The experience of cancer treatment with curative intent: A mixed-methods exploration with patients and oncology healthcare professionals

Abstract

It is estimated that 35% of patients receiving oncology treatment may be affected by psychological distress, making a compelling case for researchers to further investigate how psychosocial supportive services or interventions could best help patients reduce distress and enhance well-being during oncology treatment. The aim of this thesis was to explore patients' experiences and their psychosocial needs during the active phase of oncology treatment with curative intent. The empirical research undertaken in this thesis consisted of Studies 1 and 2 (qualitative phase) followed by Study 3 (quantitative phase). A mixed-methods approach allowed the gathering and integration of complementary qualitative and quantitative findings underpinned by a pragmatic epistemology and psychological theories of uncertainty, stress and coping.

The aim of Study 1 was to gather in-depth insights into the experiences of patients with a range of primary sites of cancer. Ten patients receiving oncology treatment with curative intent participated in individual semi-structured interviews. Six themes were identified using Interpretative Phenomenological Analysis: (i) diminished well-being; (ii) role changes in intimate relationships; (iii) heightened awareness of limited time; (iv) a new order of priorities; (v) taking things as they come and; (vi) development of trust in healthcare professionals (HPs). Study 2 involved a multi-disciplinary sample of nine HPs who also participated in individual semi-structured interviews. Six themes were identified using Thematic Analysis: (i) treating patients as people; (ii) facing death brings new meanings to life; (iii) social support as a buffer to distress; (iv) barriers to psychosocial supportive services; (v) acceptance, denial and endurance of difficulties and; (vi) compatibility of modern and alternative medicine. HPs endorsed a patient-centred approach that enables the effective identification and provision of services to meet the needs of patients with cancer.

The quantitative phase of this thesis was developed following integration of the findings of the two studies within the qualitative phase. The aim of Study 3 was to investigate daily distress, well-being, illness uncertainty, and experiential avoidance of illness uncertainty across a week of active oncology treatment with curative intent. Thirty-one patients with heterogeneous primary sites of cancer produced a total of 213 days' worth of data. Analyses were conducted at both the between- and within-person levels. On the days participants reported higher levels of experiential avoidance of illness uncertainty, they also reported corresponding increases in their levels of distress. Moreover, experiential avoidance of illness uncertainty mediated the relationship between average daily distress and well-being across a week of oncology treatment.

Taken together, this thesis supports previous qualitative and quantitative studies and offers novel contributions to the psycho-oncology literature by exploring patients' relevant psychosocial experiences during oncology treatment complemented by the perspectives of oncology HPs. A novel contribution of this thesis to the literature consisted in its within-person idiographic analysis, as well as detecting experiential avoidance as an unhelpful emotional regulatory strategy in coping with illness uncertainty. The findings of this thesis may have practical application to psychosocial supportive services and future interventions, particularly by helping patients overcome experiential avoidance and encouraging acceptance of illness and treatment uncertainty as two helpful ways of coping during oncology treatment with curative intent, which may be beneficial in reducing distress and enhancing well-being.