1

COPING BEHAVIOR IN PATIENTS WITH BREAST CANCER:

A QUANTITATIVE AND QUALITATIVE STUDY

MsC CandidateNOOR HAYATI BT JAFAR

Supervisor

DR. NORUL BADRIAH HASSAN

Co-SupervisorDR. ZAHARAH SULAIMAN

2

INTRODUCTION

PROBLEM STATEMENT

OBJECTIVE AND HYPOTHESIS

SIGNIFICANT OF THE STUDY

METHODOLOGY

EXPECTED RESULT

REFERENCES

OUTLINE

3

INTRODUCTION

• Breast cancer - defined as a cancer that affects breast tissue (National Cancer Institute, 2014).

• Several types of breast & most common is ductal carcinoma that begins in the lining of the milk ducts.

• Another type of breast cancer is lobular carcinoma that begins in the lobules of the breast (NCI, 2014)

4

• Patients with breast cancer face many challenges which include:– coming to terms with the diagnosis– managing treatment regimens– dealing with the side effects of treatment– conducting self-care and rehabilitation

(Aziz, 2002; Rowland et al., 2006; Jones, 2008)

• Many qualitative studies (Taleghani et al., 2006; Khalili et al., 2013) explore on how patients with breast cancer cope with their problems.

INTRODUCTION

5

• However, these studies were focused on:– patients' views of routine hospital follow-up (Adewuyi-Dalton et al.,

1998), – use of alternative medicine (Adler and Fosket, 1999), – attitudes and experience on genetic testing (Zilliacus et al., 2012), – mindfulness-based stress reduction (Weitz et al., 2012), – positive changes (Tsuchiya et al., 2012), – return to work (Tamminga et al., 2012; Tiedtke et al., 2012), – men's sexual issues after breast cancer in their wives (Nasiri et al.,

2012),– physical activity and exercise (Sander et al., 2012), – physician Behaviors (Pass et al., 2012).

• No study explore the overall problems with breast cancer and how patients cope with their problems.

INTRODUCTION

6

PROBLEM STATEMENT

• Limited studies on patients’ perception about breast cancer, especially in Malaysia.

• Only one study on cervical cancer has been performed in Malaysia (Wong et al., 2009). – identified cervical cancer as a horrible disease and

one that often incurred tremendous stress, emotions and physical suffering on both the patients and family members.

7

PROBLEM STATEMENT

• Appropriate coping behaviour strategy is important when dealing with breast cancer especially during treatment period such chemotherapy, radiotherapy and surgery (Saniah AR, 2010)

• However, problems before, during and after diagnosis in patients with breast cancer has not been explored.

• Therefore, the problems and coping mechanism in patients with breast cancer should be identified and effective preventive measures can be implemented.

8

OBJECTIVE

• To explore perceptions, problems and coping behaviour and to develop Health Education Module for patients with breast cancer.

GENERAL

9

OBJECTIVES

• To explore patient’s perception about breast cancer.

• To explore problems before, during and after diagnosis in patients with breast cancer.

• To study coping behavior before, during and after diagnosis in patients with breast cancer.

• To develop Health Education Module for patients with breast cancer.

SPECIFIC

10

HYPOTHESIS

• There are negative perceptions about cancer among breast cancer patients [such as….

• Emotional problem is the main problem among breast cancer patients after being diagnosed with breast cancer.

• Women with breast cancer use religious approach for coping with cancer problems.

11

SIGNIFICANT OF STUDY

Researchers and health practitioners: • very important to obtain detailed data or

information on breast cancer problems and how they cope with their problems to:– improve management– enhance more research

Patients may also benefit from this study:– improved patient care – new education module will help in patient counselling.

12

METHODOLOGY

STUDY

DESIGN

• Qualitative and quantitative study to explore perceptions, problems and coping behaviour in patients with breast cancer

REFERENCE

POPULATION

• All patients with breast cancer in Malaysia

SOURCE

POPULATION

• Patients with breast cancer at Hospital Universiti Sains Malaysia (HUSM) and Hospital Universiti Kebangsaan Malaysia (HUKM)

13

No written consent

form.

Hearing problems.

Diagnosed with schizophrenia or mental problem.

Able to communicate in English or Malay ( Bahasa Malaysia).

Patient diagnosed with breast cancer. Undergoes chemotherapy and/or radiotherapy and/or

surgery or without any treatment. All stages of breast cancer.

EXLUSION AND INCLUSION CRITERIA

METHODOLOGY

14

METHODOLOGY

SAMPLE SIZE ESTIMATIONFor qualitative study, there is no agreed method of calculating the

sample size. For this in-depth interview, the number of subjects will be based on the saturation theory (Guest et al., 2006; Francis et al., 2010). Interviews will be conducted till no new additional ideas or information

could be obtained or achieve saturation theory.

Target sample size is 30.

SAMPLING METHODPurposive sampling

15

• For each respondent, they will have three sessions of face-to-face interview. The topics to be discussed are listed below:

• Respondents will be asked on their perception about breast cancer

• Respondents will be asked in details about the problems before, during and after diagnosis in patients with breast cancer

• Respondents will be asked about the coping behaviour before, during and after diagnosis in patients with breast cancer in third follow -up.

METHODOLOGY DATA COLLECTION

16

• In each session, respondent will be interviewed for 45 minutes to one hour.

• Interview guide will be developed and pilot tested before it can be used for the actual face-to-face interview.

• Interviews will be conducted in the languages of the subjects’ choice whether in English or Malay.

• With the permission of subjects, the interview will also be tape-recorded.

METHODOLOGY DATA COLLECTION

17

• Statistical analyses - conducted by using the Scientific Program for Social Sciences (SPSS).

• Results will be presented as percentage (categorical), mean and standard deviation (numerical).

• The verbatim transcripts and coding will be analysed using NVivo 10.0 Software.

METHODOLOGY DATA ANALYSIS

18

EXPECTED RESULTS

Two oral or poster presentations. Two publications in peer review journals. A new health education module.

19

FLOW CHART

Permission from the Hospital Directors and Head Sister of Oncology Clinic HUSM and HUKM to carry out of the study.

 

 

 

 

 

 

 

 

Screening breast cancer patient

Inclusion criteria.

  

Exclusion criteria

Meeting with the respondents and giving explanation about the purpose of the study

 

Agree 

Disagree  

written informed consent from the respondents

 First interview

 Data transciption and coding first interview

 Second interview

 Data transcription and coding second interview

Third interview

 Data transciption and coding third interview

 

20

No Activity 2014 2015 2016

Month 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 1

2

1 Introduction                                                        

2 Literature review                                                        

3 Methodology                                                        

4 Data collection                                                        

5 Data analysis                                                        

6 Result                                                        

7 Discussion                                                        

8 Correction                                                        

9 Thesis submission                                                        

GANTT CHART

21

REFERENCES• Adewuyi-Dalton, R., Ziebland, S., Grunfeld, E. & Hall, A. (1998). Patients' views of routine hospital follow-

up: a qualitative study of women with breast cancer in remission. Psychooncology, 7(5), 436-9.• Adler, S. R. & Fosket, J. R. (1999). Disclosing complementary and alternative medicine use in the medical

encounter: a qualitative study in women with breast cancer. J Fam Pract, 48(6), 453-8. • Ahmad, F., binti Muhammad, M. & Abdullah, A. A. (2011). Religion and spirituality in coping with advanced

breast cancer: perspectives from Malaysian Muslim women. Journal of religion and health, 50(1), 36-45.• AR, S. (2010). Anxiety, depression and coping strategies in breast cancer patients on chemotherapy.

Malaysian Journal of Psychiatry, 19(2).• Aziz, N. M. (2002). Cancer survivorship research: challenge and opportunity. The Journal of Nutrition,

132(11), 3494S-3503S.• Jones, S. E. (2008). Metastatic breast cancer: the treatment challenge. Clinical breast cancer, 8(3), 224-233.• Rowland, J. H., Hewitt, M. & Ganz, P. A. (2006). Cancer survivorship: a new challenge in delivering quality

cancer care. Journal of Clinical Oncology, 24(32), 5101-5104.• National Cancer Institute (NCI), Breast cancer risk in American women. Accessed Jul. 2, 2014, from http://

www.cancer.gov/cancertopics/factsheet/detection/probability-breast-cancer• So, W. K. W., Marsh, G., Ling, W. M., Leung, F. Y., Lo, J. C. K., Yeung, M. & Li, G. K. H. (2010). Anxiety,

depression and quality of life among Chinese breast cancer patients during adjuvant therapy. European Journal of Oncology Nursing, 14(1), 17-22.

• Taha, H. D., Al-Qutob, R. P., Nystrom, L. A. P., Wahlstrom, R. A. P. & Berggren, V. D. (2012). inverted question markVoices of Fear and Safety inverted question mark Women inverted question marks ambivalence towards breast cancer and breast health: a qualitative study from Jordan. BMC Womens Health, 12(1), 21.

22

REFERENCES• Taleghani, F., Yekta, Z. P. & Nasrabadi, A. N. (2006). Coping with breast cancer in newly diagnosed Iranian

women. Journal of Advanced nursing, 54(3), 265-272.• Tamminga, S. J., de Boer, A. G., Verbeek, J. H. & Frings-Dresen, M. H. (2012). Breast cancer survivors' views

of factors that influence the return-to-work process--a qualitative study. Scand J Work Environ Health, 38(2), 144-54.

• Tiedtke, C., de Rijk, A., Donceel, P., Christiaens, M. R. & de Casterle, B. D. (2012). Survived but feeling vulnerable and insecure: a qualitative study of the mental preparation for RTW after breast cancer treatment. BMC Public Health, 12, 538.

• Tsuchiya, M., Horn, S. & Ingham, R. (2012). Positive changes in Japanese breast cancer survivors: A qualitative study. Psychol Health Med.

• Weitz, M. V., Fisher, K. & Lachman, V. D. (2012). The journey of women with breast cancer who engage in mindfulness-based stress reduction: a qualitative exploration. Holist Nurs Pract, 26(1), 22-9.

• Yip, C. H., Taib, N. A. & Mohamed, I. (2006). Epidemiology of breast cancer in Malaysia. Asian Pac J Cancer Prev, 7(3), 369-74.

• Zilliacus, E., Meiser, B., Gleeson, M., Watts, K., Tucker, K., Lobb, E. A. & Mitchell, G. (2012). Are we being overly cautious? A qualitative inquiry into the experiences and perceptions of treatment-focused germline BRCA genetic testing amongst women recently diagnosed with breast cancer. Support Care Cancer, 20(11), 2949-58.

23