Date of Award

2016

Document Type

Thesis

Publisher

Edith Cowan University

Degree Name

Doctor of Philosophy (Psychology)

School

School of Arts and Humanities

First Supervisor

Professor Anne Wilkinson

Second Supervisor

Professor Ken Greenwood

Abstract

Haematological cancers in bone marrow (leukaemia) and the immune system (lymphomas or myeloma) represent the sixth most common adult tumour group in Australia. These cancers often develop without warning and require intensive treatment regimes that last on average eight months, but may continue for a lifetime depending on the diagnosis. Encouragingly, advancing cancer treatments, a key accomplishment of cancer research over the past 40 years, have resulted in a growing community of cancer survivors. Approximately two in three adults diagnosed with haematological cancer (HC) can now expect to survive more than five years. However, they must attempt to navigate the potential side-effects of cancer treatment. Several studies have highlighted the negative physical, social and psychological consequences of a cancer diagnosis such as fear of reoccurrence, infertility, fatigue and depression. However, few studies have explored how these individuals adjust or cope following successful cancer treatment. Cancer survivors who maintain a positive outlook, effectively deal with their health issues and are able to resume normality in their lives are deemed to be resilient. This study aimed to investigate the resilience process that HC survivors adopt following treatment, in order to overcome such adversity. The goal was to enable identification of protective factors that lead to positive mental health outcomes, and risk factors that impede resilience, for the growing HC survivor population.

A two-phase, sequential, mixed methods design was adopted. The first (qualitative) developed a model of resilience, by exploring factors that fostered or inhibited HC survivors’ abilities to cope with this health crisis. Data were collected though semi-structured, in-depth, interviews with 23 adult HC survivors from Western Australia (M age = 52.87, SD = 16.72). Thematic and Leximancer software analyses of the interview data identified four main themes and subthemes pertaining to the cancer experience faced by these individuals: (1) the burden associated with a HC diagnosis; (2) resilience: coping with HC; (3) pathways and barriers to resilience; and, (4) survivor outcomes. These themes were then developed into a model, based on the current findings and those that had been identified in the literature.

Subsequently, in Phase Two (quantitative), a questionnaire was created using factors that surfaced during the interviews or were identified from the literature. It was first piloted (Stage I) among a convenience sample of 17 mixed cancer survivors to determine clarity, reliability and internal consistency. Afterwards, a large survey was conducted (Stage II) to test the validity of the model developed in Phase One. Twenty-four variables were investigated for their ability to predict resilience and 222 (M age = 54.35, SD = 14.31) eligible questionnaires were obtained. Using a standard multiple regression analysis, the combined effect of the 24 variables accounted for 61% of the variance in resilience scores. Active coping, positive reframing, exercise and support from family and friends were found to positively influence resilience, while self-blame negatively predicted resilience. Only three variables, venting, selfdistraction and substance use, did not contribute significantly. Greater scores on each of the remaining variables; emotional support, instrumental support, planning, acceptance, religion, humour, support (healthcare professional and significant other), appearance, researching information, alternative treatments, time-out and diet, were associated with higher levels of resilience, except for, behavioural disengagement and denial which were negatively correlated. The results identified that higher resilience levels were significantly associated with lower depression and anxiety. In addition, younger participants (< 40 years of age) or those more recently diagnosed (< 5 years) scored significantly higher on depression and anxiety and lower on resilience.

The findings highlight that the model developed in this thesis appropriately represented resilience factors identified among other cancer survivor populations. This research contributes to theory, policy and clinical practice, by providing greater insight into the experience of those living with HC and how these individuals cope. Clinicians including psychologists can use the study’s results to improve their clinical assessment and therapeutic approaches to enhance cancer survivor wellbeing. In addition, this information can assist the federal and state governments in formulating improved support infrastructure. Future research should explore how these theoretical findings can be applied practically, and assess the application of this model across cultures.

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