Abstract
Introduction
Colorectal cancer (CRC) is one of the most common cancers and a leading cause of cancer death in Iran and New Zealand. Little is known about the supportive care needs (SCNs) for patients with CRC and their families, cancer survivors’ experiences during different phases of the cancer journey or whether these needs are met. Understanding SCNs is important to guide cancer treatment, care and development of cancer care services. Additionally, the literature suggests reported SCNs are related to culture, delivery of cancer care services, and personal factors. The focus of this thesis was to explore the SCNs of individuals with CRC undergoing cancer treatment and their families in Iran and New Zealand, and to identify any differences between patients and their families’ priority of needs in both countries.
Method
The design of this study was a qualitatively driven, convergent mixed method research study, incorporating a parallel quantitative component. Participants were recruited from two tertiary hospitals, one in Iran and one in New Zealand. A total of 80 people participated in this study, 47 from Iran and 33 from New Zealand.
Supportive care needs of participants were measured by the Supportive Care Needs Survey-Short Form (SCNS-SF34) and the Spiritual Needs Questionnaire (SpNQ), and the Supportive Care Needs Survey for partner and caregivers SCNS-P&C39 for family participants). A semi-structured interview was conducted followed with the descriptive cross-sectional survey to gain more detail about both groups of participants’ supportive care needs. Data from quantitative and qualitative approaches were analysed using descriptive statistics and content analysis respectively.
Results
Iranian participants expressed higher SCNs in all dimensions except for the dimension of psychological needs, where SCNs were equal to those of New Zealand participants. Iranian participants used spiritual/religious resources more often and received more support from their families while New Zealand participants demonstrated a greater reliance on the health care system. The health system/information, psychological and financial domains were reported as the highest areas of needs by Iranian participants, while for New Zealand participants, SCNs in the physical and psychological domains were more common.
Iranian family participants expressed higher SCNs in all dimensions when compared to New Zealand family participants except for the dimension of psychological needs where SCNs were equal to those of New Zealand family participants. Iranian family participants used spiritual/religious resources more often and received more support from their families, while New Zealand family participants demonstrated a greater reliance on the health care system. Iranian family participants reported the informational, psychological and financial domains as the highest areas of needs while New Zealand family participants reported the psychological and informational domains as the areas of highest unmet needs.
Religious beliefs and activities and spiritual beliefs and powers were reported by participants as resources in dealing with cancer. This study found that religion did not play a major role in coping with cancer for New Zealand participants, whilst religion played a major role in coping for participants in Iran. The use of spirituality as a resource in managing cancer was only reported by New Zealand participants.
Discussion
This study has generated insight into the perceived SCNs of patients and their families during the treatment phase of the cancer journey in New Zealand and Iran. Differences and similarities between perceived SCNs and supportive care resources in Iran and New Zealand were noted. The similarities between SCNs may be related to cancer as a life-threatening disease; a universal phenomenon. Differences between SCNs and use of supportive resources may be related to differences in culture, provision of oncology services, and the health care system in Iran and New Zealand.
These findings are important as they suggest that patients with CRC and their families in both countries experienced unmet SCNs, and, further indicates how well cancer care services met participants’ SCNs. Additionally, these findings provide knowledge on resources that patients and their families used to cope with their cancer journey. The findings provide some direction to inform the development of cancer care services, especially in the provision of supportive care based on culture and health care provision, and inform recommendation for an integrated approach to the supportive care provision.