Kanser hastalarında stres ve başetme yolları
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Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İstanbul Bilgi Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
ÖZET: Kanser hastalığı; kronik hastalıklar içinde en önemlilerinden biri olup, bu hastalar çeşitli yöntemler kullanılarak tanı alırlar. Bu tanı hastalarda stres yaratan travmatik olaylardan biridir çünkü kişinin yaşamsal bütünlüğünü tehdit eden/bozan olaylardır. Bu tanıyı alan kişiler ölümcül bir hastalıkla karşı karşıya kaldıklarından, travmatize olabilmektedir. Bu hastalığa verilen stres tepkilerinin bir kısmı, uyum sağlama ve başetme amaçlıdır. Öyle ki, kişiler bu yeni sürece uyum sağlayamazsa fiziksel ve ruhsal dengesi ve yaşamındaki değişikliklere adaptasyonu bozulabilir. Tanı sonrası stres tepkileri, yoğun korku, çaresizlik ya da dehşet öğelerini barındırabilir. Hastanın bu strese yüklediği anlam, başetme kaynaklarının neler olduğu ve işlevselliği, kendisine uygun sosyal destek kaynakları ve ulaşılabilirliği ile yeniden şekillenmekte, yaşanan deneyim bu yeni stresli durumda olumlu ya da olumsuz başetme yöntemlerini kullanmasını sağlamaktadır. Başetme tutumlarında kişisel farklılıklar ve hastaların güçlü ve güçsüz yönlerinin stres düzeyine etkileri bilindiğinden, kesitsel tipteki bu araştırmada, kanser tanısı alan hastaların travmatik stres düzeylerini çeşitli değişkenler (yaş, cinsiyet, medeni durum, hastalık öyküsü vb.) açısından değerlendirmek, travmatik stres ile nasıl başettiklerini ve hangi başetme yöntemlerini kullandıklarını saptamak amaçlanmıştır. Çalışmanın örneklemini İstanbul Beylikdüzü Medicana International Hastanesi’nde tedavi ve takipleri yürütülen kanser hastaları oluşturmuştur. Çalışmaya başlarken 80 kişiye ulaşmak hedeflenmiştir, ancak 71 kişi ile çalışma tamamlanmıştır. Katılımcılarda, son beş yıl içinde herhangi bir kanser tanısı almış olmak, son beş yıl içinde herhangi bir kanser tanısı sonucu radyoterapi/kemoterapi ve/veya cerrahi tedavi yöntemlerini almış/alıyor olmak, en az 18 yaşında olmak, çalışmaya katılmaya gönüllü olmak şartları aranmıştır. Katılımcıların sosyo-demografik verileri değerlendirildiğinde; 34’ünün (%47,9) erkek, 37’sinin (%52,1) kadın olduğu görülmektedir. Erkeklerin yaş ortalaması 56,9, kadınların yaş ortalaması 53,7’dir. 51 kişinin (%71,8) sosyal güvencesinin SGK olduğu, 48 kişinin (%67,6) tedavi süresince şehir merkezinde ikamet ettiği, 68 kişinin (%95,8) 1. derece yakınlarında kaldığı, 50 kişinin (%70,4) çalışmadığı, 61 kişinin (%85,9) ilk kez kanser tanısı aldığı, bu tanıyı 49 kişinin (%69) 2018-2019 tarihlerinde aldığı, 45 (%63,4) kişide metastaz olmadığı geçmişte 57 kişinin (%80,3) ameliyat olduğu, en çok kalp/damar/solunum sistemi hastalıklarının (N=20, %28,2) görüldüğü belirlenmiştir. En sık olarak; doğal afeti (N=46; %64,8), yakın bir kişinin ani, beklenmedik ölümünü (N=38; %53,5), ulaşım ile ilgili kazayı (N=17; %23,9) deneyimledikleri görülmektedir. İnsan kaynaklı şiddetli acı (N=1; %1,4) ve tutsaklık (N=1; %1,4) ise en az maruz kaldıkları travmatik yaşam olaylarıdır. Çalışmada anlamlı olarak, Katılımcılardan 2018 Ocak öncesi kanser tanısı alanlar (N=22, M=43,77) ve ikinci ve daha fazla kez kanser tanısı alanların (N=10, M=48,20) Travmatik Stres Belirti Ölçeği (TSBÖ)’den anlamlı bir şekilde yüksek puan aldıkları bulunmuştur (p<0.05). Araştırma bulguları, birden çok kanser tanısı almanın ve 1 yıldan fazla süredir kanser tanısı olmanın, hastaların Travmatik Stres Belirti Ölçeği (TSBÖ)’den aldığı puan ortalamasının daha yüksek olduğunu göstermesi nedeniyle, hastalık öyküsü alırken, bu değişken açısından hastaların değerlendirilmesinin önemli olduğu düşünülmektedir. Bu bulgulardan yola çıkarak hastalara, kanser tanısı almanın yarattığı travmatik stres ile baş edebilmesi için psikososyal destek ve eğitim verilebilir. Ayrıca bulgular, hastalık öyküsünde, ameliyat ya da müdahale geçirenlerin yaşam olayları kontrol listesi ortalamasının (N=57, M=38,82) anlamlı ve daha yüksek olduğunu ve başetme tutumları puanının ise anlamlı ve daha düşük (N=57, M=33,55) olduğunu göstermiştir. Bu durum açıklanmaya muhtaç olduğundan, daha derinlikli ve retrospektif/prospektif bir araştırma yapılabilir. Çalışmamız örneklem ve çalışma metodu açısından tanımlayıcı bir çalışmadır. Bu bulguların açıklanması için kanser hastalarıyla yürütülecek prospektif çalışmalar yapılmasının gerekliliğini ortaya koymaktadır. Çalışmada anlamlı olmasa da, kadınların Yaşam Olayları Kontrol Listesi (YOKL) ve Başetme Tutumları Ölçeği (COPE)’dan aldığı puan ortalamasının erkeklerin ortalamasından daha yüksek, travmatik stres toplam puanının düşük olduğu bulgulanmıştır. Cinsiyet ile ilgili bulgularda kadın ve erkekler açısından anlamlı farklar olmayışı da, yine ayrı bir araştırma için konu olabilecek niteliktedir. Başetme tutumlarının alt ölçeklerinden elde edilen anlamlı bulgular ile hazırlanacak yapılandırılmış bir form ile hastalara sağlık profesyonelleri ile güçlendirme programları uygulanabilir.
ABSTRACT: Cancer disease, being one of the most important chronic diseases, these patients get diagnosed by using various methods. This diagnosis is one of the traumatic events that stresses patients because it is one of the events that threatens/disrupts a person’s vital integrity. The patients who are diagnosed might be traumatized since they are faced with a life-threatening disease. Some part of the stress reactions given to this disease are aimed to adapt and cope. Such that, if people cannot adapt to this new period, then his/her physical and mental balance and adaptation to changes in his/her life can be disrupted. The reactions after the diagnosis may include the elements of intense fear, helplessness or dread. The meaning patient attributes to this stress, re-shapes according to what are the resources of coping and their functionality, social support resources that are appropriate for the person and their accessibility; experienced event ensures the use of positive or negative coping strategies in the new stressful situation. Since the effects of personal differences and patient’s strengths and weaknesses on the coping sattitudes are known, the aim of this cross-sectional study is to evaluate the traumatic stress levels of the patients diagnosed with cancer in regards to various variables (age, gender, marital status, medical history), detect how they cope with traumatic stress and which coping strategies they use. The sample of this study is consisted of cancer patients who are under treatment and follow-up care in İstanbul Beylikdüzü Medicana International Hospital. At the start of the study, the aim was to reach 80 participants however, the study was completed with 71 participants. The eligibility criteria to include participants were being diagnosed with any kind of cancer in the last five years, receiving/have received radiotherapy/chemotherapy and/or surgical therapy treatments as the result of a diagnosis with any kind of cancer in the last five years, being at least 18 years old, volunteering to participate in the study. When the socio-demographic data of the participants were evaluated, it was seen that 34 of them (47,9%) were men, 37 of them (52,1%) were women. The average age of the men was 56,9, the average age of women was 53,7. It was found that the social insurance of 51 of individuals (71,8%) was SGK, 48 individuals (67,6%) resided in the city center during the treatment process, 68 individuals (95,8%) accommodated with their first degree relatives, 50 individuals (70,4%) were not employed, 61 individuals (85,9%) were diagnosed with cancer for the first time, 49 individuals (69%) received diagnosis between 2018-2019, 45 individuals (63,4%) had cancers which have not metastasized, 57 individuals (80,3%) had a surgery in the past, the most common diseases were cardiovascular/respiratory diseases (N=20, 28,2%). It was found that they most frequently experienced natural disasters (N=46, 64,8%), sudden, unexpected death of a close person (N=38, 53,5%), accidents related to transportation (N=17, 23,9%). Human-made intense pain (N=1, 1,4%) and captivity (N=1, 1,4%) were the events that they experienced the least. It was found that the participants who received a diagnosis of cancer before January 2018 (N=22, M=43,77) and the ones who received the diagnoses for the second time or more (N=10, M=48,20) got a significantly higher score from the Traumatic Stress Symptom Checklist (TSSC) (p<0.05). Because the research results showed that receiving cancer diagnosis more than once and having a cancer diagnosis for more than a year increases the mean score of cancer patients got from the Traumatic Stress Symptom Checklist (TSSC), it is considered to be important to evaluate the patients from the perspective of this variable when taking the medical history. Based on these results, psycho-social services and education can be given to patients so that they can manage with the traumatic stress of receiving a cancer diagnosis. In addition, the results showed that the mean of the Life Events Checklist (LEC) scores of the ones who had a surgery or an intervention in their medical history (N=57, M=38,83) were significant and higher and the mean of their assessment scale for coping attitudes (COPE) scores (N=57, M=33,55) were significant and lower. Since this situation is need of an explanation, a more in depth and retrospective/prospective research can be conducted. Our study is a defining study in terms of its sample and research method. It put forwards that, for these results to be explained, there is a necessity for prospective studies that will be conducted with cancer patients. In the study, it was found that the women’s mean scores of Life Events Checklist (LEC) and assessment scale for coping attitudes (COPE) were higher than men’s mean scores and their total traumatic stress score were lower, although not significant. The results related with gender not being significant have the quality to be a topic of another research. Strengthening programs through health professionals can be applied to patients via the preparation of a structured form, that will be prepared with the significant results of the subscales of the coping strategies.
ABSTRACT: Cancer disease, being one of the most important chronic diseases, these patients get diagnosed by using various methods. This diagnosis is one of the traumatic events that stresses patients because it is one of the events that threatens/disrupts a person’s vital integrity. The patients who are diagnosed might be traumatized since they are faced with a life-threatening disease. Some part of the stress reactions given to this disease are aimed to adapt and cope. Such that, if people cannot adapt to this new period, then his/her physical and mental balance and adaptation to changes in his/her life can be disrupted. The reactions after the diagnosis may include the elements of intense fear, helplessness or dread. The meaning patient attributes to this stress, re-shapes according to what are the resources of coping and their functionality, social support resources that are appropriate for the person and their accessibility; experienced event ensures the use of positive or negative coping strategies in the new stressful situation. Since the effects of personal differences and patient’s strengths and weaknesses on the coping sattitudes are known, the aim of this cross-sectional study is to evaluate the traumatic stress levels of the patients diagnosed with cancer in regards to various variables (age, gender, marital status, medical history), detect how they cope with traumatic stress and which coping strategies they use. The sample of this study is consisted of cancer patients who are under treatment and follow-up care in İstanbul Beylikdüzü Medicana International Hospital. At the start of the study, the aim was to reach 80 participants however, the study was completed with 71 participants. The eligibility criteria to include participants were being diagnosed with any kind of cancer in the last five years, receiving/have received radiotherapy/chemotherapy and/or surgical therapy treatments as the result of a diagnosis with any kind of cancer in the last five years, being at least 18 years old, volunteering to participate in the study. When the socio-demographic data of the participants were evaluated, it was seen that 34 of them (47,9%) were men, 37 of them (52,1%) were women. The average age of the men was 56,9, the average age of women was 53,7. It was found that the social insurance of 51 of individuals (71,8%) was SGK, 48 individuals (67,6%) resided in the city center during the treatment process, 68 individuals (95,8%) accommodated with their first degree relatives, 50 individuals (70,4%) were not employed, 61 individuals (85,9%) were diagnosed with cancer for the first time, 49 individuals (69%) received diagnosis between 2018-2019, 45 individuals (63,4%) had cancers which have not metastasized, 57 individuals (80,3%) had a surgery in the past, the most common diseases were cardiovascular/respiratory diseases (N=20, 28,2%). It was found that they most frequently experienced natural disasters (N=46, 64,8%), sudden, unexpected death of a close person (N=38, 53,5%), accidents related to transportation (N=17, 23,9%). Human-made intense pain (N=1, 1,4%) and captivity (N=1, 1,4%) were the events that they experienced the least. It was found that the participants who received a diagnosis of cancer before January 2018 (N=22, M=43,77) and the ones who received the diagnoses for the second time or more (N=10, M=48,20) got a significantly higher score from the Traumatic Stress Symptom Checklist (TSSC) (p<0.05). Because the research results showed that receiving cancer diagnosis more than once and having a cancer diagnosis for more than a year increases the mean score of cancer patients got from the Traumatic Stress Symptom Checklist (TSSC), it is considered to be important to evaluate the patients from the perspective of this variable when taking the medical history. Based on these results, psycho-social services and education can be given to patients so that they can manage with the traumatic stress of receiving a cancer diagnosis. In addition, the results showed that the mean of the Life Events Checklist (LEC) scores of the ones who had a surgery or an intervention in their medical history (N=57, M=38,83) were significant and higher and the mean of their assessment scale for coping attitudes (COPE) scores (N=57, M=33,55) were significant and lower. Since this situation is need of an explanation, a more in depth and retrospective/prospective research can be conducted. Our study is a defining study in terms of its sample and research method. It put forwards that, for these results to be explained, there is a necessity for prospective studies that will be conducted with cancer patients. In the study, it was found that the women’s mean scores of Life Events Checklist (LEC) and assessment scale for coping attitudes (COPE) were higher than men’s mean scores and their total traumatic stress score were lower, although not significant. The results related with gender not being significant have the quality to be a topic of another research. Strengthening programs through health professionals can be applied to patients via the preparation of a structured form, that will be prepared with the significant results of the subscales of the coping strategies.
Açıklama
Anahtar Kelimeler
Chronic diseases, cancer, traumatic stress, coping strategies, Kronik hastalıklar, kanser, travmatik stres, başetme tutumları