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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1.
NAME OF THE CANDIDATE &
ADDRESS
MRS.Natash sharma
2.
NAME OF THE INSTITUTION
3.
COURSE
SUBJECT
4.
DATE OF ADMISSION
5.
TITLE:
A study to assess the effectiveness of counseling for depression
among patients with cancer in selected hospital at Bangalore.
OF
STUDY
Harsha college of nursing
& M sc Nursing
Psychiatric nursing
5/04/2010
1
INTRODUCTION
“To talk sometimes, to listen often, to understand always.
To cure sometimes, to relieve often, to comfort always.”
Cancer is a major life – threatening disease. The World Health Organization predicts that
the global numbers of new cancer patients are expected to be increased 15 millions and
more than 11 million will die from this disease in the year 2011.20 to 40% of cancer
patients show emotional distress.
Cancer affects people in worldwide approximately 10 million people are diagnosed with
cancer and more than 6 million die of the disease every year. About 22.4 million persons
were living with cancer in the year 2007. Cancer prevalence in India is estimated to be
around 2.5 million with over 8, 00,000 new cases and 5, 50,000 deaths occurring in each
year due to this disease¹.
Cancer not only affects organs system physically but can also affect the mind as a
psychiatric disorder, depressive disorders and symptoms are common in cancer
patients(Up to 38% is having major depression). It worsens the course of cancer
treatment, persist long after cancer therapy, and reoccur with the reoccurrence of
cancer and significantly on quality of life. Depression is seen in many cancer patients
approximately 25% of palliative care patients. Palliative counseling for patients and
supportive counseling for their family are recommended as part of treatment plan.
2
Psychological support should be offered to severely depressed patients. It is well
documented that counseling and psychotherapy can interfere quality of life for cancer
patients.
The goal of counseling and psychotherapy is to help patients to make functional,
emotional, spiritual adjustment necessary to maintain their quality of life.
Counseling is defined as a process to understand and clarify his/her self determined
goals through meaningful, well informed= choices and through resolution of problems
of an emotional or interpersonal nature.2
As a matter of fact there are physical, social, emotional, and spiritual burdens placed
upon cancer patients. They and their families require adjustment, coping, and
adaptation to their living with a number of psychological, social interpersonal and
economic levels of functioning. Thus, individual counseling on how to live with their
disease are necessary.3
6.1 NEED FOR THE STUDY
Depression is a disabling illness that affects about 15% to 25% of cancer patients. It
affects men and women with cancer equally. People who face a diagnosis of cancer will
experience different levels of stress and emotional upsets.
3
Patients who are receiving palliative care for cancer may have frequent feelings of
depression and anxiety, leading to much lower quality of life.
Sadness and grief are normal reactions to the crisis faced during cancer and will be
experienced at times by all people. An important part of cancer care is the recognition
of depressing that needs to be treated. in an effort to reduce the occurrence of
depression among cancer patients, special attention is needed for changes in the
psychological status in patients with knowledge about their diagnosis and patients in
advanced disease stage. Good communication within the family reduces anxiety.
Depression can amplify the intensity of pain and can diminish one’s ability to cope up
with life. Depression can lead to difficulty in decision making at this critical time of one’s
life. Pain is a major factor which cause distress to the patient4
Coping strategies refer to the specific efforts, both behavioral and psychological, that
people employ to master, tolerate, reduce or minimize depression events. Two general
coping strategies have been distinguished: problem-solving strategies and emotionalfocused coping strategies. People use both type of strategies to combat most depressive
events 5
Coping strategies refer to the effort of an individual to master demands that are
perceived as taking or exceeding the resources
4
Cancer is a devastating disease. Awareness of this disorder tremendously impacts an
individual's life, creating a host of changes to occur. Depression is one concern that
many cancer patients experience. It is important to make an accurate and complete
assessment of depressive symptoms. Furthermore, a heightened awareness of patients'
culture and their perceptions are vital to their assessment, diagnosis, and treatment of
depression. In cases of clinical Depression, appropriate antidepressants prescribed along
with the treatment for Cancer are significant for the patient. Palliative counseling for
patients and supportive counseling for their family are recommended as part of a
treatment plan.6
Conducted a study to assess counseling needs of women with breast cancer, Research
has demonstrated that some women treated for breast cancer are at risk for significant
and persistent emotional distress and disrupted quality of life. Factors identified that
appear to make women psychologically vulnerable include younger age at diagnosis, a
history of high life stress or depression prior to diagnosis, and more advanced disease.
Research has quickly moved to develop and implement psychological interventions to
help these women, although little is known about the patients' perceptions of their
need for, and use of, such services.7
The depression is most common emotional problem among cancer patients hence the
Researcher felt that some psychological intervention will help these patient to get out of
their depression. So, the researcher was introduced to give counseling for cancer
patients.
The researcher personally felt from the experience that when he was working in clinical
set up, most of the patients with cancer develop depression and most of the time it is
not cared for or it is neglected by the health team members. So the researcher became
interested to explore the feelings of the patients and wants to help them for a better life
5
6.2
REVIEW OF LITERATURE
Literature relevant for this study will be organized in the following sections,
Section–I:
Studies related to depression among cancer patients.
Section–II:
Studies related to effectiveness of counseling among cancer
Patients
Section–I:
Studies related to depression among cancer patients
Conducted study on Management of depression in patients with advanced cancer. The
objective to formulate guidelines on the assessment, diagnosis and treatment of
depressive symptoms in patients with advanced cancer, based on a review of the
literature and clinical experience the study selection on the prevalence and diagnosis of
depression in patients with cancer or related conditions or on the management or
treatment of depressive symptoms arising in these patients. A good rapport with the
patient and an understanding of the emotional conflicts Engendered in the individual
are important for good management. Active Psychotherapeutic strategies include
cognitive therapy techniques, management of self-defeating patterns of thought and
low morale, and psychosocial group treatments. it concluded that there is a need for
more research into the diagnosis of depression in the medically ill and the use of
antidepressants and counseling techniques in patients with cancer.8
A prospective study was conducted to assess the long-term impact of attending a
support group on the prevalence of psychological morbidity in patients with breast
cancer before and after 1-year participation in the Iranian breast cancer support group.
Psychological morbidity was measured using the hospital anxiety and depression scale
6
(HADS). In addition, qualitative data were collected to throw some lights on the topic..
Analysis of the qualitative data indicated that the group involvement was the most
important factor that contributed to the patients' improved psychological well-being.
The findings of this prospective study suggest that participation in cancer support
groups could have a long-term effect in reducing anxiety and depression in breast
cancer survivors.9
conducted study on the Depression in cancer patients is common and occurs
throughout the course of cancer illness. We review diagnosing, treatment and palliative
care issues as well as epidemiology and etiology of major depression in cancer patients.
The prevalence of major depression in cancer patients was reported to range from 6 to
42%. It reflects various cancer related variables, such as pain and low performance
status as well as risks for major depression. To avoid under-diagnosing depression in
cancer patient, it should include not only psychological symptoms, but also physical
symptoms. The treatment includes patient education, counseling, behavioral techniques
and antidepressant medications. In palliative care setting, life review interview would be
effective for depression.10
Conducted study on Cancer pain and depression to the growing numbers of older cancer
patients. To provide a systematic review of the literature regarding age-related patterns
in the Intensity or prevalence of depression among cancer patients with pain. The
studies were compiled and systematically reviewed. the result showed Five articles,
describing four studies, met the inclusion and exclusion criteria. Due to high levels of
cross-study methodological variability, a qualitative review was undertaken. Three of
the four studies did not find evidence for age-related patterns in depression. The fourth
study found that depression increased with age Medical and psychological literature
databases were searched to identify eligible studies. The methodological quality and
outcomes of the studies were compiled and systematically reviewed. the study was
concluded. The weight of the evidence suggests that younger and older cancer patients
7
with pain report comparable levels of depression. However, this conclusion remains
preliminary due to the methodological limitations of the available studies.11
Conducted study on the diagnosis of depression in patients with advanced cancer with
pain researcher used a literature review and findings shows that Pain and depression
are prevalent symptoms in cancer patients. Considering the different points of
intersection between physical and mental diseases, sometimes the diagnosis of
depression in patients with cancer and pain is difficult. This datum is very important
because depression decreases considerably the quality of life of patients, and should be
diagnosed and treated properly.12
The prevalence and correlates of depression among patients with head and neck cancer.
by using quantitative studies researcher measured depression or mood in adults with
head and neck results shows. . Prevalence rates of depression are high at diagnosis,
during treatment, and in the first six months following treatment, and mild to moderate
depression may continue for three to six years after diagnosis. Certain patient
demographic characteristics (e.g., marital status, education), symptoms, and specific
time points in the illness trajectory (e.g., time of treatment) are correlated with
depression. Specific patient variables at diagnosis, such as depression, can predict
depression at later time points.13
Section–II: Studies related to effectiveness of counseling among cancer patients
This study compared the effectiveness of two psychological treatments in a group of 57
patients with various types of cancer attending the Royal Marsden Hospital. Patients
referred for psychiatric assessment who met criteria for an abnormal adjustment
reaction were randomly allocated to either 8 weeks of Adjuvant Psychological Therapy
8
(APT), a problem-focused, cognitive behavioural treatment programme, or 8 weeks of a
comparison treatment of supportive counselling. At 8 weeks from the baseline
assessment, APT had produced a significantly greater change than the counselling
intervention on fighting spirit, helplessness, coping with cancer, anxiety, and selfdefined problems. At 4 months from baseline, APT had produced a significantly greater
change than counselling on fighting spirit, coping with cancer, anxiety and self defined
problems. It is concluded that APT produces greater change in anxiety, adjustment to
cancer and use of coping strategies than a non-directive, supportive intervention over
an 8 week period of treatment. This difference persists at follow up 4 months after
baseline assessment.
Conducted study on a systematic qualitative analysis of psycho educational
interventions for depression in patients with cancer. The main objectives to determine
whether research-based recommendations can be made about the clinical management
of depression in patients with cancer. Reports of scientific studies, qualitative or
quantitative systematic reviews of scientific studies, and practice guidelines published
from 1980-2000. In all, 36 pieces of evidence supported the conclusion that psycho
educational interventions benefit depressive symptoms. Evidence included two wellconducted meta-analyses and nine well-designed randomized clinical trials with large
samples (N > 100). With regard to intervention content, 70% of behavior therapy studies
and 66% of counseling studies drew conclusions that supported the hypothesis. In
addition, 58% of studies that tested behavior therapy or counseling in combination with
cancer education had positive results. The evidence supports the conclusion that psycho
educational interventions reduce depressive symptoms in patients with cancer and that
behavior therapy or counseling alone or in combination with cancer education is
beneficial. Nurses can select from a variety of educational, behavioral, and counseling
techniques to prevent or manage depression in their patients.14
9
Conducted study on telephone interpersonal counseling for women with breast cancer
and their partners. Substantial evidence exists that face-to-face psychosocial
interventions improve psychological adjustment and health-related quality of life for
patients with cancer. Yet psychosocial interventions are not offered routinely, and many
patients with cancer do not use face-to-face counseling mechanisms. The telephone
may be an innovative and effective method of delivering interventions, and telephonedelivered interpersonal counseling may be an especially effective intervention for
women with breast cancer and their partners. this conclusion remains Despite the fact
that the telephone counseling occurred over a brief period of time, the woman and her
partner in this case study reported substantial positive changes in their own distress
(e.g., symptoms such as depression and anxiety) and the nature of their relationships
with each other and their children. This is precisely the effect that would be predicted
by interpersonal theories of psychological distress. These results were not atypical for
other women and their partners who participated in the study. 15
conducted study on Understanding and treating depression among cancer patients.
Cancer is a devastating disease. Awareness of this disorder tremendously impacts an
individual's life, creating a host of changes to occur. Depression is one concern that
many cancer patients experience. It is important to make an accurate and complete
assessment of depressive symptoms. Furthermore, a heightened awareness of patients'
culture and their perceptions is vital to their assessment, diagnosis, and treatment of
depression. In cases of clinical depression, appropriate antidepressants prescribed along
with the treatment for cancer are significant for the patient. Palliative counseling for
patients and supportive counseling for their family are recommended as part of a
treatment plan.16
10
6.3
STATEMENT OF THE PROBLEM:
A study to assess the effectiveness of counseling for depression among patients with
cancer in selected hospital at Bangalore.
6.4
OBJECTIVES:
To develop and validate counseling session for depression among samples
To assess and compare mean pretest and post test depression among the samples.
To find-out association between the mean pre-test level of depression among the
samples and their selected demographical variables (Age, Duration of cancer, and Stage
of cancer)
6.5
HYPOTHESES:
(Level of Significance is 0.05)
H1 –
The mean post test level of depression will be lower than the mean pre test level
of depression among the samples.
H2 –
There will be a significant association between the mean pretest level of
depression among samples with their selected demographic variables.
H2a – There will be a significant association between the mean pretest level of
depression & their age.
H2b - There will be a significant association between the mean pre test level of
depression and their duration of illness.
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6.6
OPERATIONAL DEFINITION:
(i) Effectiveness:
Difference between the mean post –test score and mean pre-test score level of
depression among the cancer patients in selected cancer hospital and is measured by
Zung self rating depression scale.
Depression:
In this study it refers to a group of symptoms, feeling of sadness, loneliness, despair, low
self esteem, withdrawal from inter personal contact and Physiological symptoms of
insomnia, anorexia, weight loss, and loss of hair experienced by cancer patients.
(ii)Counseling:
In this study it is a process of helping the cancer patients by sessions of interaction and
helping the patients to identify coping strategies.
(iii) Cancer:
In this study it refers to the diagnosis of cancer which is conformed by a doctor and it
includes the duration of illness, site of cancer and stages of cancer.
(iv) Socio – Demographic Variables
Age in Years –. In this study the cancer patients with age group between 25 to 65
years were included.
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Gender– Both male and female will included.
Educational Status –in this study the educational status of the samples will divided as
illiterate, primary level, high school level, higher secondary level, graduate level and
post graduate level
6.7
ASSUMPTIONS:
The hospitalized cancer patients have depression in various levels like free from
depression, mild & moderate depression.
Depression among cancer patient is influenced by various demographic variables Age,
gender and Education.
Patients may have lack of knowledge about management of depression.
6.8
DELIMITATION:
The study is delimited to 50 samples admitted in selected hospital,bangalore
The total period of data collection will be delimited only for 6 weeks.
Counseling is planned only for mild and moderate level of depression among cancer
patients.
6.9.
VARIABLE
Independent variable:In this study the independent variable will be planned Sessions on counseling.
13
Dependent variable:In this study the dependent variables will be the level of depression among patients
with cancer.
Extraneous Variables
The selected demographic variables and in this study include the age, gender, and
educational status, date of diagnosis, site of cancer, stage of cancer and the mode of
treatment.
7.
MATERIAL AND MATHOD
In this study we will use the method of interview to collect socio demography data and
self administrative rating scale will be used
7.1
RESEARCH APPROACH AND DESIGN
RESEARCH APPROACH;
Quantitative evaluative research approach will considered as an appropriate research
approach for this study.
RESEARCH DESIGN:
The research design will be - experimental research design (one group pre- test, post test design).
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study will be represented as 01 x 02 03 04
Day 1
01
X
Day 8
Day 16
Day24
O2
O3
O4
Schematic representation of research design
KEY O1 – Pretest (1) Assess the demographic variables (2)Assessment of level of
Depression among cancer patients.
X-
Counseling.
O2-
Exploration of feelings of the patient .
O3-
Developing a positive strategy towards the disease
O4-
Post-test assessment of level of depression and feelings and practices of
Individual’s coping strategies.
7.1.2 SETTING OF THE STUDY:
This study will be conducted among cancer patient with medical illness admitted
in selected Hospital, Bangalore
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7.1.3 POPULATION:
In this study the target population will be cancer patients of selected hospital, Bangalore
7.2.1 SAMPLING TECHNIQUE AND SAMPLE SIZE
Samples who will fulfill the inclusive criteria will selected through non- probability
convenient sampling technique. The sample size for this study will be 50 cancer
patients.
7.2.2. SAMPLING CRITERIA:
7.2.3(I)
INCLUSION CRITERIA
Cancer patients with the age of 25-65 years only admitted in selected Hospital at
Bangalore
Patients with mild and moderate depression.
Both male and female patients.
Patients who will willing to participate in the study.
Samples who can speak kannada or English.
7.2.4 (II)
EXCLUSION CRITERIA
Cancer patients who will very sick.
Cancer patients with severe depression.
Cancer patients who will have hearing impairment.
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7.2.5 DATA COLLECTION TOOLS AND TECHNIQUE
Tool- I: Demographic data
Demographic variables includes age, Gender, educational status, Date of diagnosis, Site
of cancer, stages of cancer, Mode of treatment, Availability of family support. (It will
not scored but will use for inferential analysis.)
Tool –II :Zung self rating depression scale .
The level of depression is measured by zung self rating depression scale. The total score
80.The Score between < 50 is considered as Normal, 51-60 indicate mild depression, 6170 indicate moderate depression and > 70 indicate severe depression.
The criteria prepared and each criteria consists of 1-4 response columns and rating as
(1)a little of the time, (2)some of the time, (3)good part of the time, (4)Most of the time.
Ten items will Positive questions and Ten will Negative questions.
7.2.6 Data Collection Procedure:
Data will be collect from the patient with cancer in selected hospital, Bangalore;
permission will collect from concern authority. The total sample size will be 50 patients
with cancer. Duration of data collection will be 4 week.
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VALIDITY OF THE TOOL
The depression scale will be standardized tool.
The prepared tools and ZDS along with statement of problem, objectives and
hypotheses will submitted to five experts. Among them three from the field of
Psychiatric nursing and one from psychiatrist and other will psychologist.
RELIABILITY OF THE TOOL
The tool will administered to 10 samples from selected Hospital, Bangalore. And
reliability of Zung Depression Scale will checked by Split Half Technique
7.2.7 Plan for Data Analysis:
Collected data will planned to organized, tabulated and analyze will be using the
frequent distribution, descriptive statistics(mean, SD, and mean score percentage and
inferential statistics (paired ‘t’ test Chi-square) which will do to find out association
between the selected demographic data of the sample with the depression among
patients with cancer.
7.3.
Does the study required investigation or intervention to be conducted on
patient on other human or animal? If so please describe briefly?
Yes, the study will be conduct on patients with cancer in selected hospital, Bangalore.
7.3.4 ETHICAL CLEARANCE
The permission will be obtained from ethical committee of the college and medical
superintended from selected hospital at Bangalore.
18
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12.Denise .F. Polit and Beck. (2004). “Nursing Research”, 1st Ed, Lippincott Williams and
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