DISSERTATION ON
“ASSESS THE EFFECTIVENESS OF ONCO-MENTAL HEALTH PROGRAMME ON THE MANAGEMENT OF PSYCHOSOCIAL PROBLEMS AMONG BREAST CANCER SURVIVORS AT TERTIARY
CARE HOSPITAL, AT CHENNAI-03”.
M.Sc. (NURSING) DEGREE EXAMINATION BRANCH – V MENTAL HEALTH NURSING
COLLEGE OF NURSING
MADRAS MEDICAL COLLEGE, CHENNAI -03.
A dissertation submitted to
THE TAMILNADU DR.M.G.R MEDICAL UNIVERSITY, CHENNAI- 600 032.
In partial fulfillment of the requirement for the award of the degree of MASTER OF SCIENCE IN NURSING
OCTOBER 2020
“ASSESS THE EFFECTIVENESS OF ONCO-MENTAL HEALTH
PROGRAMME ON THE MANAGEMENT OF PSYCHOSOCIAL PROBLEMS AMONG BREAST CANCER SURVIVORS AT TERTIARY CARE HOSPITAL,
AT CHENNAI - 03”.
Examination : M.Sc. (N) Degree Examination
Examination Month and Year : _________________________
Branch and course : V- MENTAL HEALTH NURSING
Register No : 301831103
Institution : COLLEGE OF NURSING,
MADRAS MEDICAL COLLEGE.
CHENNAI – 600 003
Sd: ____________________ Sd: ___________________
Internal Examiner External Examiner
Date: ___________________ Date: __________________
THE TAMIL NADU DR.M.G.R MEDICAL UNIVERSITY, CHENNAI-600 032.
CERTIFICATE
This is to certify that the dissertation titled “Assess the effectiveness of Onco- Mental health programme on the management of psychosocial problems among breast cancer survivors at Tertiary care hospital Chennai-03”is a bonafide work done by T. BHARATHI, M.Sc Nursing II year Student, College of Nursing, Madras Medical College, Chennai-3. submitted to The Tamil Nadu Dr. M.G.R Medical University, Chennai-32, in partial fulfilment of the requirement for the award of degree of Master of Science in Nursing, Branch-V, Mental Health Nursing, under our guidance and supervision during the academic year 2018 -2020.
A.Thahira Begum,M.Sc (N),MBA.,M.Phil., Dr.E.Theranirajan,M.D,FRCPCHP,(UK),RCPCHP,(UK) Principal, Dean,
College of Nursing, Madras Medical College, Madras Medical College, Chennai-03.
Chennai-03.
“ASSESS THE EFFECTIVENESS OF ONCO-MENTAL HEALTH
PROGRAMME ON THE MANAGEMENT OF PSYCHOSOCIAL PROBLEMS AMONG BREAST CANCER SURVIVORS AT TERTIARY CARE HOSPITAL,
AT CHENNAI-03”.
Approved by the dissertation committee on CLINICAL SPECIALITY GUIDE
Mr. M. Nithyanantham, M.Sc (N)., (Ph.D). ___________________
Reader Head of the department, Department of Psychiatric nursing, Madras Medical College,
Chennai-03.
PRINCIPAL
Mrs. A. Thahira Begum, M.Sc (N)., MBA., M.Phil., Principal,
College of Nursing, Madras Medical College, Chennai – 03.
DEAN
Dr. E. Theranirajan, MD, DCH, MRCPCH (UK), FRCPCH (UK) Dean,
Madras Medical College, Chennai -03.
A dissertation Submitted to
THE TAMILNADU Dr. M.G.R MEDICAL UNIVERSITY, CHENNAI–32.
In partial fulfillment of the requirement for the award of the degree of MASTER OF SCIENCE IN NURSING
OCTOBER 2020
CERTIFICATE OF PLAGIARISM
This is to certify that the dissertation work titled, “Assess the effectiveness of Onco-Mental health programme on the management of psychosocial problems among breast cancer survivors at Tertiary care hospital Chennai-03” of the candidate BHARATHI.T, for the partial fulfilment of M.Sc. Nursing Programme in the branch of Mental Health Nursing has been verified for plagiarism through relevant plagiarism checker. We found that the uploaded thesis file from introduction to conclusion pages and rewrite shows 4% of plagiarism (96% uniqueness) in this dissertation.
Clinical speciality Guide
Mr. M. Nithyanantham, M.Sc (N)., (Ph.D).
Reader Head of the department, Department of Psychiatric nursing, Madras Medical College,
Chennai-03
Mrs.A.ThahiraBegum,M.Sc.(N),MBA.,M.Phil., Principal,
College of Nursing, Madras Medical College, Chennai – 03.
ACKNOWLEDGEMENT
“I am with you and will save you, declares the Lord”. Jeremiah 30:11
First and foremost I praise and thank the lord almighty, the one above us for his abundant grace, love, protection and blessings bestowed on me to face all the hassles during the course of my entire study.
Thanks are gratitude, saying thank you is more than good manners. It is good spirituality
I wish to express my sincere thanks to Dr. E.THERANIRAJAN, M.D.,DCH., MRCPCH(UK),FRCPCH(UK) Dean, Madras Medical College, Dr. Sudha shesayan, M.S., Vice Principal, Madras Medical College, Chennai, for providing necessary facilities and extending support to conduct this study.
I extend my humble thanks to Mrs. A. Thahira Begum, M.Sc (N)., M.B.A., M.Phil., Principal, College of Nursing, Madras Medical College, Chennai-3, for her guidance, and support to complete the study in a successful manner.
It’s my great at pleasure to express my gratitude to my teacher Mr. M. Nithyanantham, M.Sc (N).,(Ph.D). Reader, Vice principal, HOD in Mental
Health Nursing, College of Nursing, Madras Medical College, Chennai -03 for his constant guidance, encouragement and support for completing this study in a successful manner.
I owe my deepest sense of gratitude to Dr. Shankar Shanmugam M.Sc(N), Ph.D, Reader , HOD in research, College Of Nursing, Madras Medical College, Chennai-03. for his timely assistance in guidance, motivation, encouragement, valuable suggestion, towards the successful completion of this study.
I express my thanks to Mrs.G. Mala., M.Sc (N)., M.B.A., Nursing Tutor, College of Nursing, Madras Medical College, Chennai-03. for his encouragement and guidance in all the possible way to complete this study.
I express my thanks to Mr. K. Kannan., M.Sc (N)., M.B.A., Nursing Tutor, College of Nursing, Madras Medical College, Chennai-03. for his encouragement and guidance in all the possible way to complete this study.
I am grateful to all faculties of the College of Nursing, Madras Medical College, Chennai-03, for their support and guidance for this study.
I render my sincere thanks to Dr.V.VISWANATHAN NDRT, DCH., Professor and Head of Radiation Oncology and incharge of medical oncology and Dr.G. GOPU, M.S.,M.Ch., Professor and Head of Surgical Oncology, Tertiary care hospital, Chennai- 03 for granting permission to conduct this study.
I deem it a great privilege to express my gratitude to Dr. V. Venkatesh Mathan Kumar., MD., Associate Professor,Institute of Mental
Health, Kilpauk, Chennai -10, for his support and guidance for this study.
I am extremely grateful to Mr.G.Natchimuthu, M.Sc. (N), Lecturer, in Mental Health Nursing, Institute of Mental Health, Chennai-10, for his encouragement, valuable suggestion, support and advice given in this study.
I extend my thanks to Nursing Superintendent and Staff Nurses in Institute of Mental Health to their support and cooperation to complete my study successful.
I acknowledge my sincere thanks to Mr. A. Vengatesan, M.Sc., M.Phil., P.G.D.C.A., Ph.D. Former Deputy Director in statistics,Director of Medical Education, Chennai, for his valuable suggestion and guidance in statistical analysis of data for this study.
I extend my thanks to Mr. R. Ravi, M.A, B.L.I.Sc., Librarian, College of Nursing, Madras Medical College, Chennai-03 for his co-operation and assistance which helps to gain in-depth knowledge regarding this study.
My sincere thanks to my Study Participants of primary caregivers of mentally ill clients at Institute of Mental Health, Chennai, for their co-operation and support for this study.
My special and deep thanks to my Beloved Husband Mr.S.ARUMUGAM, and my lovable sons A.B.SUGHI SEERAN and A.B.THAAMAN, for their loving support and timely help to complete the study successfully and my whole heart thanks to my sisters family, relatives, colleague and well-wishers for their timely help, support, cooperativeness for my successful completion of my study.
I express my gratitude to all my classmates who directly and indirectly supported me for completing this study successfully.
I express my sincere gratitude to my friend Mr.C.SRINIVASAN for their support to complete the study.
Finally I thank all whom I have not mentioned but nevertheless have been instrumental in the successful completion of the dissertation.
ABSTRACT
Depression and anxiety and stress are the most common disorders that can be present in breast cancer patients through their illness from diagnosis to the end of the disease and Quality of Life (QOL) is impaired through their course of diagnosis, staging, and treatments consequences which may result in physiological effect of cancer.
METHODOLOGY: A Quasi experimental design with 60 breast cancer patients were non- randomly selected by purposive sampling method and divided into experimental and control groups, 30 participants in each group. The study was conducted in Rajiv Gandhi government general hospital, Chennai and the data were collected using a Depression Anxiety Stress Scale 21 (DASS21) questionnaire. In experimental group, the researcher assessed the level of depression, anxiety, stress in the pre-test and Onco-mental health programme was given to the breast cancer patients daily for about 40-45mins for 4 weeks and the post-test assessment was done using the same questionnaire, and in control group pre-test and post-test was collected using the same tool without any intervention. The collected data were analyzed using descriptive and inferential statistics
RESULT: The study result shows that of Onco-mental health programme regarding the management of psychosocial problems among breast cancer client’s pre test score of depression (76.67%) anxiety (83.33%) stress (56.67%) and post test score of depression (56.67%) anxiety (10%) stress (13.33%), the mean difference between pre test and post test score was depression (20%) anxiety (73.33%) stress (43.34%) thus breast cancer clients got reduction in depression, anxiety and stress after administration of Onco-mental health programme at (p=0.001).
CONCLUSION: The study concluded that Onco-mental health programmee was effective in reducing the level depression, anxiety, and stress among breast cancer patients during the time of admission for reduces the psychosocial problems and improving the quality of life.
Keywords: Onco-mental health programme, breast cancer, psychosocial problems.
LIST OF CONTENTS Chapter
No Title Page No
I
Introduction
1.1 Background of the study 1.2. Need for the study
1.3. Statement of the problem 1.4. Objectives of the study 1.5. Operational definitions 1.6. Assumption
1.7. Hypothesis 1.8 Delimitation
1.9 Conceptual framework II Review of Literature
2.1 Reviews of related studies
III
Research Methodology 3.1 Research Approach 3.2. Research Design 3.3 Setting of the study 3.4 Duration of the study 3.5 Study population 3.6 Sample
3.7 Sampling size 3.8 Sampling technique 3.9 Research variables
3.10 Criteria for sample selection 3.10.1. (a). Inclusive Criteria 3.10.1. (b). Exclusive Criteria
3.11 Tool for Data Collection
3.11.1. Section A: Socio demographic variables 3.11.2. Section B: Clinical variables
3.11 3. Section C: DASS21 questionnaires 3.12 Content validity
3.13 Ethical Consideration 3.14. Pilot study
3.15 Reliability of the Tool 3.16 Data collection procedure 3.17 Intervention Protocol
3.18 Data entry and Data Analysis IV Data analysis and interpretation
V Discussion
VI Summary, Implication, Recommendation,, Limitation, Conclusion
6.1 Summary of the study 6.2 Implication
6.3 Recommendation 6.4 Limitation
6.5 Conclusion Reference
Appendices
LIST OF TABLES
Table no Title Page no
3.1 Research design
3.2 Schedule for Data Collection
3.3 Intervention protocol for Family Instruction Module 4.1 Distribution of socio demographic variables of
Experimental and Control Group
4.2 Distribution of clinical profile of breast cancer clients 4.3 Comparison of pre test level of depression score 4.4 Comparison of pre test level of anxiety score 4.5 Comparison of pre test level of stress score 4.6 Comparison of post test level of depression score 4.7 Comparison of post test level of anxiety score 4.8 Comparison of post test level of stress score
4.9 Comparison of pre test and post test level of depression score
4.10 Comparison of pre test and post test mean Depression score
4.11 Comparison of pre test and post test level of anxiety score 4.12 Comparison of pre test and post test mean
Anxiety score
4.13 Comparison of pre test and post test level of stress score 4.14 Comparison of pre test and post test mean
Stress score
4.15 Effectiveness of onco-mental health programme and generalization of depression reduction score
4.16 Effectiveness of onco-mental health programme and generalization of anxiety reduction score
4.17 Effectiveness of onco-mental health programme and generalization of stress reduction score
4.18 Association between Post-test level of Depression score and Demographic variables(Experiment)
4.19 Association between the Post-test level of Depression score and Demographic variables (control)
4.20 Association between Post-test level of Anxiety score and Demographic variables(Experiment)
4.21 Association between Post-test level of Anxiety score and Demographic variables (control)
4.22 Association between Post-test level of Stress score and Demographic variables (Experiment)
4.23 Association between Post-test level of Stress score and Demographic variables (control)
4.24 Correlation between Post-test of Depression. Stress and Anxiety score
LIST OF FIGURES
Figure No Title
2.1 Conceptual framework based on Bettyneuman’s model 3.1 Schematic representation of research design
4.1 Age distribution of the breast cancer clients.
4.2 Religion distribution of breast cancer clients
4.3 Marital status of distribution of the breast cancer clients 4.4 Number of children of distribution of the breast cancer clients 4.5 Dietary pattern of distribution of the breast cancer clients 4.6 Educational status of the breast cancer clients
4.7 Occupational status of the breast cancer clients 4.8 Family monthly income of the breast cancer clients 4.9 Type of family of the breast cancer clients
4.10 Area of living of breast cancer clients
4.11 Awareness of breast self examination of breast cancer clients 4.12 Awareness of treatment modalities of breast cancer of clients
4.13 Comparison of pre-test and post-test depression score among experiment group and control group
4.14 Comparison of pre-test and post-test anxiety score among experiment group and control group
4.15 Comparison of pre-test and post-test stress score among experiment group and control group
4.16 Association between the post test level of depression score and survivors age of experimental group
4.17 Association between post test level of depression score and number of children for experimental group
4.18 Association between post test level of depression score and type of family in experimental group
4.19 Association between post test level of anxiety score and survivors number of children in experimental group
4.20 Association between post test level of anxiety score and type of diet pattern in experimental group
4.21 Association between post test level of anxiety score and survivors occupation in experimental group
4.22 Association between post test level of stress score and survivors age in experimental group
4.23 Association between post test level of stress score and number of children in experimenal group
4.24 Association between post test level of stress scoree and type of family in experimental group.
LIST OF APPENDICES
S.NO TITLE
1 Certificate of approval from institutional ethics committee 2 Certificate of content validity by Experts
3 Letter seeking permission to conduct study 4 Tool for data collection Tamil and English 5 Onco-Mental Health programme module 6 Informed consent Tamil and English 7 Certificate for English Editing 8 Certificate for Tamil Editing 9 Certificate of Plagiarism
10 Photos
LIST OF ABBREVIATIONS
Abbreviation Explanation
WHO World Health Organization
NIMH National Institute of Mental Health
NIMHANS National Institute of Mental Health And Neuro Sciences
US United State
BSE Breast Self Examination
S Significance
NS Non significance
H Hypothesis
CI Class intervals
CAM Complementary and Alternative Medicine
QOL Quality of Life
ICD International classification of Disease
DSM Diagnostic and Statistical Manual of Mental Disorder RGGGH Rajiv Gandhi Government General Hospital
1
Chapter –1
Introduction
2 CHAPTER –I INTRODUCTION
"The natural healing force within each one of us is the greatest force in getting well." -Hippocrates
The word cancer still conjures up deep fears of a silent killer that creeps up on us without warning. Cancer is evoking such desperation that it has become a metaphor for grief and pain, a scourge straining our intellectual and emotional resources. The numbers are such that each of us will be touched either as a patient, a family member or a friend. There are over 20 million people living with cancer in the world today. Themajority of clients live in the developing world.Gro Harlem Brundtland (2002)
Recent times have seen an increase in the incidence of cancer. This is mainly attributed to urbanization, industrialization, lifestyle changes, population growth and increased life span. In India, the life expectancy at birth has steadily risen from 45 years in 1971 to 62 years in 1991, indicating a shift in the demographic profile. It is estimated that life expectancy of the Indian population will increase to 70 years by 2021–25. This has caused a paradigm shift in the disease pattern from communicable diseases to non-communicable diseases like cancer, diabetes and hypertension.
Cancer is a class of diseases characterized by out-of-control cell growth. There are over 100 different types of cancer, and each is classified by the type of cell that is initially affected. Cancer harms the body when damaged cells divide uncontrollably to form lumps or masses of tissue called tumours (except in the case of leukaemia where cancer prohibits normal blood function by abnormal cell division in the blood stream).
Tumours can grow and interfere with the digestive, nervous, and circulatory systems and they can release hormones that alter body function. Tumours that stay in one spot and demonstrate limited growth are generally considered to be benign. More dangerous, or malignant, tumours form when two things occur:
Cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells. If the spread is not controlled, it can result in death. Cancer is caused by both external factors (tobacco, infectious organisms, chemicals, and
3
radiation) and internal factors (inherited mutations, hormones, immune conditions, and mutations that occur from metabolism). Every day, our bodies are exposed to cancer-causing agents in the air, food and water. Typically, our immune system recognizes those abnormal cells and kills them before they produce a tumour. There are three important things that can happen to prevent cancer from developing the immune system can prevent the agents from invading in the first place. DNA can repair the abnormal cells or killer T-cells can kill off cancer cells. Research has shown that stress can lower the body’s ability to do each of those things.
Breast cancer is an uncontrolled growth, or malignant tumour of breast cells..
Breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, and fluid coming from the nipple, a newly-inverted nipple, or a red or scaly patch of skin. In those with distant spread of the disease, there may be bone pain, swollen lymph nodes, shortness of breath, or yellow skin.It has been seen as a traumatic experience to women due to its impacts on their self-image and sexual relationship, so most of the breast cancer patients have psychological reactions such as denial, anger, or intense fear toward their disease and treatment process, and many of have psychiatric morbidities. Breast cancer is the most common cancer type among females worldwide, as 1 in 8 women will be diagnosed with the disease in their lifetime. (Christensen and Marck, 2017).
Many of the breast cancer patients experience fatigue, depression, and/or anxiety months to years after their breast cancer diagnosis with these symptoms being associated with greater disability and a poorer quality of life. Depressive disorders may include major depressive disorder, dysthymic disorder, and adjustment disorder with depressive mood and mixed depressive and anxious mood disorders. Other commonly encountered psychiatric disorders in breast cancer patients include anxiety disorders including generalized anxiety disorder, post-traumatic stress syndrome and adjustment disorder with anxious mood. Because of the unique psychosocial, medical and hormonal factors that may influence mood in breast cancer patients, epidemiological and treatment data on depression from other populations cannot be assumed to generalize to this population.
4
Cancer is associated with significant psychological and social morbidity. Many researchers have reported that mental disorders such as depression, anxiety and delirium occur more frequently in cancer patients to warrant a detailed assessment and clinical interventionIqbal A, Syed (2014)One in 4 people with cancer have clinical depression. Clinical depression causes great distress, impairs functioning, and might even make the person with cancer less able to follow their cancer treatment plan.American Cancer Society (2018)
Two hundred fifteen randomly accessed cancer patients who were new admissions to three collaborating cancer centres were examined for the presence of formal psychiatric disorder. Each patient was assessed in a common protocol via a psychiatric interview and standardized psychological tests. The American Psychiatric 3 Association's DSM-III diagnostic system was used in making the diagnoses. Results indicated that 47% of the patients received a DSM-III diagnosis. Approximately 85%
of those patients with a positive psychiatric condition were experiencing a disorder with depression or anxiety as the central symptom. The large majority of conditions were judged to represent highly treatable disorders.Journal of American Medical Association (2019)
During the years 2004-2009, 10,153 consecutive patients were routinely screened with the Psychosocial Screen for Cancer questionnaire at two major cancer centres. Patients' mean age was 59 years and 45% were men. Across cancer types, 59.0% of patients showed clinical levels of anxiety. Further, 52.9% of patients reported clinical symptoms of depression. Analyses reported the highest levels of distress at the time point of cancer diagnosis. As expected, women showed higher rates of anxiety and depression, and for some cancer types the prevalence was two to three times higher than that seen for men. In some cancer types emotional distress was inversely related to age. Patients younger than 50 and women across all cancer types revealed either 4 subclinical or clinical levels of anxiety in over 50% of cases.
Findings describe levels of emotional distress after diagnosis. These results inform
that cancer patients are most likely in need of psychosocial support.
Linden (2014)
5
Depression, anxiety, stress and other forms of psychological morbidity such as adjustment disorders are common in cancer patients. Research from the USA estimates between 35 and 50% of cancer patients are affected by psychological problems. (European Journal of Cancer Care, 2015)
Stress is defined as a real or interpreted threat to the physiological or psychological and behavioural response. It is a bodily or mental tension resulting from factors that tend to alter an existing equilibrium. Stress may be positive or negative. It involves a stressor and a stress response. The National Centre for Complementary and Alternative Medicine supports to reduce stress. It is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine". Complementary approaches that may be used with cancer treatment are acupuncture, art therapy, aroma therapy, bio-feedback, massage, prayer, meditation, music therapy and yoga. Complementary and alternative medicine (CAM) use among cancer patients varies according to geographical area, gender, and disease diagnosis.
The brain is a highly efficient system that is connected to every cell in your body by billions of connections. Positive thought is essential to producing positive results. Negative thoughts and emotions lower the immune system, while positive thought and emotions actually boost the immune system. Our mind has the power and capability to help influence the body in healing is quite astonishing and at times, it seems unbelievable what can happen with this powerful influence. The connection between the mind and physical health has been well recognized and researched. One among the application of those studies is mentioned as the therapeutic Guided Imagery, which will help us to tap into its powerful influence for cancer treatment and recovery. Guided imagery is a proactive way to deal with negative thoughts and feelings. It’s also effective in relieving potential symptoms of depression, such as fatigue, stress, and anxiety. Guided imagery sessions can be brief, which make them easy to incorporate into hectic schedules. Bennet (2018)
6 1.1 BACKGROUND OF THE STUDY
Limited research on psychiatric disorders prevalence among women treated for breast cancer. To explore the prevalence of anxiety and depression in a sample of women treated for breast cancer and to find possible associated factors for these disorders. Breast cancer survivors are the largest group of cancer survivors in the world. Having had a breast cancer diagnosis may adversely affect the patient’s mental health. We aimed to estimate the long-term risk of anxiety and depression in women with history of breast cancer compared to those who have never had cancer
Cancer pervades many dimensions of an individual’s life – demanding a holistic treatment approach. However, studies with combined medical and psychological interventions (MPIs) are sparse. High-level stress and poor quality of life (QOL) can hinder patients’ prognosis. The study thus aimed to analyze the impact of combined medical and psychological (psychoeducation, relaxation technique–
guided imagery, and cognitive therapy) interventions on stress and QOL of cancer patients – head and neck, breast, and lung cancer. Women diagnosed with breast cancer frequently attribute their cancer to psychological stress, but scientific evidence is inconclusive. We investigated whether experienced frequency of stress and adverse life events affect subsequent breast cancer risk.
The prevalence of depression is high during the first year after breast cancer diagnosis, and according to a systematic review by Zainal et al., The three studies with the highest prevalence of depression included patients in their first year after diagnosis. (Maass et al., 2015).One study demonstrated in a very large sample of cancer patients that the prevalence of depression among breast cancer survivors was about 32.8%. It has also been reported that 40% of the patients who experience disease recurrence would suffer from anxiety and depression (Vahdaninia et al., 2019). In 227 advanced breast cancer, Grabsch et al. found a 42% rate of psychiatric disorders and 35.7% of these had depression or anxiety or both. Minor depression was found in 25.6%, major depression in 7% and anxiety disorder in 6.2% (Reich et al., 2008).
7 1.2 NEED FOR THE STUDY
Cancer is a life-threatening disease that often impacts on a patient’s welfare and wellbeing and attention to these issues is thus an important aspect of comprehensive patient care. Cancer is a leading cause of disease worldwide. The World Age- Standardised (AS) incidence rate shows that there are 205 new cancer cases for every 100,000 men in the world, and 165 for every 100,000 females. Ferlay J,Soerjomataram I,Ervik M, et ai (2018)
It is predicted there will be 23.6 million new cancer cases worldwide each year by 2030, if recent trends in incidence of major cancers and population growth are seen globally in the future. This is 68% more cases than in 2012. (Worldwide cancer incidence statistics) Cancerresearchuk.org (2019)
Worldwide, breast cancer is the most-common invasive cancer in women. It affects 1 in 7 (14%) of women worldwide, Breast cancer comprises 22.9% of invasive cancers in women and 16% of all female cancers. In 2017, it comprised 25.2% of cancers diagnosed in women, making it the most-common female cancer. In 2018, breast cancer caused 458,503 deaths worldwide (13.7% of cancer deaths in women and 6.0% of all cancer deaths for men and women together). Lung cancer, the second most-common cause of cancer-related deaths in women, caused 12.8% of cancer deaths in women (18.2% of all cancer deaths for men and women together)
The incidence of breast cancer varies greatly around the world, it is lowest in less- developed countries and greatest in the more-developed countries. In the twelve world regions, the annual age-standardized incidence rates per 100,000 women are as follows: 18 in Eastern Asia, 22 in South Central Asia and sub-Saharan Africa, 26 in South-Eastern Asia, 26, 28 in North Africa and Western Asia, 42 in South and Central America, 42, 49 in Eastern Europe, 56 in Southern Europe, 73 in Northern Europe, 74 in Oceania, 78 in Western Europe, and 90 in North America. Metastatic breast cancer affects between 19% (United States) and 50% (parts of Africa) of women with breast cancer.
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The number of cases worldwide has significantly increased since the 1970s, a phenomenon partly attributed to the modern lifestyles. Breast cancer is strongly related to age with only 5% of all breast cancers occurring in women under 40 years old. There were more than 41,000 newly diagnosed cases of breast cancer registered in England in 2011; around 80% of these cases were in women age 50 or older. Based on U.S. statistics in 2015 there were 2.8 million women affected by breast cancer. In the United States, the age-adjusted incidence of breast cancer per 100,000 women rose from around 102 cases per year in the 1970s to around 141 in the late-1990s, and has since fallen, holding steady around 125 since 2003. However, age-adjusted deaths from breast cancer per 100,000 women only rose slightly from 31.4 in 1975 to 33.2 in 1989 and have since declined steadily to 20.5 in 2014
Breast cancer is the most common cancer type among females worldwide, as 1 in 8 women will be diagnosed with the disease in their lifetime (Christensen and Marck, 2017). The problems experienced by survivors include physical symptoms, psychological reactions and existential concerns, which potentially disrupt their well- being (Würtzen et al., 2018). The overall prevalence of depression in oncology patients remains unclear, and according to previous studies the prevalence is reported to be between 0% and 58%. The wide range of rates may be due to several factors, including: (i) the use of different instruments to assess depression with different psychometric properties, (ii) the use of different criteria for defining depression, and (iii) differences between included cancer populations with respect to cancer type, stage and treatment modality (Krebber et al., 2019). In patients with a prognosis of six months or less, prevalence of depression according to the ICD-10 diagnostic criteria was 22%. Also, studies focusing on psychological distress during the clinical course of the disease showed a significant increase in psychological distress during the last two to three months before death and especially in the last month of life (Fafouti et al., 2010).
A data of cancer patients was compiled from 2004 to 2010 in India. Based on the increasing trends of cancer patients during the last few decades, the numbers of cancer patients have been predicted by the end of 2015 and 2020 in India. These compiled data show that the number of male, female and the total cancer patients in 2004 were 390809, 428545 and 819354 respectively. The number of male and female
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cancer patients increased continuously up to 2009, with 454842, 507990 and 962832 cases for male, female and total cancer patients, respectively. Similarly, 462408 male cancer patients and 517378 female cancer patients were recorded, with a total number of 979786 patients in 2010. Thus, it is clear that the number of cancer cases has increased gradually with time. Imran Ali (2017) Other studies have consistently indicated that these depressive disorders represent common forms of psychological distress experienced by cancer patients (Okamura 2019) and are more common in patients with advanced cancer ( Kugaya 2018). Thus depression is one of the most widely recognized psychiatric disorders in cancer patients (McDaniel 2015). Depression not only produces serious suffering (Block 2014), but also worsens quality of life (Grassi 2016), reduces compliance with anti- cancer treatment (Colleoni 2019), can lead to suicide (Henriksson 2015), is a psychological burden on the family (Cassileth 2019), and prolongs hospitalization (Prieto 2019). Thus, the appropriate management of depression in cancer patients is critically important.
Emotional distress in cancer patients is associated with a reduction in overall quality of life among patients, and has a negative impact on compliance levels with medical treatment, and carries an elevated risk of mortality, so emotional distress is recognized as the sixth vital sign in cancer care. Moreover, patients with cancer and co morbid depression have worse anxiety, pain, fatigue, and functioning than do other patients with cancer, and are more likely to have suicidal thoughts. Despite the effect distress has on daily functioning, distress in cancer patients is often overlooked and under-treated. In patients with breast cancer, the skills and strengths to aid coping and recovery from problems and challenges caused by the disease are associated with multiple variables, which may be evaluated by characteristics related to the patient, stage of the disease and treatment, and environment.
Outcomes for breast cancer vary depending on the cancer type, the extent of disease, and the person's age. The five-year survival rates in England and the United States are between 80 and 90%. In developing countries, five-year survival rates are lower. Worldwide, breast cancer is the leading type of cancer in women, accounting
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for 25% of all cases. In 2018 it resulted in 2 million new cases and 627,000 deaths. It is more common in developed countries and is more than 100 times more common in women than in men.
MENTAL HEALTH NURSING CARE DELIVERY MODEL
ROLE OF PSYCHIATRIC NURSE
Nurse plays a centre role in psychosocial problems such as depression, anxiety and stress care management of breast cancer through family onco-mental health programme. Imparting the knowledge, regarding psychosocial problems and its symptoms and management. Also influences the clients to handle circumstances peacefully and reduction of depression, anxiety and stress by onco-mental health programme. The main core is establishing therapeutic relationship with the client. As the part of multidisciplinary team, the nurse should inculcate the awareness about the consequences of psychosocial problems of breast cancer. The main aim of the nurse should ensure the quality of life of breast cancer client.
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An individual must practice healthy life style like meditation, take it is an easy way, should never get stressed and upset, should modify dietary habits, and should maintain regular exercises. Prevention of 9 mental illness were one of the important goals of mental health nurse. Nurses play an essential role in reducing the psychosocial problems of breast cancer clients by explaining the conditions and to reduce the social stigma.
According to the American Psychiatric Nurses Association (APNA) (2019) Psychiatric nurses are experts in crisis intervention, mental health assessment, medication and therapy, health teaching, teaching home care management, psycho education, counselling and patient assistance. So, investigator felt to reduce depression, anxiety and stress by the intervention of onco-mental health programme to breast cancer survivors and to promote quality of life their well being.
1.3STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of onco-mental health programme on the management of psychosocial problems among breast cancer survivors, at Tertiary care Hospital, Chennai-03”.
1.4 OBJECTIVES OF THE STUDY
1. To assess the pre-test level of psychosocial problem of breast cancer survivors such as anxiety, depression and stress.
2. To assess the post-test level of psychosocial problem of breast cancer survivors after onco-mental health programme.
3. To compare the pre-test level of psychosocial problem with post-test level of psychosocial problems.
4. To associate between socio demographic variables with post- test level of onco- mental health programme.
1.5OPERATIONAL DEFINITIONS ASSESS:
It refers to making a judgment about the amount, number, or value of something.
In this study assess refers to judging the level of depression, anxiety and stress among
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breast cancer clients receiving treatment as determined by Depression, Anxiety and Stress Scale (DASS 21)
EFFECTIVENESS:
It means producing or capable of producing a desired effect.
In this study it refers to the intended change that occurs after Onco-Mental Health programme in the level of depression, anxiety and stress among breast cancer clients receiving treatment as measured by DASS 21 in experimental group.
ONCO-MENTAL HEALTH PROGRAMME:
It refers to a wide variety of techniques, including simple visualization and direct suggestion using imagery, metaphor and storytelling, fantasy exploration and game playing, dream interpretation, drawing, and active imagination where elements of the unconscious are invited to appear as images that can communicate with the conscious mind.
In this study it refers to the technique of visualization and imagination as means of relaxation by listening to verbal commands, to reduce the level of depression, anxiety and stress among 30 breast cancer clients receiving treatment.
PSYCHOSOCIAL PROBLEMS:
In this study it refers to psychosocial dysfunction or psychosocial morbidity, in which lack of development or diverse atrophy of the psychosocial self, often occurring alongside other dysfunction that may be physical, emotional or cognitive in nature.
In this study it refers to depression, anxiety and stress are the psychosocial problems among breast cancer survivors.
DEPRESSION:
It is an alteration in mood that is expressed by feelings of sadness, despair, and pessimism. There is a loss of interest in usual activities, and somatic symptoms may be evident. Changes in appetite and sleep patterns are common.
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In this study it refers to a state of intense sadness and negative attitudes towards one’s present condition evidenced by dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest/involvement, anhedonia and inertia.
ANXIETY:
A diffuse apprehension, that is vague in nature and is associated with feelings of uncertainty and helplessness.
In this study it refers to the anticipation the client has towards his/her diagnosis, prognosis and the treatment evidenced by autonomic arousal, skeletal muscle effects, situational anxiety and subjective experience of anxious affect.
STRESS:
Stress is a state of mental or emotional strain or tension resulting from adverse or demanding circumstances.
In this study it refers to emotional pressure experienced by cancer clients due to adverse circumstances highlighted by levels of non-chronic arousal through difficulty in relaxing, nervous arousal and being easily upset/agitated irritable/over- reacted and impatient.
1.6ASSUMPTIONS:
Cancer patients experience depression, anxiety and stress
Onco-Mental Health programme is effective in reducing the level of depression, anxiety and stress among cancer clients.
1.7HYPOTHESES
• H1: There will be significant difference between pre and post-test level of Onco- Mental health programme on psychosocial problems such as depression, anxiety and stress among breast cancer survivors.
• H2:There will be significant association between post-test level of psychosocial problems of depression, anxiety and stress with selected socio-demographic variables.
14 1.8 DELIMITATIONS:
The proposed study is delimited to
1. Breast Cancer clients between the age group of 20 – 80 years only.
2. The sample size of 60 only.
3. Those who were willing to participate in the study 4. The data collection period is limited to 4 weeks only.
5. Breast Cancer clients receiving treatment at medical and surgical oncology ward at Tertiary care hospitalChennai. 03
1.9 CONCEPTUAL FRAMEWORK BETTY NEUMAN’S SYSTEM MODEL The central components of BettyNeuman system model are:
Whole person
There are physiological, psychological, socio-cultural, developmental and spiritual variables. Each of these variables contributes to the reaction to stressors in each individual.The patient who diagnosed as cancer and on treatment they have psychological distress due to physical symptoms and serious illness, disease prognosis, death.
Stressors
Neuman in 1995 defined stressors as “stimuli that produce tension and have more potential for causing instability”. The system always has to deal with one or the other stressor at any point in time. Here the researcher has identified that the major stressor affecting the individual as a whole was patients who already diagnosed as cancer and on treatment that contributed to the social stigma, fear about physical symptoms, and alter body image due to surgical intervention and prognosis of illness the impact of it within and around the client system.
The normal line of defence
According to Neuman’s theory, it describes a solid circle that that refers to the stability of the individual (Neuman 1995). Any stressor can invade the normal line of defense. In this study the stressors that invaded the normal line of defense can be identified as psychological distress due to incurable disease (Cancer) and physicalsymptom.
15 Flexible line of defence
It is the outer and initial response of an individual towards the stressors which act as a protective buffer that alters over some time. If the individual can maintain a well build a flexible line of defense that can result in the strengthening of his system.
In this study the role of study to acknowledge the depression, stress, anxiety in patients who diagnosed as cancer and on treatment
Lines of resistance
For the study participants were prompt and early screening of depression, anxiety and other psychiatric illness improving the client's health status and to get better prognosis.
Level of interventions
These are actions that help an individual out to regain their state of wellness equilibrium. These interventions have to be provided to patients based on the available resources and the degree of stressor the client experiences. Through the study, the researchers have given Onco-mental health programme improving the cancer patient’s referral quality of life.
Primary prevention
This mode of intervention is carried out when any stressor is identified by the client system. The rectification of these stressors helps to strengthen the line of defense of an individual. The study was focused on identifying depression, stress, anxiety patients who already diagnosed as cancer and on treatment
Secondary prevention
Secondary prevention results when the stressor has already affected the client by breaking the line of defense and the individual has initiated symptoms. It focuses on the early detection of psychological symptoms which was mention early and providing appropriate psychological intervention like Onco-mental health programme.
Tertiary prevention
This mode refers to the adjustment of the client to attain stability through the treatment process. It helps to strengthen the individual’s response to a stressor and to acquire wellness by strengthening the line of defense. Tertiary prevention invariably focusing on bringing back the stable system, after identification of psychological distress and treats the psychological symptoms will reduce the isolation behaviour and good treatment adherence, come back to normal life.
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Chapter -2
Review of Literature
18 CHAPTER -II
REVIEW OF LITERATURE
Review your twice every day in order to be focused onachieving them.
-Les Brown Review of literature is one of the most important steps in the research process. It is an account of what is already known about a particular phenomenon.
Literature review is an account of the previous efforts and achievements of scholars and researchers on a phenomenon. Literature review is the contribution it makes to the new knowledge, insight, and general scholarship of researchers.
The related literature review for the study is divided four parts
A. Review of literature related to depression and anxiety among breast cancer survivors
B. Review of literature related to stress and anxiety among breast cancer survivors
C. Review of literature related to psychosocial problems among breast cancer survivors D. Review of literature related to effectiveness of instructional teaching module on reducePsychosocial problems among breast cancer survivors
A.REVIEW OF LITERATURE RELATED TO DEPRESSION AND ANXIETY AMONG BREAST CANCER SURVIVORS
Helena Carreira et al. (2019) conducted a cohort study, Risk of anxiety and depression in breast cancer survivors compared to women who have never had cancer in the United Kingdom. Conducted with 59,972 women (mean 62 years; standard deviation (SD) 14.0) had history of breast cancer. The study revealed that the incidence of anxiety in breast cancer survivors was 0.08 (95% confidence interval (95%) 0.07- 0.08) per 1000 person-years, and the incidence of depression was 70 (95%CI 68-71) per 1000 person-years.
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Hassan Ahmadi Gharaei et al. (2019) conducted a Meta-analysis of the prevalence of depression among breast cancer survivors in Iran: an urgent need for community supportive care programs, total sample size of the studies contained 2,799 women with BC, including 1,228 women who were diagnosed with depression. The prevalence of depression ranged from 14.00% (95% CI, 4.91 to 23.09) to 95.90%
(95% CI, 91.97 to 99.83).findings indicate a high prevalence of depression among BC patients.
Martha Carolina Valderrama Rios et al.(2018) conducted a study Anxiety and depression disorders in relation to the quality of life of breast cancer patients with locally advanced or disseminated stage, 107 women histologically confirmed to have breast cancer, in stages IIB, IIIA, IIIB, IIIC and IV. Factor analysis and multidimensional scaling methods were used to analyse patterns of association. Study showing proximity between depressive symptoms and physical symptoms, as well.
Azat Jafari et al.(2018) conducted a systemic review of cross-sectional studies in Iran of the 160 publications. Age of women with breast cancer in selected studies ranged from 43.8 (SD = 47.1) to 55.9 (SD = 14.6) years. Duration of cancer in most studies was about 1-2 years. In most studies, mild levels of depression for women with breast cancer were present. However, in one study it was stated that 69.4% of participants had serious levels of depression with breastcancer
Konstantinos Tsaras et al. (2018) conducted a descriptive cross sectional study Assessment of Depression and Anxiety in Breast Cancer Patients: This done with 152 breast cancer patients who were attending an outpatient oncology department was recruited. Data were collected with a structured questionnaire. Breast cancer patients are in high risk for developing psychiatric disorders such as depression and anxiety.
Debasweta Purkayasthaet al. (2017) conducted a study among breast cancer patient.
Study group age was 53 to 56 years. Among 270 patients 21.5% with depression, 22%
had moderately severe to severe depression. Quality of life is analyzed reported their overall QOL was “poor” and 34 patients reported to be dissatisfied with their health.
Study result was an association between depression and QOL.
Hanan Yusif Aly et al. (2017) conducted a interview study of Depression and Anxiety among Females with Breast Cancer in Sohag University: A cross-sectional observational survey conducted through an interview total of 96 women with a mean age of 49.16 years old were included in our survey. More than half (53.13%) had an
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advanced stage; the majority (95.83%) had breast surgery; 97.92% received systemic chemotherapy; more than half (54.17%) received breast radiation and 53.13% were omitted from hormonal treatment while 46.87% got it. Fifty-nine patients (61.46%) were disease-free and 26.04% had progressive disease on conducting the study. Nearly half of them reported depression, anxiety, or both (46.87%, 49.96% and 32.29%, respectively). One-third reported an advanced degree of depression, anxiety or both (33.34%; 33.33%, and 32.29%, respectively). As regards associations; patients with progressive/relapse disease have higher anxiety and depression with sustained statistically significant relationship in univariate and multiple regression analyses (p- value = 0.03 and 0.04, respectively); while hormonal treatment has a statistically significant positive impact on anxiety alone (p-value 0.02).
Sutanay Bhattacharya et al. (2017) conducted a cross sectional descriptive study of Depression in cancer patients undergoing chemotherapy in a tertiary care hospital of North Bengal, India, Out of 174 cancer patients, 97 (55.7%) were found to be depressed. Depression was comparatively higher in patients ≥50 years; in males; those belonging to religion other than Hindus; who received higher education; had monthly family income ≥5000 rupees and were involved in moderate or heavy work. Nearly 70.6% of blood cancer patients; 64.3% of those who had been receiving chemotherapy for ≥6 months and 56.9% of those in their 4th or less cycle of chemotherapy were found to be depressed.
Anish Khalil et al. (2016) conducted a Cross-Sectional study Prevalence of Depression and Anxiety among Cancer Patients, conducted in tertiary care hospital, oncology department, 300 patients were interviewed result showed that 146 (48.7%) patients were suffering from anxiety and depression. Patients are with anxiety and depression, the following factors were found out to be significant with associated value< 0.05. The prevalence of anxiety and depression amongst the cancer patients was high and education remained an important significant factor for it.
Vivek Srivastava et al. (2016) conducted a prospective study, Prevalence of anxiety and depression among the breast cancer patients, in general surgery department with 200 patients at Varanasi. This Study clearly shows that younger age group, low monthly income, having less financial support, low education level and being single were associated with anxiety and depression. For managing breast cancer patients more care
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or support should be given to this type of patients as they are at high risk of anxiety and depression.
B. LITERATURE ABOUT STRESS AMONG BREAST CANCER
Maedeh Rezaei et al.(2019) conducted a study on Stress Management in Patients with Breast Cancer Using a Supportive Approach: A systematic Review, All the included studies had an interventional design focusing on stress management approaches and their related covariates in women with BC. The findings were assessed regarding two interventions and duration of interventions session, study result showed that 6 were about mindfulness, 2 about relaxation, and 7 about stress-related cognitive-behavioral therapy were reduce the stress among breast cancer clients.
Ottlingam Somasundaram Ravindran et al.(2019) conducted a study of A comparative study on perceived stress, coping, quality of life, and hopelessness between cancer patients and survivors. Author Used purposive sampling technique, this study was conducted in the Medical Oncology Department of a multi-specialty tertiary care teaching hospital. Thirty participants (15 cancer patients and 15 cancer survivors) in the age range of 30–60 years were assessed by the Perceived Stress Scale, Coping Checklist, Quality of Life-Cancer, and Beck.
Prasad Vijay Barre et al.(2018)conducted a study on Stress and Quality of Life in Cancer Patients: Medical and Psychological Intervention, at cancer hospitals employing one-group pre-test-post-test-preexperimental design. It has high impact in reducing stress and psychosomatic complaints. This study concluded that combined MPI has a positive impact on decreasing stress and improving QoL in cancer patients, which can further enhance their prognosis.
Minouk J. Schoemaker et al. (2016) conducted a study on Psychological stress, adverse life events and breast cancer incidence: a cohort investigation in 106,000 women in the United Kingdom There was no association of breast cancer risk overall with experienced frequency of stress. Risk was reduced for death of a close relative during the 5 years preceding study entry (RR = 0.87, 95 % confidence interval (CI):
0.78–0.97), but not for death of a spouse/partner or close friend, personal illness/injury, or divorce/separation. There was a positive association of divorce with oestrogen- receptor-negative (RR = 1.54, 95 % CI: 1.01–2.34), but not with oestrogen-receptor-
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positive breast cancer. Risk was raised in women who were under age 20 at the death of their mother (RR = 1.31, 95 % CI: 1.02–1.67), but not of their father, and the effect was attenuated after excluding mothers with breast or ovarian cancer (RR = 1.17, 95 % CI:
0.85–1.6)
Negin Maleknia et al.(2015) conducted a study on The Relationship between Stress Coping Styles and Quality of Lifeamong Patients with Breast Cancer, in kerman, Iran descriptive correlational study was conducted on 50 patients with breast cancer, convenience sampling technique, used stress coping scale and EORTC Quality of Life Questionnaire, study results showed a significant positive relationship between problem-focused coping strategies and two dimensions of QOL
C. LITERATURE ON PSYCHOSOCIAL PROBLEMS AMONG BREAST CANCER SURVIVORS
Harper G. Hubbeling et al. (2018) conducted a study on Psychosocial needs of young breast cancer survivors in Mexico City, Mexico, qualitative study, 25 women participated, aged 40years, 30–60 minute semi-structured audio-recorded interviews done. Early interventions given on fertility loss education, access to reconstructive surgery and body image support, guidance to return-to-work, assistance with childcare, integration of psychological care,. Study results that psychological and social distress for young breast cancer survivors, comprehensive supportive care integrating early palliative and psychosocial interventions to prevent complications later in survivorship.
Silviaschmid et al (2017) conducted a study on Psychosocial problems and needs of posttreatment patients with breast cancer and their relatives, Seventy-two patients (n = 72) participated with a relative in a cross-sectional mail-survey, 1–22 months after cancer treatment. Continued assessment of the patients’ and their relatives’ needs and of the patients’ symptoms provide the basis for purposeful counselling and education.
Filiz İzciet al. (2016) conducted a study onPsychiatric Symptoms and Psychosocial Problems in Patients with Breast Cancer, study revealed that prevalence of psychological disorders in patients with cancer range from 29% to 47%. And also observed that 20–45% of the patients continued to have a psychiatric disorder 1 year after the mastectomy, review on this issue reported that 10–25% of patients with cancer were diagnosed with major depressive disorders.
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Errol J.Philip et al. (2016) conducted a study onPsychosocial Issues in Post-treatment Cancer Survivors: 317 cancer survivors with mixed diagnosis assessed with psychosocial issues checklist and quality of life, results that average 1.7 psychosocial issuesand reported significant impairment in adjustment and quality of life. This study is important in guiding the development of effective survivorship care and adjustment and care needs of survivors.
Lohsy et al. (2015)conducted a study on breast cancer at University Malaya Medical Centre, among147 women were examined the relationship between depression, anxiety and stress before and after a patients self management intervention in a cohort of women diagnosed with breast cancer. Depression, Anxiety and Stress Scale (DASS 21) was used for the study. The study findings revealed a mean score of 12.67 for stress, 9.13 for anxiety and 9.28 for Mohamed Torkaman et al.(2014)conducted an experimental study was among 30 women diagnosed with breast cancer in Mahdiyeh Medical Diagnostic Centre in Hamedan, Iran, to study the effectiveness of supportive Group Psychotherapy for Depression, Anxiety and Stress. The Depression, Anxiety and Stress Scale (DASS 42) was used for the study. Study revealed that pre test mean scores for depression, anxiety and stress were 19.2 ± 9.22, 19.28 ± 6.54, 26 ± 7.31 respectively.
D. LITERATURE FOR INTERVENTION TO REDUCE PSYCHOSOCIAL PROBLEMS
R.Widiasihet al. (2019) conducted a study on literature review of Psychosocial Interventions for Improving the Quality of Life in Breast Cancer Survivors: 543 articles were identified and after manual review, 7 studies were identified and appraised.
Results, there were six randomized control trial and one quasi-experiment method involved in the analysis step. The interventions were mindfulness therapy, behavioural therapy, acceptance and commitment therapy were significant effects in reducing psychological problems such as anxiety, depression, and mood problems also improved patients' QOL.
Elham Taeidi et al. (2018) conducted a study on The Effect of Problem Solving Therapy on Breast Cancer Women, 34 women selected by convenience sampling technique, problem solving therapy given, results of intervention group in pretest, posttest and follow-up study was 40.00 ± 4.18, 76.11 ± 2.54, and 77.05 ± 2.10,
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respectively. Therefore, problem solving therapy improves the psychological wellbeing of the patients (P < 0.05).
Nancy E Avis et al. (2018) conducted a study on Psychosocial problems among younger women with breast cancer, A cross‐sectional survey of 204 women diagnosed with breast cancer at age 50 or younger within the past 3.5 years was conducted to examine issues particularly faced by younger women. The questionnaire included standardized measures of problems related to breast cancer (CARES) and open‐ended questions asking women about their experiences, result showed that women facing psychosocial problems since their diagnosis.
Charlotte Grégoire et al. (2017) conducted a study on Group interventions to reduce emotional distress and fatigue in breast cancer patients: 123 patients were participated.
Mind–body interventions given, Emotional distress, fatigue, and sleep quality were assessed before (T0) and after interventions (T1), and at 3-month (T2) and 9-month follow-ups (T3). The results showed that mind–body interventions improve the well- being of breast cancer patients
Di We et al. (2016) conducted a study on Effectiveness of Physical, Psychological, Social, and Spiritual Intervention in Breast Cancer Survivors: An Integrative Review An integrated intervention provides an expanded view of care that not only focuses on the alleviation of physical and psychological symptoms but also integrates existential distress and spiritual needs of patients as well. Study reveals that
psychological, social, and spiritual intervention for breast cancer survivors can positively influence the physical, emotional, functional, and social/family well-being of breast cancer survivors.
Yaowarat Matchim et al. (2016) conducted a study on Effects of Mindfulness-Based Stress Reduction (MBSR) on Health among Breast Cancer Survivors A quasi- experimental, pre-and posttest control group design was selected intervention MBSR given. Study reveals that significant improvement in physiological and psychological outcomes including reduced blood pressure, heart rate, and respiratory rate and increased mindfulness state at the level of p = .05 to p = .001 and reducing mood disturbance.
Sahar Mohabbai et al. (2015) conducted study on Effectiveness of Group Training Based on Acceptance and Commitment Therapy on Anxiety and Depression of Women with Breast Cancer, quasi-experimental study, 30 patients with breast cancer were
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selected by convenience sampling method and randomly assigned, group training given, Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BHI-II) tool used, study reveals that anxiety and depression significantly decreased (p<0/05). Anxiety and depression before the experiment were 37.1 and 45.4, after the experiment they decreased to 28.8 and 36 respectively.
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Chapter- 3
Methodology
27 CHAPTER III
RESEARCH METHODOLOGY
“We must revisit the idea that science is a methodology and not ontology”
-DeepakChopra
Research Methodology is a way to find out the result of a given problem on a specific matter or problem that is also referred as research problem. In Methodology, researcher uses different criteria for solving/ searching the given research problem.
Different sources use different type of methods for solving the problem. Ifwe think about the word “Methodology”, it is the way of searching or solving the research problem
(Industrial Research Institute, 2010)
The methodology is the theoretical, systematic and the analysis of the methods, which is applied in the field of research. It indicates the process of organizing the data collection procedure for gathering valid and reliable data for investigation. This chapter provides a brief description of the method adopted by the investigator in this study. It includes the research design, setting of the study, population, sample, and sample size, sampling technique, description of the tool, pilot study, data collection procedure and plan for data analysis.
3.1 RESEARCH APPROACH
The research approach selected to accomplish the objectives of the study was Quantitative research approach. Since the purpose of the study was to find out the effectiveness of specific psychiatric nursing intervention on management of psychosocial problems among breast cancer survivor, Quantitative research approach was considered to be most appropriate.
3.2 RESEARCH DESIGN
A research design are invented to enable the researcher to answer research questions as validly, objectively, accurately and economically as possible.(Polit and Beck 2005)
The research design selected for this study was “Quasi Experimental Research Design” used to assess the onco-mental health programme on the management of psychosocial problems among breast cancer survivors.
