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)

Sendo um fenômeno que permeia o existir, o adoecer se torna alvo importante de reflexões para diferentes abordagens. Enquanto experiência do humano, possui caráter científico, mas principalmente singular a partir de uma postura não redutora quanto à concepção de pathos. Concebendo a apropriação do homem no que diz respeito às suas formas de comunicação consigo e com o mundo, são observados diferentes modos de ação dos pacientes hospitalizados que lidam com o adoecer de câncer. Enquanto uns não conseguem dar qualquer sentido à vivência desse fenômeno, outros vislumbram o adoecer como horizonte de crescimento em suas jornadas de vida. A partir do conhecimento de que tantos outros modos de estar no mundo podem se fazer presentes entre essas pessoas, este estudo tem como objetivo geral a busca pela compreensão da experiência do adoecer pela perspectiva de pessoas com câncer que se encontram hospitalizadas. Pesquisar sobre a vivência de internamento em enfermaria oncológica e compreender o desvelamento de sentidos na experiência do adoecer com câncer constituem os objetivos específicos. Visando conciliar a proposta desta pesquisa com o conhecimento prático adquirido pela pesquisadora enquanto psicóloga hospitalar, foram utilizados como instrumentos a entrevista geradora de narrativa e o diário de campo. Os dados foram coletados em hospital de grande porte da cidade de Recife PE, numa enfermaria de oncologia, com participantes de ambos os sexos e idade mínima de 18 anos. Tendo como fundamentação teórica os estudos do psiquiatra Viktor Frankl, os dados foram analisados a partir da perspectiva da filósofa Dulce Critelli no que se refere ao movimento de desvelamento do fenômeno, e de Gadamer, com sua noção de conversação e fusão de horizontes. Como resultados foram obtidas narrativas que propiciam o desenvolvimento de novos olhares para o fenômeno do adoecer, desmistificando alguns pensamentos culturalmente estabelecidos que restringem a vivência do câncer ao sofrimento intenso e inevitável. / Being a phenomenon that permeates the existence, sickening becomes an important target of reflections for different approaches. As a human experience, it holds a scientific character, but primarily singular from anon-reductive posture regarding the conception of pathos. Conceiving human appropriation with regard to ones own ways of selfcommunication and communication with the world, its possible to observe different means of action by hospitalized patients who deal with sickening by cancer. While some don't succeed in giving any meaning to the living of this phenomenon, others glance sickening as a growing horizon in their life journey. Based on the knowledge that so many other ways of being in the world can be present among these people, this study states as its main objective to search for comprehension of the sickening experience by the perspective of cancer patients under hospitalization. To research the internment experience in oncology infirmary and to comprehend the unveiling of senses in the experience of sickening by cancer constitute the specific objectives. Aiming to conciliate the proposal of this research with the practical knowledge acquired by the researcher as a hospital psychologist, the tools used for the research were the narrative interview and the field diary. The data was collected in a large hospital in the city of Recife - PE, in an oncology infirmary, with participants of both sexes and with the minimum age of 18. The theoretical fundamentals were based upon the studies of the psychiatrist Viktor Frankl, the data were analyzed by the perspective of the philosopher Dulce Critelli regarding the unveiling of senses and of Gadamer concerning his notion of conversation and fusion of horizons. The results were obtained as narratives that allowed the development of a new look in the sickening phenomenon, demystifying some culturally established beliefs that restrict the experience of cancer to intense and inevitable suffering.

Orientador: Sílvia Regina Brandalise / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-17T02:55:11Z (GMT). No. of bitstreams: 1 Perina_ElisaMaria_D.pdf: 1193619 bytes, checksum: 7cda6c283059389c190b1f4ec5abc432 (MD5) Previous issue date: 2010 / Resumo: Com o surgimento de novos recursos diagnósticos e terapêuticos, o tratamento das crianças e adolescentes com câncer resultou em significativo aumento da sobrevida. Os efeitos tardios relacionados a doença e ao tratamento causam impacto na saúde e na qualidade de vida dos jovens recuperados de câncer, abrindo a discussão dos limites da cura frente a toxicidade e qualidade. Com o objetivo de avaliar a qualidade de vida relacionada a saúde de adolescentes sobreviventes de câncer na infância e verificar sua relação com ansiedade, depressão e estresse pós-traumático, realizou-se um estudo quantitativo transversal analítico com 208 adolescentes, entre 13 e 18 anos, que se encontravam ha mais de três anos fora de terapia, em seguimento multiprofissional no Ambulatório da Clinica Apos o Termino da Terapia do Centro Infantil de Investigações Hematológicas Dr. Domingos A. Boldrini, no período de marco de 2009 a abril de 2010. Utilizaram-se o Questionário Pediátrico de Qualidade de Vida PedsQL¿ - Relato do adolescente e Relato dos pais sobre o adolescente - 13 a 18 anos para a determinação do escore de qualidade de vida relacionada a saúde, a Escala Hospitalar de Ansiedade e Depressão ("Hospitalar Anxiety and Depression Scale" - HAD) e a Versão Civil da Avaliação de Estresse pós-traumático ("Post- Traumatic Stress Disorder Checklist - Civilian Version). Constataram-se diferenças dos aspectos, atividade, sumários e escore total de qualidade de vida do PedsQL¿ entre os adolescentes segundo o gênero e o tipo de câncer. Houve correlação significativa e diferença entre a avaliação dos adolescentes e dos pais. Comprovou-se a relação inversa entre a qualidade de vida e a idade, a ansiedade, a depressão e o estresse pós-traumático. Apesar de apresentarem seqüelas físicas e comprometimento no aspecto funcional, a qualidade de vida dos adolescentes foi considerada satisfatória, baseado no escore total do PedsQLTM. A identificação precoce das necessidades dos sobreviventes, no programa de seguimento de sobreviventes de câncer na infância, e dos fatores de risco para o desencadeamento de efeitos tardios, somáticos ou psicossociais, permitira estruturar novas intervenções para a sua efetiva reabilitação. / Abstract: With the emergence of new diagnostic and therapeutic resources, the treatment of children and adolescents with câncer resulted in a significant increase in survival. Secondary effects of the disease impact the health and quality of life of young people recovered from câncer. Aiming to evaluate the quality of life related to adolescent health in childhood câncer survivors and to assess its relation to anxiety, depression and posttraumatic stress, we conduct an analytical cross-sectional quantitative study with 208 adolescents between 13 and 18 years, off therapy for more than three years in After Completion of Therapy Clinic of Children's Center of Hematologic Investigation Dr. Dominic A. Boldrini (Centro Infantil de Investigações Hematológicas Dr. Domingos A. Boldrini, Campinas, SP, Brazil), from March 2009 to April 2010. We used the Pediatric Quality of Life Inventory PedsQL¿ Generic Score Scale Adolescent ages 13-18 years - Self-report by adolescent and Report from parents of adolescents, the Hospital Anxiety and Depression Scale and the Post-Traumatic Stress Disorder Checklist - Civilian Version. Differences were observed at aspects, activity, summaries, and total score of the PedsQL¿ among adolescents according to gender and type of câncer. There was significant correlation and difference between the assessment of adolescents and their parents. Proved the inverse relationship between quality of life and age, anxiety, depression and post-traumatic stress. Although they present no physical disability and impairment in the functional aspect, the quality of life for adolescents was considered satisfactory, based on PedsQL¿. Early identification of the needs of survivors in the after completion of therapy clinic follow, and risk factors for the onset of late effects, somatic or psychosocial interventions new structure will allow for their effective rehabilitation. / Doutorado / Saude da Criança e do Adolescente / Doutor em Saude da Criança e do Adolescente

M.Cur. (Psychiatric Nursing) / A diagnosis of cancer causes certain fears to arise in a patient, as well as among his family, activating intense emotional responses in everyone concerned. Examples of such emotions are anger. self-reproach, gUilt, heartache, helplessness and mourning. An acceptance of the circumstances does not necessarily occur, and the phases of the mourning process may be continually interchanging. As a result of all these emotions experienced by the patient with cancer as well as his family, mental discomfort is likely to occur. The family has to adapt its usual mechanism for handling internal discomfort, in order to include the pressure and demands to which they will be exposed as a result of the cancer and treatment thereof. Family cohesion will not necessarily be advanced as a result of this heightened pressure, and additional pressure may be placed on relationships within the family. Members of a family often find it difficult to discuss openly their fears, worries and feelings. for the simple reason that they are scared of becoming upset themselves, or alternately upsetting the rest of the family. Holding themselves back in this way may lead to a feeling of being isolated, which in turn leads to feelings of uncertainty being experienced. In this way the members of a family may find themselves becoming less and less involved with each other and with the patient's treatment, all as a result of not being able to talk about their fears and other intense emotions and therefore not being able to realise all these feelings. As a result of the family's uncertainty concerning their handling of the situation, they experience a loss of control and a change in their ability to handle their situation. These factors contribute to their experience of mental discomfort. Mental discomfort is not visible to others, therefore it is very rarely treated by the multiprofessional team. If the members of the team notice the existence of such discomfort, they will still emphasise the medical treatment, since they themselves may be uncertain as to any effective treatment for such a family. The registered nurse who is in continuous contact with the patient and his family, therefore has the challenge to support the family who suffers from mental discomfort in order to lessen their suffering and facilitate their striving towards achieving wholeness once more, whether in hospital, at home or in a community centre. There are several methods of interaction available for the treatment of such a family. Mental discomfort can be reduced by psychiatric nursing accompaniment. The purpose of this study was to explore and describe the folloWing: the contribution made by psychiatric nursing accompaniment through the medium of a psychiatric nursing specialist, as regards lessening the mental discomfort of the family of a patient being treated in an oncology unit or at home. A further purpose was to set certain guidelines for the registered nurse, concerning her support of the family of a patient in an oncology unit or at home, thereby lessening their mental discomfort. An exploratory, descriptive, contextual study was done on a family with one member who has been diagnosed with cancer, and who received treatment in an oncological unit and at home. This family submitted themselves to psychiatric nursing accompaniment. A purposive, non-selective sample was used and the family had to satisfy certain specific criteria pertaining to mental discomfort...

L’anxiété est très fréquente chez des patientes présentant un cancer du sein non-métastatique et peut avoir des répercussions importantes sur leur prise en charge médicale ainsi que sur leur bien-être physique et psychologique. S’il existe une littérature abondante sur le sujet, de nombreuses questions subsistent concernant l’évaluation et la prise en charge de l’anxiété durant la radiothérapie et dans la phase de rémission qui suit. <p><p>Ce travail de thèse a investigué ces questions au travers de deux études empiriques répondant aux objectifs suivants: (a) l’évaluation de l’évolution et des prédicteurs de l’anxiété durant le traitement de radiothérapie et (b) le développement et l’évaluation de l’efficacité de deux interventions psychologiques de groupe sur la régulation de l’anxiété après la radiothérapie. <p><p>Les résultats de la première étude (a) montrent que les niveaux d’anxiété les plus élevés sont observés lors de la simulation et de la première séance de radiothérapie et diminuent, ensuite, rapidement jusqu’à la fin du traitement. Bien que les niveaux d’anxiété soient relativement faibles pour de nombreuses patientes et semblent être de nature anticipatoire, certaines patientes présentent des niveaux cliniquement significatifs d’anxiété. De plus, un niveau cliniquement significatif d’anxiété à la première séance de radiothérapie est prédit par des facteurs liés à la communication entre les patientes et l’équipe de radiothérapie. Les résultats de la seconde étude (b) indiquent qu’une intervention de groupe à composantes multiples qui combine le soutien, les techniques cognitivo-comportementales et l’hypnose est plus efficace qu’une intervention de groupe à composante unique basée sur le soutien pour aider les patientes à mieux réguler leur anxiété après la radiothérapie. <p><p>Les résultats de ce travail de thèse soulignent l’importance d’évaluer l’anxiété chez les patientes à des moments critiques de leurs parcours médical et d’identifier les patientes qui présentent des niveaux cliniquement significatifs d’anxiété pour leur offrir un soutien adapté. Ces résultats suggèrent également d’améliorer les prises en charge afin de réduire l’anxiété des patientes. Des prises en charge offertes par les équipes de radiothérapie nécessitent une personnalisation de la communication établie avec les patientes et l’utilisation de stratégies proactives d’évaluation, d’information et de soutien. Des prises en charge psychologiques de groupe nécessitent quant à elles de combiner les composantes thérapeutiques les plus optimales. Enfin, ce travail de thèse souligne l’importance de continuer à développer et à améliorer les méthodes d’évaluation et d’intervention.<p> / Doctorat en Sciences Psychologiques et de l'éducation / info:eu-repo/semantics/nonPublished

Made available in DSpace on 2017-06-01T18:08:25Z (GMT). No. of bitstreams: 1 dissertacao_leopoldo_barbosa.pdf: 1570543 bytes, checksum: 90721e57a703b52f01b2d043554bd68d (MD5) Previous issue date: 2008-03-01 / The treatment of patients with larynx cancer who carry through the surgery of Total Laringectomy (TL), frequently implies the necessity of aggressive procedures that they can cause irretrievable esthetic and functional injuries, such as the use of nasogastric feeding, stoma, loss of speaks and the olfactive sense, difficulty to swallow certain foods and the impossibility of immersion in liquids, causing a series of repercussions a psychosocial dimension. Through a qualitative methodology based in the narrative of the patients and its caregivers, we objectify to investigate the possible psychosocial repercussions in the subjective construction of patients submitted to the TL. We search, also, to characterize the occured changes in the daily one of the patients, its familiar and social relations, with intention to understand as these changes affect its emotional balance and to understand its strategies of psychological confrontation. All the passage around the illness is lived by the patient and its family as a moment of crisis, crossed for a deep feeling of precariousness, demanding a series of readjustments that affect its routine expressivelly and of its family ones. Ahead of the diverse physical sequels decurrent of the TL and its treatment, the loss of speaks assumes with priority role taking the patient to isolate itself of its social conviviality, to move away from its professional functions, what it generates, consequently, improper feelings, low auto-esteem, shame and, even though, guilt for the belief of that its bad habits had contributed to become sick. The family, for its turn, suffers doubly: of a side for the perception of fragility and fear of loss and, of another one for attempts, nor always successful, to give support and to offer ambience for the new necessities that if present. One perceives, still, that on aspects to the religiosity, to the support of the family and trustworthiness in the team are faced as source of motivation for the treatment. The experience of become sick is extremely rich of is felt: dis-arming, easying to occupy with what it interests and reallyis present in here and now, asking for support spaces where abdicating of itself it implies in confiding for another one. Beyond going deep thematic relative to Clinical and Hospital Psychology, we believe that this research could assisting in them in the identification of clinical devices for the action of the Psychologist who works in this context. Other studies and reflections are necessary so that let us can more good understand these as much faces that involved the human being, without imprisoning it, considering it in its multiple singularity, however, can affirm that the contact with these patients and the search of understanding of its sufferings take us, each time more, to take the ethics of the care as the main referencial in our Clinical activity / O tratamento de pacientes com câncer de laringe que realizam a cirurgia de Laringectomia Total (LT), freqüentemente implica a necessidade de procedimentos agressivos que podem causar lesões estéticas e funcionais irrecuperáveis, tais como o uso de sonda nasogástrica, traqueostoma, perda da fala e do sentido olfativo, dificuldade para engolir certos alimentos e a impossibilidade de imersão em líquidos, acarretando uma série de repercussões em uma dimensão psicossocial. Através de uma metodologia qualitativa, baseada na narrativa dos pacientes e seus cuidadores, objetivamos investigar as possíveis repercussões psicossociais na construção subjetiva de pacientes submetidos à LT. Caracterizamos mudanças ocorridas no cotidiano dos pacientes e em suas relações familiares e sociais, com o intuito de compreender como estas mudanças afetam o seu equilíbrio emocional e as suas estratégias de enfrentamento psicológico frente a elas. Todo o percurso em torno da doença é vivido pelo paciente e por sua família como um momento de crise, atravessado por um profundo sentimento de precariedade, que exige uma série de readaptações que afetam expressivamente a rotina e o contexto social em que vivem. Diante das diversas seqüelas físicas decorrentes da LT e do seu tratamento, a perda da fala assume papel prioritário levando o paciente a isolar-se do seu convívio social, afastar-se de suas funções profissionais, o que gera, conseqüentemente, sentimentos de inadequação, baixa auto-estima, vergonha e, até mesmo, culpa pela crença de que seus maus hábitos contribuíram para o adoecer. A família, por seu turno, sofre duplamente: de um lado pela percepção de fragilidade e medo de perda de um ente querido e, de outro, por tentativas, nem sempre bem sucedidas, de dar suporte e oferecer ambiência para as novas necessidades que se apresentam. Percebe-se, ainda, que os aspectos ligados à religiosidade, ao apoio da família e confiabilidade na equipe são encarados como fonte de motivação para o tratamento. A experiência do adoecimento é extremamente rica de sentidos: des-armando, des-pre-ocupando para ocupar-se com o que interessa e realmente está presente no aqui e agora, pedindo espaços de amparo onde o abdicar de si implica em abrir-se para outro. Além de aprofundar temáticas relativas à Psicologia Clínica e Hospitalar, acreditamos que essa pesquisa pôde nos auxiliar na identificação de dispositivos clínicos para a ação do Psicólogo que trabalha nesse contexto. Outros estudos e reflexões são necessários para que possamos melhor compreender essas tantas facetas que envolvem o humano, sem aprisioná-lo, considerando-o em sua singularidade múltipla. No entanto, podemos afirmar que o contato com esses pacientes e a busca de compreensão de seus sofrimentos leva-nos, cada vez mais, a tomar a ética do cuidado como o principal referencial em nossa atividade Clínica

Made available in DSpace on 2017-06-01T18:08:57Z (GMT). No. of bitstreams: 1 aline_agustinho_silva.pdf: 421990 bytes, checksum: 80938a30e28a3aac8caa31d2fab4660b (MD5) Previous issue date: 2015-03-26 / Being a phenomenon that permeates the existence, sickening becomes an important target of reflections for different approaches. As a human experience, it holds a scientific character, but primarily singular from anon-reductive posture regarding the conception of pathos. Conceiving human appropriation with regard to one s own ways of selfcommunication and communication with the world, it s possible to observe different means of action by hospitalized patients who deal with sickening by cancer. While some don't succeed in giving any meaning to the living of this phenomenon, others glance sickening as a growing horizon in their life journey. Based on the knowledge that so many other ways of being in the world can be present among these people, this study states as its main objective to search for comprehension of the sickening experience by the perspective of cancer patients under hospitalization. To research the internment experience in oncology infirmary and to comprehend the unveiling of senses in the experience of sickening by cancer constitute the specific objectives. Aiming to conciliate the proposal of this research with the practical knowledge acquired by the researcher as a hospital psychologist, the tools used for the research were the narrative interview and the field diary. The data was collected in a large hospital in the city of Recife - PE, in an oncology infirmary, with participants of both sexes and with the minimum age of 18. The theoretical fundamentals were based upon the studies of the psychiatrist Viktor Frankl, the data were analyzed by the perspective of the philosopher Dulce Critelli regarding the unveiling of senses and of Gadamer concerning his notion of conversation and fusion of horizons. The results were obtained as narratives that allowed the development of a new look in the sickening phenomenon, demystifying some culturally established beliefs that restrict the experience of cancer to intense and inevitable suffering. / Sendo um fenômeno que permeia o existir, o adoecer se torna alvo importante de reflexões para diferentes abordagens. Enquanto experiência do humano, possui caráter científico, mas principalmente singular a partir de uma postura não redutora quanto à concepção de pathos. Concebendo a apropriação do homem no que diz respeito às suas formas de comunicação consigo e com o mundo, são observados diferentes modos de ação dos pacientes hospitalizados que lidam com o adoecer de câncer. Enquanto uns não conseguem dar qualquer sentido à vivência desse fenômeno, outros vislumbram o adoecer como horizonte de crescimento em suas jornadas de vida. A partir do conhecimento de que tantos outros modos de estar no mundo podem se fazer presentes entre essas pessoas, este estudo tem como objetivo geral a busca pela compreensão da experiência do adoecer pela perspectiva de pessoas com câncer que se encontram hospitalizadas. Pesquisar sobre a vivência de internamento em enfermaria oncológica e compreender o desvelamento de sentidos na experiência do adoecer com câncer constituem os objetivos específicos. Visando conciliar a proposta desta pesquisa com o conhecimento prático adquirido pela pesquisadora enquanto psicóloga hospitalar, foram utilizados como instrumentos a entrevista geradora de narrativa e o diário de campo. Os dados foram coletados em hospital de grande porte da cidade de Recife PE, numa enfermaria de oncologia, com participantes de ambos os sexos e idade mínima de 18 anos. Tendo como fundamentação teórica os estudos do psiquiatra Viktor Frankl, os dados foram analisados a partir da perspectiva da filósofa Dulce Critelli no que se refere ao movimento de desvelamento do fenômeno, e de Gadamer, com sua noção de conversação e fusão de horizontes. Como resultados foram obtidas narrativas que propiciam o desenvolvimento de novos olhares para o fenômeno do adoecer, desmistificando alguns pensamentos culturalmente estabelecidos que restringem a vivência do câncer ao sofrimento intenso e inevitável.

A child diagnosed with a life-threatening illness such as cancer, and is hospitalized for extensive periods of time, is faced with innumerable stressful and traumatic circumstances. This emotionally challenging life situation can bring on much emotional distress such as anxiety. Thus, it has become imperative that the oncology child is assisted and supported, in his individual struggle to cope with the harshness of his strained reality. In this study the hospitalized oncology child was provided with a means of support and intervention through the use of Gestalt play therapy. Gestalt play therapy was conducted to assist the child to express and work through feelings of anxiety and related emotional distress associated with his present life experience. Gestalt play therapy was presented with six case studies. The researcher explored and described the experiences of each case study from which, the researcher drew conclusions and made recommendations. / Social Work / M.Diac. (Play Therapy)

published_or_final_version / Community Medicine / Master / Master of Philosophy

by Siu Pik-ngan. / Questionnarie in Chinese. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1997. / Includes bibliographical references (leaves 74-79). / List of Tables --- p.v / List of Figures --- p.vi / List of Appendices --- p.vii / Introduction --- p.1 / Method --- p.28 / Results --- p.36 / Discussion --- p.55 / References --- p.74 / Appendices --- p.80