Calver, Louise
(2018)
How patients adjust psychologically to the experience of head and neck cancer: a grounded theory.
DClinPsy thesis, University of Nottingham.
Abstract
Introduction: Head and neck cancer presents unique challenges to patients due to its effects on vital human functions and its potential for facial disfigurement. Literature discussing the associated psychosocial difficulties is growing However, there is currently limited understanding about how patients may adjust to the physical, functional, and psychological effects experienced as a result of head and neck cancer and its treatment. Existing adjustment theories have not been grounded in patient data and often minimise the roles of emotions and other people.
Objectives: The study aimed to explore how patients with head and neck cancer adjust psychologically to their experiences, and the specific processes involved in this adjustment. The study also aimed to generate a theoretical model, grounded in patient data, to serve as a framework for informing psychological intervention.
Method: Twelve participants with diagnoses of head and neck cancer (past or present) engaged in a semi-structured interview, conducted individually. Data were transcribed verbatim and analysed using grounded theory, undertaken from a critical realist epistemology.
Results: Participants described adjustment as an ongoing, fluctuating, all-encompassing process which spanned years following cancer treatment. The core process involved participants modifying their relationship with the changes brought about by cancer, from battling against them to learning to live alongside them. Encompassed within this core process were eleven further processes which included “survive mode”, “instrumental support from others”, “making a choice”, “developing own understanding”, “acceptance”, “talking with others”, “making changes”, “redefining or regaining normality”, “barriers to progress”, “managing emotions and distressing thoughts”, and “putting things into perspective”.
Discussion: Some problems encountered by head and neck cancer patients may be unique, however, the processes participants engaged in to adjust may be similar across other cancer types and chronic illness. These processes were linked to existing theories and literature. Clinical implications include the consideration of the global impact of head and neck cancer, since all aspects of life must be adjusted. Therefore future psychological interventions must recognise this and consider patients holistically and not focus purely on direct effects of cancer. There are also a number of research implications which include the need for additional exploration into information needs of head and neck cancer patients, exploration of the change processes associated with ‘acceptance’, the need for family and carer support, and use of longitudinal designs to track changes in adjustment over time.
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