Coping of Chinese women with breast cancer : psychological adjustment through reframing

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Coping of Chinese women with breast cancer : psychological adjustment through reframing


Author: Ching, Siu-yin
Title: Coping of Chinese women with breast cancer : psychological adjustment through reframing
Degree: Ph.D.
Year: 2001
Subject: Breast -- Cancer -- Psychological aspects
Women -- China -- Hong Kong
Hong Kong Polytechnic University -- Dissertations
Department: Dept. of Nursing and Health Sciences
Pages: 488 leaves ; 30 cm
Language: English
InnoPac Record:
Abstract: The purpose of this study was to understand the phenomenon of the coping of Chinese women with breast cancer. With the adoption of the philosophical basis and methodology of the grounded theory, a two-staged qualitative study was conducted. In the first stage, unstructured, in-depth interviews were conducted with 15 women with breast cancer to explore the phenomenon of the coping with breast cancer. In order to control the effect on generality of both scope of population and the conceptual level of the theory, subjects who met the following criteria were recruited: (a) 18 years or above; (b) Chinese; (c) female; (d) without previous diagnosis of cancer; (e) without mental illness prior to the diagnosis of cancer; (f) recognized the diagnosis of cancer; (g) able to communicate in Cantonese; and (h) without clinically confirmed metastasis to other organs. "Refraining" was identified to be the core variable and patterns of use of coping strategies were noted. With the objectives of further developing the categories and exploring the change in coping across time, women with breast cancer were followed and interviewed for three times (i.e. shortly after being diagnosed, during treatment, and during rehabilitation) in the second stage of the study and 20 interviews were done. Based on the findings, a model of psychological adjustment of Chinese women to the impact of breast cancer was developed. Uncertainty was identified to be the most salient characteristics of breast cancer. Refraining process was found to be an important process in adjusting to the impact of breast cancer. It comprised of four phases which were paralleled to the medical stages in the cancer experience: (i) Disruption of frame; (ii) Holding onto the pre-existing frame; (iii) Recognizing the inadequacy of the pre-existing frame; and (iv) Reconstructing new frame. In the phase of reconstructing new frame, the women needed to complete the acceptance work, sustaining work and integration work through the appraisal process, controlling process, and assimilation process. In the refraining process, two contextual conditions, i.e. focus and approach, were found to be discriminating in describing the difference in coping. With construction of a typology by using the two contextual conditions, four modes of coping were identified: fighting, following the natural course, struggling, and bearing and their coping were characterized by differential strategies according to the nature of the problems, conforming, struggling, and bearing respectively. Social support was found to be the most powerful buffer that intervened in the reframing process. Modifiers (i.e. cultural influences, personal beliefs and values, background conditions, developmental stage of the women) intervened in the reframing process by posing additional demands on the use of coping strategies. This finding highlights the significance of understanding the women's interpretation of the situation in adjusting to the impact of breast cancer. Adaptive coping depends on the coherence between the new fame for breast cancer and the women's existing system of frame. In order to address the needs of the women in adjustment, the interventions of health care providers must be mode-specific and phase-specific. Consideration of the influence of the context, buffer, and modifiers is essential. Future directions for research are suggested.

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