、檢討及建議 --- p.123 / Chapter 第一節 --- 硏究結果討論 --- p.123 / Chapter 一、 --- 自助團體情感支持硏究結果與西方 研究的异同及討論 --- p.123 / Chapter 二、 --- 社會支持理論和槪念的适用性討論 --- p.127 / Chapter 第二節 --- 待5幵究或澄淸的議題 --- p.129 / Chapter 一、 --- 患者的情感問題： 乳腺癌是否破坏了患者的婚姻質量？ --- p.129 / Chapter 二、 --- 家庭的支持功能問題： 什么是對患者的“愛´ح ？ --- p.131 / Chapter 三、 --- 來自“大鍋飯´ح的資源： 制度安排帶給乳腺癌患者什么？ --- p.131 / Chapter 四、 --- 未接受乳房再造術： 經濟的？醫療的？制度的？觀念的？ --- p.132 / Chapter 五、 --- 關於自助團體的几點發現 --- p.132 / Chapter 第三節 --- 建議 --- p.134 / Chapter 一、 --- 政府部門與自助團體建立伙伴關係 --- p.134 / Chapter 二、 --- 加強對患者家庭的輔導，引進境外社會工 作理念和實務，開展針對性情感治療 --- p.134 / Chapter 三、 --- 營造新女性文化，關注自身生存質量 --- p.135 / Chapter 四、 --- 未來的硏究 --- p.136 / 參考書目 --- p.138 / 附錄 / 附錄一統計結果列表 --- p.152 / 附錄二 量表信度列表 --- p.173 / 附錄三調查問卷 --- p.177 / 附錄四訪談指引 --- p.185

研究背景：婦科癌症的診斷及各種相關的治療，對性功能、生活質素及心理健康都有負面的影響。文獻指出心理教育對婦科癌症病人這方面的影響有正面的效果，但是效用的証據並不一致。 / 系統化綜述: 本研究首先進行系統化綜述，並根據喬安娜．布里格斯的方法進行，目的在於確定心理教育對婦科癌症病人的性功能、生活質素及心理健康的功效，以及辨認一套有效的心理教育課程給予婦科癌症病人。總共有十一份隨機控制實驗的文獻，包括九百七十五位婦科癌症病人，被納入本綜述，其中四份可比較的文獻進行了薈萃分析。根據兩份評估心理教育對抑鬱功效的文獻薈萃結果顯示，心理教育對改善抑鬱徵狀有顯著的改善。另外兩份文獻評估心理教育對生活質素的功效，薈萃結果顯示心理教育對身理方面的生活質素未有明顯的改善，相反地，提供資訊性的教育對婦科癌症病人心理方面的生活質素有明顯的功效。關於心理教育對性功能的功效，似乎對性生活有所改善，但是並未能在性功能的評估工具反映出來。關於心理教育對心理健康的功效，除了抑鬱以外，似乎未有足夠的証據顯示有顯著的功效。系統化綜述建議心理教育予婦科癌症病人應包括三種元素：資訊提供、行為治療及心理支持；形式可以是個人、個人及伴侶共同參予、或小組；應由護士提供；於癌症治療開始前進行，直至出院後；包括四堂課程，每堂三十分鐘至一小時完成。 / 試驗性研究目的：試驗性研究目的是測試提供一套根據系統化綜述結果設計的心理教育予香港婦科癌症病人的可行性，以及評估該課程對改善香港婦科癌症病人的性功能、生活質素、及心理健康的功效。 / 試驗性研究方法：試驗性研究採用隨機控制實驗的方法，把二十六位婦科癌症病人分配到兩個不同的組別。實驗組的參加者，接受一套心理教育；對照組的參加者於實驗組的同一時段收到研究員的訪問。不論哪個組別的參加者，都會進行指標評估，包括性功能、生活質素、不明朗、社交支持、焦慮及抑鬱的狀況。研究指標分別在手術前(T0)、手術後及住院期間(T1)，和手術後8星期(T2)。實驗組的參加者及於臨床工作的護士更會被邀請進行了簡單的傾談，從而了解她們對此心理教育的意見及感受。非參數統計推斷方法用以檢驗組內和組間於上述各指標的差異。實驗組的參加者及護士參予的面談，會進行錄音及內容分析。 / 研究結果：於兩組之間的比較，實驗組的參加者對疾病資料的不一致，有顯著的改善。但是，兩組之間的性功能、生活質素、不明朗、社交支持、焦慮及抑鬱均未有顯著的分別。參加者於面談中指出，心理教育可減低婦科癌症病人的壓力，對她們來說有著實際的用途。 / 研究結論：系統化綜述顯示心理教育對婦科癌症病人有正面的功效。雖然試驗性研究的定量資料結果指出心理教育對香港的婦科癌症病人，除了對疾病資料的不一致有所改善外，在其他各方面的評估，均未有顯著的功效，但是，品質數據的結果顯示婦科癌症病人確實需要心理教育，而此教育於臨床環境實行是可行的。 / Background: A diagnosis and treatment of gynecological cancer (GC) has adverse effects on the sexual functioning, quality of life and psychological outcomes of patients. Psychoeducational interventions (PEIs) are recommended for GC patients to improve their outcomes, but evidence for their effectiveness is far from conclusive. / Systematic review: A systematic review was first carried out according to the Joanna Briggs Institute (JBI) approach to identify the best available evidence relating to the effectiveness of PEIs for GC patients in sexual functioning, quality of life and psychological outcomes. A total of 11 randomized controlled trials (RCTs) involving 975 GC patients were included in the systematic review, but only four comparable studies were appropriate for meta-analysis. PEIs significantly improved depressive symptoms, standardized mean difference (SMD) = -0.80, 95% CI [-1.05 to -0.54], p = < .00001, among the patients. However, there was no significant benefit to the physical aspect of quality of life, SMD = -0.12, 95% CI [-0.45 to 0.20], p = .46. Conversely, information-only therapy demonstrated significant effects on the mental aspects of quality of life, SMD = -0.41, 95% CI [-0.74 to -0.08], p = .01. In addition, from qualitative data, PEIs appeared to be helpful in improving sexual life, but changes in sexual functioning scores were not statistically significant. The interventions appeared to have only limited beneficial effect on anxiety, distress, adjustment to illness and uncertainty, and had no significant effect in improving mood, self-esteem or ability to cope. The review also suggested that PEIs for GC patients would incorporate information provision, behavior therapy and psychological support. The format might be individual, with or without a partner’s participation, or in a group. A nurse was found to be the ideal provider. The interventions could be arranged at the start of cancer treatment and then be continued after discharge, and the number of sessions might be four, each lasting between 30 minutes and one hour. / Aim of pilot study: A program of PEIs was designed based on the systematic review, and piloted on Hong Kong GC patients to test the feasibility and effectiveness of implementing the interventions in Hong Kong. / Pilot research plan: The pilot study was a single-blinded RCT and mix-method design. Twenty-six subjects were randomly assigned to either the intervention or attention control group. The intervention group received the program of PEIs, while the attention control group received attention from the researcher over the same period. Data collection was carried out at baseline (T0), after the operation and during the in-hospital period (T1) and eight weeks after the operation (T2). Qualitative data was collected from the intervention group and nurses working in the clinical setting at T2. Non-parametric tests were used to compare the baseline and various outcome variables within and between groups. Audio-tapes of semi-structured interviews were transcribed verbatim, and content analysis was performed to identify significant themes. / Key findings of pilot study: Participants in the intervention group had statistically significantly less inconsistent information on illness than the attention control group, but there were no statistically significant differences in all other outcome variables including sexual functioning, quality of life, uncertainty, social support, anxiety and depression. Qualitative data from the participants indicated the program of PEIs reduced their stress level and was useful. / Conclusion: The systematic review demonstrated evidence of the positive effects of PEIs on GC patients. Although there were no significant effects appearing in most quantitative results of the intervention program in the pilot study, the qualitative results indicated that the interventions were found desirable by Hong Kong GC patients. Nurses identified implementing the program as feasible in clinical settings. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Chow, Ka Ming. / Thesis (D.Nurs.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 185-204). / Abstracts also in Chinese; appendixes includes Chinese. / Chapter CHAPTER 1 --- INTRODUCTION / Chapter 1.1 --- Introduction --- p.1 / Chapter 1.2 --- Aims and significance of the study --- p.4 / Chapter 1.3 --- Overview of the thesis --- p.4 / Chapter CHAPTER 2 --- LITERATURE REVIEW / Chapter 2.1 --- Introduction --- p.6 / Chapter 2.2 --- Impact of GC on sexual functioning --- p.6 / Chapter 2.2.1 --- Mixed types of GC --- p.7 / Chapter 2.2.2 --- Ovarian cancer --- p.10 / Chapter 2.2.3 --- Cervical cancer --- p.11 / Chapter 2.2.4 --- Impact of GC on sexual functioning in Chinese culture --- p.15 / Chapter 2.3 --- Impact of GC on quality of life --- p.18 / Chapter 2.3.1 --- Mixed types of GC --- p.19 / Chapter 2.3.2 --- Cervical cancer --- p.21 / Chapter 2.3.3 --- Impact of GC on quality of life in Chinese culture --- p.24 / Chapter 2.4 --- Impact of GC on psychological well-being --- p.25 / Chapter 2.4.1 --- Mixed types of GC --- p.26 / Chapter 2.4.2 --- Cervical cancer --- p.29 / Chapter 2.4.3 --- Impact of GC on psychological well-being in Chinese culture --- p.30 / Chapter 2.5 --- Current nursing practice on sexuality with GC patients --- p.30 / Chapter 2.5.1 --- Attitudes of health-care professionals towards sexuality --- p.31 / Chapter 2.5.2 --- Information needs of GC patients --- p.33 / Chapter 2.5.3 --- Sexuality assessment --- p.35 / Chapter 2.5.4 --- Sexuality interventions --- p.37 / Chapter 2.6 --- Psychoeducational interventions (PEIs) --- p.38 / Chapter 2.6.1 --- Theoretical background --- p.38 / Chapter 2.6.2 --- Effects of PEIs on cancer patients --- p.40 / Chapter 2.6.3 --- Effects of PEIs on GC patients --- p.42 / Chapter 2.7 --- Summary --- p.44 / Chapter CHAPTER 3 --- SYSTEMATIC REVIEW (PHASE I) / Chapter 3.1 --- Introduction --- p.46 / Chapter 3.2 --- Review objectives and questions --- p.46 / Chapter 3.3 --- Inclusion criteria --- p.48 / Chapter 3.3.1 --- Types of studies --- p.48 / Chapter 3.3.2 --- Types of participants --- p.48 / Chapter 3.3.3 --- Types of interventions --- p.48 / Chapter 3.3.4 --- Types of outcome measures --- p.49 / Chapter 3.4 --- Search strategy --- p.50 / Chapter 3.5 --- Methods of the review --- p.52 / Chapter 3.5.1 --- Assessment of methodological quality --- p.52 / Chapter 3.5.2 --- Data extraction --- p.52 / Chapter 3.5.3 --- Data synthesis --- p.53 / Chapter 3.6 --- Systematic review results --- p.54 / Chapter 3.6.1 --- Description of studies’ retrieval and selection --- p.54 / Chapter 3.6.2 --- Methodological quality of the included studies --- p.57 / Chapter 3.6.2.1 --- Randomization --- p.57 / Chapter 3.6.2.2 --- Blinding --- p.57 / Chapter 3.6.2.3 --- Consent and completion rates --- p.58 / Chapter 3.6.2.4 --- Power estimation --- p.58 / Chapter 3.6.2.5 --- Result data --- p.58 / Chapter 3.6.3 --- Details of the included studies --- p.59 / Chapter 3.6.3.1 --- Country of origin --- p.59 / Chapter 3.6.3.2 --- Samples --- p.59 / Chapter 3.6.3.3 --- Components of PEIs --- p.59 / Chapter 3.6.3.4 --- Comparison group --- p.61 / Chapter 3.6.3.5 --- Format of PEIs --- p.62 / Chapter 3.6.3.6 --- Provider of PEIs --- p.62 / Chapter 3.6.3.7 --- Provision time frame of PEIs --- p.63 / Chapter 3.6.3.8 --- Duration of PEIs --- p.63 / Chapter 3.6.3.9 --- Outcome measurements --- p.64 / Chapter 3.6.4 --- Effects of PEIs on outcomes --- p.64 / Chapter 3.6.4.1 --- Sexual functioning --- p.65 / Chapter 3.6.4.2 --- Quality of life --- p.65 / Chapter 3.6.4.3 --- Psychological outcomes --- p.68 / Chapter 3.6.4.3.1 --- Anxiety and depression --- p.68 / Chapter 3.6.4.3.2 --- Distress --- p.70 / Chapter 3.6.4.3.3 --- Adjustment to illness --- p.71 / Chapter 3.6.4.3.4 --- Mood --- p.71 / Chapter 3.6.4.3.5 --- Self-esteem --- p.72 / Chapter 3.6.4.3.6 --- Uncertainty --- p.72 / Chapter 3.6.4.3.7 --- Coping --- p.72 / Chapter 3.6.4.4 --- Brief summary --- p.72 / Chapter 3.6.5 --- Design of PEIs --- p.73 / Chapter 3.6.5.1 --- Effective components --- p.73 / Chapter 3.6.5.2 --- Effective format --- p.75 / Chapter 3.6.5.3 --- Effective provider --- p.76 / Chapter 3.6.5.4 --- Effective provision time frame --- p.76 / Chapter 3.6.5.5 --- Effective duration --- p.77 / Chapter 3.7 --- Discussion --- p.78 / Chapter 3.7.1 --- Effects of PEIs on sexual functioning --- p.80 / Chapter 3.7.2 --- Effects of PEIs on quality of life --- p.82 / Chapter 3.7.3 --- Effects of PEIs on psychological outcomes --- p.84 / Chapter 3.7.3.1 --- Anxiety and depression --- p.84 / Chapter 3.7.3.2 --- Distress --- p.86 / Chapter 3.7.3.3 --- Adjustment to illness --- p.87 / Chapter 3.7.3.4 --- Mood --- p.87 / Chapter 3.7.3.5 --- Self-esteem --- p.88 / Chapter 3.7.3.6 --- Uncertainty --- p.88 / Chapter 3.7.3.7 --- Coping --- p.89 / Chapter 3.7.4 --- Design of PEIs --- p.89 / Chapter 3.7.4.1 --- Effective components and theories --- p.89 / Chapter 3.7.4.2 --- Effective format --- p.92 / Chapter 3.7.4.3 --- Effective provider --- p.93 / Chapter 3.7.4.4 --- Effective provision time frame --- p.93 / Chapter 3.7.4.5 --- Effective duration --- p.94 / Chapter 3.8 --- Summary of systematic review --- p.95 / Chapter 3.8.1 --- Implications for practice --- p.95 / Chapter 3.8.2 --- Implications for research --- p.97 / Chapter 3.9 --- Summary --- p.100 / Chapter CHAPTER 4 --- METHODOLOGY OF PILOT STUDY (PHASE II) / Chapter 4.1 --- Introduction --- p.102 / Chapter 4.2 --- Rationale for conducting a pilot study --- p.102 / Chapter 4.3 --- Aims and objectives --- p.103 / Chapter 4.4 --- Operational definition --- p.104 / Chapter 4.4.1 --- Psychoeducational interventions (PEIs) --- p.104 / Chapter 4.4.2 --- Sexual functioning --- p.105 / Chapter 4.4.3 --- Quality of life --- p.105 / Chapter 4.4.4 --- Uncertainty --- p.105 / Chapter 4.4.5 --- Anxiety --- p.106 / Chapter 4.4.6 --- Depression --- p.106 / Chapter 4.4.7 --- Social support --- p.106 / Chapter 4.5 --- Interventions --- p.107 / Chapter 4.5.1 --- Program of PEIs --- p.107 / Chapter 4.5.1.1 --- Theoretical framework underpinning the interventions --- p.107 / Chapter 4.5.1.2 --- Components of the program of PEIs --- p.113 / Chapter 4.5.1.2.1 --- Information provision --- p.113 / Chapter 4.5.1.2.2 --- Behavioral therapy --- p.113 / Chapter 4.5.1.2.3 --- Psychological support --- p.114 / Chapter 4.5.1.3 --- Design of the program of PEIs --- p.115 / Chapter 4.5.2 --- Attention control --- p.121 / Chapter 4.5.3 --- Usual care --- p.122 / Chapter 4.6 --- Methodology --- p.123 / Chapter 4.6.1 --- Study design --- p.123 / Chapter 4.6.2 --- Study setting --- p.125 / Chapter 4.6.3 --- Sample --- p.126 / Chapter 4.6.3.1 --- Sampling method --- p.126 / Chapter 4.6.3.2 --- Sample size determination --- p.127 / Chapter 4.6.3.3 --- Recruitment process --- p.128 / Chapter 4.7 --- Data collection --- p.129 / Chapter 4.7.1 --- Measures --- p.129 / Chapter 4.7.2 --- Study instruments --- p.130 / Chapter 4.7.2.1 --- Demographic data sheet --- p.130 / Chapter 4.7.2.2 --- Sexual functioning --- p.131 / Chapter 4.7.2.2.1 --- Justification for choosing the instrument --- p.134 / Chapter 4.7.2.3 --- Quality of life --- p.134 / Chapter 4.7.2.3.1 --- Justification for choosing the instrument --- p.136 / Chapter 4.7.2.4 --- Uncertainty --- p.136 / Chapter 4.7.2.4.1 --- Justification for choosing the instrument --- p.138 / Chapter 4.7.2.5 --- Social support --- p.139 / Chapter 4.7.2.5.1 --- Justification for choosing the instrument --- p.141 / Chapter 4.7.2.6 --- Anxiety and depression --- p.141 / Chapter 4.7.2.6.1 --- Justification for choosing the instrument --- p.143 / Chapter 4.7.2.7 --- Semi-structure interview --- p.144 / Chapter 4.7.2.7.1 --- Intervention recipients --- p.144 / Chapter 4.7.2.7.2 --- Health-care providers --- p.144 / Chapter 4.7.3 --- Data collection procedure --- p.145 / Chapter 4.8 --- Data analysis --- p.149 / Chapter 4.8.1 --- Quantitative data --- p.149 / Chapter 4.8.1.1 --- Comparison of baseline data --- p.151 / Chapter 4.8.1.2 --- Comparison of outcome variables --- p.151 / Chapter 4.8.2 --- Qualitative data --- p.153 / Chapter 4.9 --- Ethical considerations --- p.154 / Chapter 4.1 --- Summary --- p.155 / Chapter CHAPTER 5 --- RESULTS OF THE PILOT STUDY / Chapter 5.1 --- Introduction --- p.156 / Chapter 5.2 --- Recruitment of participants --- p.157 / Chapter 5.3 --- Characteristics of all participants --- p.159 / Chapter 5.3.1 --- Demographic and clinical characteristics --- p.159 / Chapter 5.3.2 --- Homogeneity of the participants --- p.161 / Chapter 5.4 --- Baseline outcome variables --- p.164 / Chapter 5.4.1 --- Baseline outcome variables of all participants --- p.164 / Chapter 5.4.2 --- Comparison of baseline outcome variables between intervention and attention control groups --- p.166 / Chapter 5.5 --- Outcome variables within-group changes --- p.168 / Chapter 5.5.1 --- Quality of life --- p.168 / Chapter 5.5.2 --- Uncertainty --- p.170 / Chapter 5.5.3 --- Social support --- p.174 / Chapter 5.5.4 --- Anxiety and depression --- p.179 / Chapter 5.6 --- Outcome variables between-group changes --- p.181 / Chapter 5.6.1 --- Sexual functioning --- p.181 / Chapter 5.6.2 --- Quality of life --- p.184 / Chapter 5.6.3 --- Uncertainty --- p.185 / Chapter 5.6.4 --- Social support --- p.187 / Chapter 5.6.5 --- Anxiety and depression --- p.190 / Chapter 5.7 --- Feasibility of implementing the PEI program in Hong Kong clinical settings --- p.191 / Chapter 5.7.1 --- Intervention recipients’ perspective --- p.191 / Chapter 5.7.1.1 --- Emotional support --- p.192 / Chapter 5.7.1.1.1 --- Offering psychology support --- p.192 / Chapter 5.7.1.1.2 --- Removing worries about sexual life --- p.192 / Chapter 5.7.1.2 --- Informational support --- p.193 / Chapter 5.7.1.2.1 --- Acquiring knowledge on illness --- p.193 / Chapter 5.7.1.2.2 --- Behavioral therapy helpful in post-operative care --- p.193 / Chapter 5.7.1.2.3 --- Resources available in the community --- p.194 / Chapter 5.7.1.3 --- Elements of the program --- p.194 / Chapter 5.7.1.3.1 --- Appropriate design of the interventions --- p.194 / Chapter 5.7.1.3.2 --- Content of information provided --- p.195 / Chapter 5.7.1.4 --- Feelings towards the program --- p.195 / Chapter 5.7.1.4.1 --- Appreciation of the interventions --- p.195 / Chapter 5.7.1.4.2 --- Lack of GC health education --- p.196 / Chapter 5.7.2 --- Health-care providers perspective --- p.196 / Chapter 5.7.2.1 --- Opinions regarding the program --- p.197 / Chapter 5.7.2.1.1 --- Quality of information provided --- p.197 / Chapter 5.7.2.1.2 --- Usefulness of the interventions --- p.197 / Chapter 5.7.2.2 --- Suggestions for improvement --- p.198 / Chapter 5.7.2.2.1 --- Content of information provided --- p.198 / Chapter 5.7.2.2.2 --- Format of the interventions --- p.199 / Chapter 5.7.2.2.3 --- Coverage of the patient population --- p.199 / Chapter 5.7.2.3 --- Feasibility of implementing the program in Hong Kong --- p.200 / Chapter 5.7.2.3.1 --- Anticipated barriers --- p.200 / Chapter 5.7.2.3.2 --- Solutions to the barriers --- p.201 / Chapter 5.8 --- Summary --- p.201 / Chapter CHAPTER 6 --- DISCUSSION OF THE PILOT STUDY / Chapter 6.1 --- Introduction --- p.205 / Chapter 6.2 --- Baseline characteristics of the participants --- p.205 / Chapter 6.2.1 --- Demographic and clinical characteristics --- p.206 / Chapter 6.2.2 --- Baseline outcome variables --- p.208 / Chapter 6.3 --- Effectiveness of the PEI program --- p.211 / Chapter 6.3.1 --- Quality of life --- p.211 / Chapter 6.3.2 --- Uncertainty --- p.214 / Chapter 6.3.3 --- Social support --- p.216 / Chapter 6.3.4 --- Anxiety and depression --- p.218 / Chapter 6.3.5 --- Sexual functioning --- p.221 / Chapter 6.4 --- Feasibility of implementing the PEI program in Hong Kong --- p.223 / Chapter 6.4.1 --- Intervention recipients’ perspective --- p.223 / Chapter 6.4.2 --- Health-care providers’ perspective --- p.226 / Chapter 6.5 --- Limitations of the pilot study --- p.229 / Chapter 6.5.1 --- Four types of validity threats --- p.229 / Chapter 6.5.2 --- Limitations in attention placebo, intervention format and integrity --- p.232 / Chapter 6.6 --- Summary --- p.234 / Chapter CHAPTER 7 --- CONCLUSION / Chapter 7.1 --- Introduction --- p.235 / Chapter 7.2 --- Implications for nursing practice --- p.235 / Chapter 7.3 --- Implications for future research --- p.236 / Chapter 7.4 --- Conclusion --- p.239 / REFERENCES --- p.241 / APPENDICES --- p.267

This study has objectively assessed the role of fear of death and dying in a retrospective biased sample of 83 patients treated for initial breast cancer at Ball Memorial Hospital, Muncie, Indiana, 1972-1973.Increased delay is significantly associated with advanced clinical stage of breast cancer. No significant relationship exists between temporal delay and the Collett-Lester Fear of Death Scales. Small positive correlations exist between delay and the Fear of Death Scales, The strongest fear is the fear of dying of self. Fear of death of self is significantly related to advanced clinical stage of breast cancer. Fear of death of others, fear of dying of self, and fear of dying of others are not significantly related to clinical stage of breast cancer. A significant linear relationship between age and temporal delay is present. Increased delay was not significantly related to other psychosocial variables tested. Tendencies to greater delay occurred with certain psychosocial variables.Advanced clinical stage of breast cancer was significantly related to unhappiness at the time of occurrence and the idea of hereditary tendency. Stage of disease was not significantly related to other psychosocial variables tested. Advanced age and social position tend to be associated with advanced breast cancer. Significant relationships existed. between fear of dying of others and reason for seeking medical treatment, and fear of death of others and worry about things other than health and the ides of a hereditary tendency. No significant relationships existed between the Collet Lester Fear of Death Scales and other psychosocial variables tested. Fear of dying of self remained the strongest fear, Some tendencies to greater delay and fear of death and dying were presentBall State UniversityMuncie, IN 47306