How question. Results The results produced two themes

How Men Diagnosed and Living with Advance Prostate Cancers’ Use Their
Own Practises to Promote and Maintain their Emotional Well-Being: A Thematic
Analysis

 

 

Abstract

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Objective

Men
who are diagnosed and living with prostate cancer, their responses develop a
wide range of emotions. This report explores the ways in which men with
advanced prostate cancers’ individual approach to maintain and promote their
emotional well-being.

Method

A
sample of 3 males who have advanced prostate cancer was recruited from the
Prostate Cancer UK’s (registered charity) through a volunteer sampling. They
further participated in a semi-structured interview schedule in their homes.
Participants were asked to talk through their treatment and diagnosis; impact
on their well-being, and the ways in which they strategize to ensure emotional
well-being. Thematic Analysis was used to code and develop two themes within
the data collected associated with the research question.

Results

The
results produced two themes emerging in the transcript – ‘living with advanced
prostate cancer (APC)’ and ‘striving to make the most out of life’. The
emotional well-being of participants left uncertainty separating from life and
their loved ones. Participants ensured to maintain and promote their well-being
through emotions, reconnecting with families/community, which gave them a sense
of control. All of this has shown positive emotional well-being, which
indicates areas for health professionals could possibility explore to aid men
re-establish their life-purpose.

Conclusion

The
findings which have emerged from all three transcripts present value towards
psychological interventions such as mindfulness with men who have advanced
prostate cancer as a way to think positively from their situation.

 

Introduction

Advanced
prostate cancer (APC) is a cancer which spreads further from the prostate to
other parts of the individuals’ body. APC is able to cause symptoms with
physical morbidities such as problems with urination, bone pain and fatigue
caused by the disease spreading across the body (Heidenreich et al., 2014). There are various
treatments available for help such as chemotherapy, androgen deprivation
therapy (ADT) other comforting treatments to help manage these symptoms. In particular,
patients who are diagnosed and living with APC experiences a decrease in
health-related quality of life, and consequently feel worse in terms of
psychological distress and being able to adjust to the stage of the disease (Resnick & Penson, 2012).
Results have shown 41% of patients with APC reported not feeling the people understood
what they are going through, greater percentage showed patients to feel emotional
distress and uncertainty the with diagnosis of APC (62%), fearful (33%), sad
(32%) and felt isolated (20%; Aning et al., 2012). However, limited research in the area of
psychological well-being amongst men with APC tends to focus more towards
treatments such as ADT and the side effects such as mood swings or depression. Therefore,
psychosocial interventions have shown improvement coping with stress management
skills and decrease levels of perceived stress to be beneficial across a range
of health-related quality of living outcomes amongst prostate cancer survivors;
this includes physical, family/social, emotional well-being and functional domain
(Benedict et al., 2015). However,
research is currently undergoing in Health Psychology to re-focus on engaging
men with well-being, than simply highlighting their deficits. This can either
be through consideration or seeking help for depression with a diagnosis (Ridge
et al., 2011).

This report aims to explore 3
interviews for analysis on the experience of males with prostate cancer.
Specifically, a qualitative study was conducted in order to explore men with
advanced prostate cancers’ own practises with promoting and maintaining an
emotional well-being. Thematic Analysis (TA) was chosen an appropriate method
to identify, analyse and report any recurring themes associated with the
specific research question.

 

Methodology

Participants

Participants were based in the UK and
were recruited through a volunteer sample from the Prostate Cancer UK’s
(registered charity). Inclusion criteria required English speaking men with
APC, and using strategies in order to maintain and promote their emotional
well-being. All participants were Caucasian and were management level
professionals; either retired or taken early retirement due to diagnosis. Age
and demographic information of participants is provided down below:

Table
1. Demographic
information on participants with advanced prostate cancer (APC).

Participant

Age

Time
Since Diagnosis (years)

Treatments
Received

Physical
Function

Robert

52

3

Androgen Deprivation Therapy (ADT) and
Radiotherapy

Active and mobile

Jack

72

10

ADT

Physical function reduced and unable to exercise

Clive

53

4

ADT, Second-Line ADT and Chemotherapy

Active and mobile

 

Materials

Ethical approval was first to be
obtained from the University of Westminster research ethics committee. An
advert was used to place on the bulletin of the registered charity as mentioned
in order to recruit volunteers from Prostate Cancer UK. Researchers would then contact
volunteers to confirm basic information and details as mentioned. Briefed
information sheet and consent form were to be provided before the interviews
were to commence, followed by a debriefing form to know the true purpose of the
study and further contact details for support.

Design

This study used a qualitative design
using a semi-structured interview and Thematic Analysis (TA). This method is able
to familiarize the data, generate initial codes, search for themes among codes,
review these themes, define and name the themes, and lastly producing the final
report. This analysis is able to provide flexibility, be useful by qualitative
learners and be resource efficient (Braun & Clarke, 2006).

Procedure

Ethical approval was first obtained
from the University of Westminster by the research ethics committee. An advert
was placed in the Prostate Cancer UK’s (registered charity) bulletin to receive
volunteers. Participants were to be English speaking men, diagnosed with
advanced prostate cancer and self-identified to using strategies to maintain and
promote their emotional well-being. Men who came forward were contacted via
telephone or email by the researcher and were asked to confirm age other
demographics (Table 1). All participants were then briefed and given consent
forms as anonymity was preserved by pseudo names and rights to withdraw any
time during the research. All participants were interviewed in their homes, to
discuss their treatment and diagnosis, personal meanings of well-being and
emotions, the impact prostate cancer had on them, and strategies they used to preserve
emotionally well. The interview durations was between 1h 27 min – 2 h (M time –
1h 45 min). All interviews were to be recorded and then transcribed word for
word. Once transcribed, a thematic analysis was used to code and theme (see
appendix A) and then placed into a table (see appendix B). Lastly, participants
were then debriefed about the study.

 

Results

This report focuses on a thematic
analysis, two key themes occurred from all three interviews which was ‘living
with advance prostate cancer’ and ‘making the most of life’. There was
significance within all three transcripts with uncertainty for the future and
living with the advanced prostate cancer.

Theme 1: Living with Advanced Prostate Cancer

The impact of living with advanced
prostate cancer had an affect across all three men’s emotional well-being. For
example, in Robert’s transcript, it was highlighted his uncertainty coping with
the diagnosis which had left him in disbelief.

“But
straight away there was a ‘that’s not me,’ vegetarian, healthy, no history of
cancer in the family, no it will just be the motorbike thing, that’s what it’ll
be” – Robert

Being diagnosed with cancer has led
all three men to question their identity and actions on the circumstances. On
the other hand, living with APC has displayed a range of emotions in response
to their situation. All three men were able to express their feelings towards
the support given to them from people outside their family. An example of this
was shown in Jack’s transcript.

“So
and…I enjoy it, I enjoy being with the people. I mean when we get together in
the patient carer group (laughs), we gets down to business, but there’s always
laughter. Some of them are ex-patients, some of them are carers, some of them
are actually dying. I mean we’ve lost quite a number of people from the group
that subsequently died.

But
it’s very, very therapeutic for me”.
– Jack

Jack has come to value the support
around him from individuals who are in the same position through volunteering.
For all three men, emotional expression became therapeutic, which may have
developed a psychological distance from death and reinforcing their sense of
masculinity. However, Clive had a different experience.

“Now, whether the health
care professionals tailor how they deal with individuals based on their
judgement of individuals…I don’t know, I’ve only got my own experience. But my
experience is, erm, you’re offered a specialist nurse who you can go to
anytime, but outside of that – no real, no real support from an emotional or a
physically well-being point of view. Quite, quite weak” – Clive

 

Clive expresses a decrease with further emotional and
physical support for his well-being outside of healthcare professionals. This
may consequently cause more psychological distress unable to cope with the
stage of disease.

 

Theme 2: Striving to Make the Most out of Life

Participants have presented to strive
and make the most out of their life in a goal-orientated way to maintain and
promote emotional well-being. For example, Jack emphasises his volunteer role
and how this has changed him.

“And…because
the cancer support centre was so good to me in turning me around, I’ve become
more and more engrossed in volunteering, because the people who’ve helped me, I
want to put something back” – Jack

Clive has shown a sense of social connection
and belonging by helping others which helps promote emotional well-being, and
less of feeling separated from life or feeling alone living with APC by
adopting this new role in life which has given him a purpose. Participants have
also mentioned making the most out being with family members. This example was
shown by Clive.

“So,
when I said I tried to be normal, when I reached a certain place, I thought,
well now is the time for me. So….you know to give myself to my wife and the
kids more than I had been…” – Clive

This creates a sense of duty regained
again, and masculine attitude to be able to look after the family. On the other
hand, participants have also emphasised a sense of physical ability which
created more awareness to be mindful as well as sensory pleasure for the
individual. An example of this was shown in Roberts’s transcript.

“I
took my bike up there, took my life in my hands and cycled through central xx
actually, which was marvellous actually, it was absolutely marvellous and I
loved my time there, it was really good fun”. – Robert

Here, Robert also reinforces physical
ability to carry out existing hobbies such as riding his bicycle which helps
promote and maintain emotional well-being. This helps to move away from living
with APC which build uncertainty with life and death.

 

Discussion

Overall, the study adopted knowledge
on how the impact of living with advanced prostate cancer affected their
emotional well-being and uncertainty with their future selves. In relation to
previous research, the current findings have provided an insight on how advanced
cancer gives them sense of uncertainty on hearing the diagnosis, which has
created a sense of fear that cancer has truly taken over their lives (Aning et
al., 2012). However to maintain a health emotional well-being, participants
have expressed the support from others outside of their family to have a change
in perspective and take control in their life. 
The support from those understanding their condition creates a sense of
community and belonging. On the other hand, some participants have felt the
lack of support from others outside to promote and maintain an emotional
well-being. This supported previous finding which have shown those living with
APC experience a decline in health-related quality of life, which may affect
psychological distress due to the severity of their stage in diagnosis (Resnick & Penson, 2012).
Previous research has noted to ensure emotional well-being in well promoted,
the importance of stress coping management skills have shown to be beneficial
within health-related quality of living outcomes with APC (Benedict et al.,
2015).  This has known to be a necessary
approach which presents optimism and positivity, key aspects for maintaining
and promoting emotional well-being.

The study presented limitations by
only interviewing three men who were all living in the United Kingdom. All the
participants where Caucasian, married and management level professions, this
lacks generalizability as there has been no consideration of men of different
colour, ethnicity or educational level diagnosed with advanced prostate cancer.
The sample has also shown to be bias in the study considering how all the
participants were selected through a volunteer sampling. Therefore, it was no
surprise for participants to have an interest in volunteering and give back to
the community. Future research to use interventions such as mindfulness
approaches which was shown to potentially enhance attempts to change participants’
perspectives to appreciate life more whilst offering them coping mechanism to
overcome struggles they may face in the future. This has already shown
effectiveness in patients groups with advanced prostate cancer (Chambers et
al., 2012).

 

Reflection

Overall, analysing
each transcript I’ve come to realize that men can sometimes retain their
emotional distress, or not feel it is ideal to reveal them in order to uphold
this masculine identity amongst family members. Therefore, I felt it would be
useful for researchers to target areas in which are weak in individuals and
raise any concern which they may feel to ensure better coping strategies used
to deal with these threats. Lastly, I personally feel more could be done to
ensure the emotional well-being of men who are diagnosed with a terminal
illness, which would lead to a greater improvement in their quality of life. 

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