The number of patients who suffer from colorectal cancer in Thailand has increased
during the last three decades as a result of the change to a Westem-style diet. Due to
many patients presenting at a late stage and the location of tumours in the rectum,
patients have a higher probability of needing a colostomy. This study explores the
experiences, coping strategies and the factors that influence coping strategies over a sixmonth
period in a group of Thai colorectal cancer patients who have a colostomy.
The conceptual framework used in this study was based on the Moos and Schaefer
conceptual model of the stress and coping process. A case study methodology was
employed to collect both quantitative and qualitative data from eleven participants at
three points in time: within one month after the operation to create a colostomy, three
months and six months after the operation. Data were collected from structured
interviews, which followed the Coping Responses Inventory (CRI), the Ostomy
Adjustment Scale (OAS), the Personal Resources Questionnaire 2000 (PRQ 2000), the
Life Orientation Test-Revised (LOT-R), and the Functional Assessment Cancer Therapy-
Colon (FACT-C). These data provided information on the participants' levels of coping
strategies, adjustment to a colostomy, social support, optimism and quality of life. Indepth
interviews with open-ended questions provided a deeper understanding of the
participants' experiences in relation to their colostomy.
Findings from quantitative data showed statistically significant changes in the
participants' quality of life over time, particularly in their physical and functional wellbeing.
An examination of the coping focus used (approach and avoidance) indicated that
participants utilised both approach and avoidance coping at the same time, although
approach coping was more common. Changes in the most frequently and the least
frequently used coping subtypes at six months after the operation were observed.
Correlation tests showed various relationships between the levels of quality of life
domains and coping subtypes as time passed. Multidimensional scaling procedures
uncovered a consistent pattern of coping which involved 'problem solving' and 'seeking
guidance and support'. Six major qualitative themes emerged through content analysis of
the in-depth interview data. The themes described how participants' psychological and
emotional concerns changed over time; the steady improvements in physical health after
the operation; the difficulties of adjusting to life with a stoma; facing up to the reality of
the new circumstances; the spiritual aspects of their lives; and the level of social support
experienced. Religious beliefs such as the 'Law of Kanna', as well as a variety of
religious rituals and other practices such as Buddhist chanting and "making merit" played
important roles in coping. The findings from the quantitative and qualitative data were
used in a complementary and confirmatory manner to provide a richer understanding of
the participants' experiences as they coped with this life changing event.
The findings of the study are significant as they provide important indicators for
improvements in nursing service, particularly the development of nursing procedures to
enhance the psychological aspects of care. In addition, they offer important indicators for
improvement of the nursing curriculum and directions for further research in Thai culture
and the health care system.
| Identifer | oai:union.ndltd.org:ADTP/219203 |
| Date | January 2005 |
| Creators | Rattanajarana, Sahattaya, n/a |
| Publisher | University of Canberra. Health Sciences |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | ), Copyright Sahattaya Rattanajarana |
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