The number of patients who suffer from colorectal cancer in Thailand has increased during the last three decades as a result of the change to a Western-style diet. Due to many patients presenting at a late stage and the location of tumours in the rectum, patients have a higher probability of needing a colostomy. This study explores the experiences, coping strategies and the factors that influence coping strategies over a six month period in a group of Thai colorectal cancer patients who have a colostomy. The conceptual framework used in this study was based on the Moos and Schaefer conceptual model of the stress and coping process. A case study methodology was employed to collect both quantitative and qualitative data from eleven participants at three points in time: within one month after the operation to create a colostomy, three months and six months after the operation. Data were collected from structured interviews, which followed the Coping Responses Inventory (CRI),the Ostomy Adjustment Scale (OAS),the Personal Resources Questionnaire 2000 (PRQ 2000),the Life Orientation Test-Revised (LOT-R),and the Functional Assessment Cancer Therapy- Colon (FACT-C). These data provided information on the participants' levels of coping strategies, adjustment to a colostomy, social support, optimism and quality of life. In depth interviews with open-ended questions provided a deeper understanding of the participants' experiences in relation to their colostomy. Findings from quantitative data showed statistically significant changes in the participants' quality of life over time, particularly in their physical and functional wellbeing. An examination of the coping focus used (approach and avoidance) indicated that participants utilised both approach and avoidance coping at the same time, although approach coping was more common. Changes in the most frequently and the least frequently used coping subtypes at six months after the operation were observed. Correlation tests showed various relationships between the levels of quality of life domains and coping subtypes as time passed. Multidimensional scaling procedures uncovered a consistent pattern of coping which involved 'problem solving' and 'seeking guidance and support'. Six major qualitative themes emerged through content analysis of the in-depth interview data. The themes described how participants' psychological and emotional concerns changed over time; the steady improvements in physical health after the operation; the difficulties of adjusting to life with a stoma; facing up to the reality of the new circumstances; the spiritual aspects of their lives; and the level of social support experienced. Religious beliefs such as the 'Law of Kanna, as well as a variety of religious rituals and other practices such as Buddhist chanting and "making merit" played important roles in coping. The findings from the quantitative and qualitative data were used in a complementary and confirmatory manner to provide a richer understanding of the participants' experiences as they coped with this life changing event. The findings of the study are significant as they provide important indicators for improvements in nursing service, particularly the development of nursing procedures to enhance the psychological aspects of care. In addition, they offer important indicators for improvement of the nursing curriculum and directions for further research in Thai culture and the health care system.
目次
Abstract i Acknowledgement iii Table of Contents vi List of Tables xiii List of Figures xvii Appendices xviii Chapter 1: Introduction 2 1.1 Colorectal cancer: statement of the problem 2 1.2 Importance of the present study 4 1.3 Research background of coping with colorectal cancer and a colostomy 6 1.4 Thai culture context of the present study 9 1.5 Purpose 10 1.6 Assumptions 10 1.7 Significance of this study 10 1.8 Definition of terms 11 1.9 Structure of the thesis 12 Chapter 2: Conceptual Background 15 Introduction 15 Section 2.1: Colorectal cancer 15 2.1.1 Risk factors 15 2.1.2 Symptoms, screening tests and presentations 19 2.1.3 Prognosis and survival rate 21 2.1.4 Treatments for Colorectal Cancer 22 Section 2.2: The Impact of Colorectal Cancer and a Colostomy 30 2.2.1 The physical impact 30 2.2.2 The psychosocial impact 32 2.2.3 The spiritual impact 35 Section 2.3: Nursing care for colorectal cancer patients with a colostomy 37 2.3.1 Physical nursing care 37 2.3.2 Psychosocial nursing care 42 2.3.3 Spiritual nursing care 43 2.3.4 Research on the competencies of Thai professional nurses in mental health nursing 49 2.3.5 Research on nursing care for colorectal cancer patients 50 2.3.6 Research on nursing care for colostomy patients and quality of care in Thailand 52 Section 2.4: Crises and Coping 2.4.1 Dual crises after hearing the word 'cancer' and 'a colostomy' 55 2.4.2 Effects of crisis 56 2.4.3 Crisis Theory and a Conceptual Model of the Stress and Coping process: Moos and Schaefer (1 993) 61 2.4.4 Research supports the conceptual framework of the Moos and Schaefer model 65 2.4.5 The Cultural factors which influence coping in Thai patients 71 2.4.6 Research on coping with colorectal cancer and a colostomy 81 Summary 83 Chapter 3: Research Methodology 84 Introduction 84 3.1 Conceptual framework 84 3.2 A flexible case study design 89 3.3 Population and sample 91 3.4 Sample size 92 3.5 Sampling procedure 93 3.6 Ethical considerations 93 3.6.1 Project Approval 94 3.6.2 Permission to use questionnaires 94 3.6.3 Patients' rights 94 3.7 Research sites 95 3.7.1 Songklanagarind Hospital 95 3.7.2 Ramathibodi Hospital 95 3.7.3 National Cancer Institute, Thailand 95 3.8 Data collection 96 3.8.1 Gaining entrance to the research sites 96 3.8.2 Recruiting the participants 96 3.8.3 Location of interviews 96 3.9 Emergent issues in the data collection 97 3.10 Resolution of problems 98 3.1 1 Quantitative data collection 99 3.1 1.1 Structure interviews 100 3.1 1.2 Questionnaire measures 101 3.1 1.3 The pilot study 104 3.1 1.4 The interview schedule 105 3.12 Preparing the quantitative data for analysis 106 3.12.1 Scoring issues 106 3.12.2 The data screening process 106 3.12.3 The data checking process 106 3.13 Statistical analyses 106 3.14 Qualitative collection 109 3.14.1 Achieving methodological rigour 110 3.15 Preparing the qualitative data for analysis 111 3.16 Qualitative data analysis 112 3.16.1 Sample identification 113 3.16.2 Category identification 113 3.16.3 Open coding 113 3.16.4 Creating a coding frame 114 3.16.5 The process of data analysis 114 Summary 115 Chapter 4: The Quantitative Findings from the Case Studies 117 Introduction 11
