Download 7. materials and method of study

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT
1. 1.
NAME AND ADDRESS
Ms. ELIZABETH NIMMY SAM
OF THE CANDIDATE
1ST YEAR MSc NURSING
KNN COLLEGE OF NURSING
YELAHANKA, BANGALORE
2.
2
NAME
OF
THE
INSTITUTION
KNN COLLEGE OF NURSING,
CA 23/B, A SECTOR, SATELITE TOWN,
YELAHANKA, BANGALORE-64
3.
3
COURSE
STUDY
OF
AND
THE 1ST YEAR M.SC (NURSING)
MEDICAL-SUGRICAL NURSING
THE
SUBJECT
4.
4
5
DATE OF ADMISSION 15-06-2011
TO THE STUDY
TITLE OF THE STUDY
THE
RELATIONSHIP
BETWEEN
SPIRITUAL WELL BEING AND LEVEL OF
DEPRESSION AMONG CHRONIC CANCER
PATIENTS.
1
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“I LEARNED TO SURRENDER COMPLETELY MY VANITY
MY FACE TO THE WORLD
IN THAT CRISIS I PRAYED”
Allis storm wolf
Health is described as an ideal state of physical, social, psychological and
spiritual wellbeing. Something to strive for, but never to attain. Good health is always
around the corner but never actually reached, because there is always something more
to be achieved .Like the proverbial elephant, it is difficult to define but easy to spot
when we see it. “You look well “ stands as a common greeting or” feeling good “.The
idea of health is capable of wide and narrow application and can be negatively as well
as positively defined. We can be in good health and poor health.1
Health is always related to other complex ideas such as illness and disease.
Disease disrupts our lives in many ways. It may reduce our ability to perform our life
roles effectively or to engage in activities we used to enjoy2. The diagnosis of a
chronic or life threatening disease may bring shock, fear, anxiety, anger or grief. It
may also cause the clients to question the meaning and purpose of their lives to
become more inwardly focused or to embrace life. The nature of the illness affects the
way person reacts to disruptions. Among the chronic illness cancer is an important
focus of the century.3
2
Cancer was recognized in ancient times by skilled observers who gave it the
name cancer (crab) because it stretched out in many directions like the legs of crab.
The term cancer is an umbrella word used to describe group of more than 100 disease
in which cells multiply and spread without restraints, interrupting normal body
physiology and causing life threatening complications. Although mainly it considers
as a disease associated with aging, it diagnosed in people in all ages. Cancer causes
greater anxiety and apprehension. Its Physiologic and psychological impact on
patients and their families cause profound changes in their lives. Cancer treatment
may last a life time and too often do not result in the cure for which the patients hope
,myth surround malignant disease, often focusing on its incurability and may foster
feelings of hopelessness and death.4
Evidence shows that cancer patients have poorer health outcome than a similar
individual with any other illness. Cancer patients struggle to find a balance in their lives
and sense of wholeness and life purpose. There are always exceptions in regard to the
level of distress they face. For some patients cancers become an experience that
provides self reflection and an enhanced sense of what life is about. Regardless of each
patients journey with cancer, having cancer affects each person’s physical, social,
psychological and spiritual wellbeing. Each cancer patient undergoes through different
level of depression and anxiety ones they diagnosed with cancer.5
A number of studies have documented a substantial prevalence of depression
and depressive symptoms among cancer patients. Surprisingly the more narrowing the
term depression is defined, the lower the prevalence of depression reported. Reported
rates of depressive symptom vary from 25% to 50%in samples of hospitalized cancer
patients .In recent years an observational cohort study conducted among 222 women
3
with a diagnosis of early breast cancer revealed prevalence of depression and anxiety
was 33%at diagnosis ,15%after 1 year and 45%after 5 years.6
Depression will complicate patients effort to cope with the illness &adhere to
medical treatment .Yet this comrobid psychiatric illness overlooked, since its
symptoms are easily misattributed to cancer &its treatment. Pervasive sadness and
hopelessness can be explained as a reaction to poor diagnosis, sleep disturbance to
disease related anxiety and poor appetite due to chemotherapy side effects. Important
issues in the life of any persons with cancer may include the fear of death, interruption
of life plans, changes in the body images and self esteem, changes in social role and
life style. Patient who are receiving the radiation therapy and chemotherapy may have
frequent feeling of depression and anxiety leading too much lower quality of life.
Feeling of being of burden to the family &the body image changes and the pain leads
them to hopelessness and ultimately to depression.7
When people find out that they have cancer, they often have feelings of
disbelief, denial or depression or despair. These symptoms and fears usually lessons
as the person adjust to the diagnosis and depend upon alternative therapy like yoga,
meditation and prayer, counseling etc.Spiritual well being is one among the common
alternative therapy which cancer patients seeks for.8
The word spirituality derives from the Latin word ‘spiritus’ which refers ‘to
breathe’ or ‘win’. The spirit gives life to person. Spiritual wellbeing is often described
as having two dimension .The vertical dimension support the transcendent
relationship between a person and god or some other higher power. The horizontal
dimension describes positive relationship and connection of people with others. Those
4
who are spiritually healthy, experience joy, able to forgive, accept hardship and
mortality.9
Health care research shows the association between spirituality and illness
related depression. There are beneficial health outcome when an individual is able to
engage his or her belief in a higher power and sense of a source of strength or support.
Many people use prayers as a method of coping because it is effective in minimizing
stress, anxiety and depression. However the healing power of spirituality is not
completely understood, maybe it is the individuals intrinsic spirit that seems to be an
important factor in healing.10
6.1 NEED FOR THE STUDY
Science daily in the year 2004 September reported that depression increases
cancer patients risk of dying .Depression can affect cancer patient’s likelihood of
survival. This result highlights the need of systemic screening of psychological
distress, subsequent treatment and alternative therapy11. The relationship between
depression and cancer is bi directional. More rapid progression and increased
symptoms of cancer are associated with more severe depression.12
A meta analysis study was conducted in Canada by the graduates of British
Columbia in the year 2008, to determine the effect of depression on cancer patients
disease progression and survival .The researchers found 26 studies with total of 9417
patients examined the effect of depression on cancer progression .They found an
increase risk of death in patients who report more depressive symptoms than others.
So the study suggest for the regular screening of patients for depression and
alternative therapies.13
5
A study was conducted in Chicago in the year 2003 among electrical workers
found that those with cancer were twice as likely to develop depression and its
symptoms .Depression and anxiety are not uncommon among people diagnosed with
cancer. Often doctors and nurses focus on the physical effect of cancer treatment
while the symptoms of depression may not be recognized and can go untreated
.Patient with untreated depression or anxiety may less likely to take their cancer
medication and maintain health and prone to withdraw from family or other social
support. This can affect the result of cancer treatment. This study also pointing out the
need of depression assessment and alternative therapy for the enhancement of quality
of life.14
However about 25%of cancer patients will experience major depression over
the course of their illness. People with cancer are 3 times more likely than the general
population to develop depression and twice as likely as other hospitalized patients. The
greater the pain the more likely the depression .15
A study was conducted to investigate the frequency of co morbidity and to
demonstrate the best method for assessing depression among cancer patients. The
subjects were 50(25 male and 25 female) cancer patients. All subjects were
interviewed by psychiatrist and were administered psychological test such as SAS
(self rating anxiety scale), SDS (self rating depressive scale, HADS (hospital anxiety
and depression scale) and DRP (depression related personality traits).The interview
revealed that44% of cancer patients had mental disorder according to DSM4.The most
frequently observed disorder was depression which was seen in 28%of cancer
patients.16
6
According to one review nearly 1 in 6 patients with cancer (16.5%)shows
symptoms of clinical depression .Past studies and national cancer institute estimation
is about 1 in 4 patients suffers from depression after diagnosis of cancer.17
Cancer or simply the thought of cancer may cause stress which may result in
depression. A study was conducted among 578 women with early stage breast cancer
revealed that those who reported hopelessness and helplessness were more likely to
relapse or die within 5 years compare to the patients who seeks the spiritual wellbeing
and other alternative therapy to find hope in life .18
Recently some studies explored the association between spirituality and
depression among 162 terminally ill cancer patients. Nelson in the year of 2002 found
the existence of a positive relationship between spiritual well being and depression
from his study among cancer patients. The power of spirituality is that it can provide a
frame work through which someone may interpret events to help self understanding
and ability to cope with unpleasant and unavoidable circumstances without becoming
depressed.19
A qualitative study conducted among 3 Malaysian women with breast cancer, to
understand their experience with spirituality and transformation on as they cope with
the challenges of breast cancer .Data were gathered using in-depth interview .Study
discussed in the context of 2 broad areas like what are the new meanings these women
discovered in their experience with cancer and how did the new meaning changed
their lives? The study suggest that cancer survivors, experience with cancer and
learning process must be understood within the appropriate cultural context. This is
especially for spirituality. The common emphasis of spirituality on relationship with
7
god, self and others, may significantly influence how people learn to live with
cancer20.
In spite of the person who is suffering from depression may think it is actually
very easy to overcome depression from a spiritual point of view. The use of religious
or spiritual coping strategies may be particularly prevalent when dealing with stress of
cancer diagnosis. However there has been very little research conducted about
spiritual well being and depression in chronic illness like cancer. Hence the
investigator chosen the study to assess the relationship between spiritual wellbeing in
reduction of depression among cancer patients and motivate the patients to engage in
more spiritual activities and to contribute the result to the professional body of
knowledge which the nurses can implement in caring of the cancer patients.21
6.2 REVIEW OF LITERATURE:
A literature review is a body of text that aims to review the critical points of
current knowledge including substantive findings as well as theoretical and
methodological contributions to a particular topic. Simai Haji Mati was quoted saying
that literature review should be referred to as reviewing and analyzing the work of
literature in relation to the specified topic in research. A well-structured literature
review is characterized by a logical flow of ideas; current and relevant references with
consistent, appropriate referencing style; proper use of terminology; and an unbiased
and comprehensive view of the previous research on the topic.22
8
Depression among cancer patients
A descriptive study
conducted on 266 consecutive patients at a range of
inpatient &outpatient setting including home care,hospice,private and tertiary care
hospitals from 1st march to 30th June 2002 in western Australia and new south
wales.The tool used for the study was hospital anxiety & and depression scale(HADS)
and subscale for possible cases. The result showed that from the whole sample 45.8%
of patients were possibly depressed and 36.9% were possibly anxious .Study concluded
by highlighting the need for routine screening for anxiety and depression in cancer care
centers. 23
A longitudinal study was conducted to investigate the incidence of cancer
related depression and its relationship with the quality of life.262 in- patients with
cancer of digestive system including pancreatic, liver, esophagus gastric and
colorectal cancer from Guangzhou hospital, china were the samples of the study
between June 2007 to June 2009.The Hamilton rating scale for depression was used to
assess depression.24 questionnaire was used to analyze the degree of depression.
Quality of health of all patients was evaluated by EORTC QLQ-C30.The result
showed that digestive cancer patients have higher incidence of depression .Among
this pancreatic cancer suffers from increased depression compared with other kind of
cancer patients. Cancer patients with depression in role, emotional and social
functioning were sharply poorer than those without depression .The study concluded
that depressive symptoms of cancer lower the quality of life.24
9
A study was conducted in Australia among 60 cancer patients (30
men+30women) aged 45 years and above to assess the severity of psychological
depression in cancer patients. Kessler psychological depression scale was used to
assess the depression. The result showed that 7.57% of participants had high level of
depression psychologically. The study concluded that the risk of psychological
depression among cancer patients strongly increases with the level of disability25
A cross sectional case control study design was used among severely or
terminally ill cancer patients in Kathmandu, Nepal. The aim of the study was to assess
the prevalence of depression and anxiety among them. The tool used was structured
performance general health questionnaire and hospital anxiety and depression scale
(HADS). The study revealed that depression was present in 28%of cancer patients26.
Depression and spiritual wellbeing among cancer patients
A cross sectional study was conducted among chronic cancer patients in USA to
identify the relationship between spiritual wellbeing and depression .The study
included 60 patients aged 60 years or older with chronic cancers. Spiritual wellbeing
was measured using the total scale and two subscales of the functional assessment of
chronic illness therapy, spiritual wellbeing scale. Depression by using the geriatric
depression scale (GDS-SF).Finally the study revealed that 32% had clinically
significant depression (GDS-SF>4).Greater spiritual wellbeing was strongly inversely
correlated with depression .In particular, greater meaning, peace was strongly
associated with less depression. So researchers concluded that enhancement of patients
sense of spiritual wellbeing might reduce or prevent depression. So the quality of life
also will be improved in the population.27
10
A cross sectional study was conducted among 50 patients with advanced cancer
to recognize the influence of spiritual wellbeing (spwB) on symptoms of distress,
depression and other dimension of quality of life with advanced cancer. The
instruments used for this study were visual analogue scale for pain (VAP), hospital
anxiety depression scale (HADS).Functional assessment of cancer therapy, palliative
care (FACT-pal) and functional assessment of chronic illness therapy spiritual
wellbeing .Results of the study showed that depression and anxiety were negatively
correlated with spiritual wellbeing. The study concluded that spWB is an important
component of quality of life in advanced cancer patients and is closely related to the
physical and psychological symptoms of distress. Study suggests that it should be
adequately and appropriately addressed in cancer treatment and care.28
A study was conducted among lung cancer (n=88) and large bowel cancer
patients (n=56) in Australia. The goal of the study was to establish whether a spiritual
perspective is correlated with more effective coping skills and intra psychic process.
The result showed that significant correlation among inner spirituality, spiritual coping
and spiritual wellbeing. The patients with high spirituality are more prone to develop
their potentiality and capacities .They have more effective coping with stressful
situations .The profile of patients with lower intrinsic spirituality and spiritual coping
scores suggest ineffective coping with high risk of depression. The study concluded
that the presence of a spiritual dimension may be a marker of patients with good
adaptation to cancer treatment.29
A study was conducted in Japan among 68 terminally ill cancer patients
randomly allocated to a short term life review interview group or a control group .The
11
patients completed questionnaire pre-post treatment, including the meaning of life,
hospital anxiety and depression scale(HADS),a numeric scale for psychological
suffering and items from the good death inventory (hope,burden,life completion and
preparation)intervention group showed significally greater improvement compared
with those of control group. The study concluded that the short term life review is
effective in improving the spiritual wellbeing of terminally ill cancer patients and
reducing psychological distress and promoting good death30.
A qualitative study was conducted among 14 cancer patients to understand the
relationship between spirituality and cancer under cancer patient perspectives. The
subjects analyzed according to inductive thematic content and the result showed that
cancer patients search spirituality as a way to cope with the disease aiming to minimize
their suffering or obtain a higher hope of cure with treatment. Finally the study revealed
the importance of recognizing spirituality as a coping strategy in planning care31.
A mailed cross sectional survey was conducted among 614 cancer survivors
identified through the Pennsylvania cancer registry. The subjects were 3 - 4.5 years
postdiagnosis.The aim of the study was to assess the characteristic of spiritual health
following a cancer diagnosis and to evaluate the relationship between spiritual change
and quality of health. The results showed that although large proportions of individuals
reported that cancer had positively affected their spiritual wellbeing (40.3%
experienced highly positive spiritual change, 68%felt high sense of purpose,
75.9%reported being very hopeful. The study concluded that having cancer affects
many different aspects of spiritual wellbeing, both positively and negatively. The
positive change in spiritual wellbeing also improves the quality of life32
12
A cross sectional study was conducted among prostate cancer patients in Goa to
find out the role of spirituality in relationship between religiosity and depression .367
men (average age between 60-70) with prostate cancer completed measures of
religiosity, spiritual wellbeing, quality of life and depression. The result showed that
there was a small relationship between intrinsic religiosity and depression (r=0.23,p<0.05) but a strong association between spirituality and depression (r=0.58,p<0.001).The study concluded that when examining religiosity and spirituality ,the
main component that may help to reduce depression is sense of meaning and peace in
life. This result highlights the potential importance of developing spiritual wellbeing
through interventions33.
6.3 STATEMENT OF THE PROBLEM
A correlational study to explore the relationship between spiritual wellbeing and level
of depression among chronic cancer patients in selected hospital, Bangalore.
6.4 THE OBJECTIVES OF THE STUDY
1. To assess the spiritual wellbeing of the chronic cancer patients.
2. To assess the level of depression among the chronic cancer patients.
3.
To explore the relationship between spiritual wellbeing and level of depression
among chronic cancer patients.
4.
To find the association between level of depression in cancer patients with
selected demographic variables.
5. To find the association between spiritual wellbeing in cancer patients with selected
demographic variables.
6.5 HYPOTHESES:
H1 - There will be significant level of depression among cancer patients.
H2-There will be significant spirituality among cancer patients.
13
H3 - There will be significant relationship between spiritual wellbeing and level of
depression among cancer patients.
H4
-
There will be significant association between depressions with selected
demographic variables.
H5 - There will be significant association between spiritual wellbeing and selected
demographic variables
6.6ASSUMPTIONS:

Cancer patients are able to express their spiritual wellbeing and depression

Cancer patients may have depression compared to other patients.

Spirituality may help to develop positive attitude towards life.

Spirituality will have an important role in reducing depression in cancer patients.
6.7OPERATIONAL DEFINITIONS
Correlational study- It is a study to find out the significant relationship between
spiritual wellbeing and level of depression among selected chronic cancer patients.
Spiritual wellbeing- Sense of peace and satisfaction in life attained by the individual
due to the personal relationship with the god.
Depression- It is a psychological state of an individual with the feeling of helplessness,
hopelessness, worthlessness and dissatisfaction about life which occurred due to
cancer.
Cancer patients- In this study it refers to patients who are admitted in the hospital
diagnosed with chronic cancers like breast cancer, lung cancer, gastric cancer,
colorectal cancer .cervical cancer and oral cancer
14
6.8 DELIMITATIONS
The study is delimited to

Cancer patients with selected chronic cancer conditions.

Cancer patients in selected cancer hospital ,Bangalore

4 weeks period of data collection.

60 chronic cancer patients.
7. MATERIALS AND METHOD OF STUDY
7.1 SOURCES OF DATA:
Chronic cancer patients of selected cancer hospital, Bangalore.
7.2 METHOD OF COLLECTION OF DATA
7.2.1 TYPE OF STUDY/RESEARCH APPROACH
Non experimental descriptive correlational approach.
7.2.2 RESEARCH DESIGN
Descriptive correlational design.
7.2.3 VARIABLES

Research variables-spiritual wellbeing and level of depression of cancer patients.

Attribute variables- age, sex, economical status, educational status, family,
supportive system.
7.2.4 SAMPLING TECHNIQUE
Purposive sampling technique.
7.2.5 SAMPLE AND SAMPLE SIZE.
60 cancer patients with selected chronic conditions.
15
7.2.6 SELECTION CRITERIA
Inclusion criteria

Cancer patients who are willing to participate in the study

Cancer patients with selected chronic cancer conditions.

Cancer patients who can understand Kannada and English.
Exclusion criteria

Cancer patients who are not willing to participate in the study.

Patients who are not able to express spirituality and depression.

Patients who are not able to understand English and Kannada.
7.2.7 DURATION OF THE STUDY
One month of data collection.
7.2.8 TOOL OR INSTRUMENTS
Section A: socio demographic data.
Section B: standardized depression scale.
Section C: standardized spiritual wellbeing scale.
Section D: self administered structured questionnaire.
7.2.9 DATA COLLECTION PROCEDURE.
After obtaining formal permission from the concerned hospital authorities, the samples
will be selected by purposive sampling technique. Written consent will be taken from
the participants after explaining the purpose of the study. Data will be collected from
the patients who are able to understand the questions through self administered
structured questionnaire.
7.2.10 PLAN FOR THE STATISTICAL ANALYSIS:
The data obtained will be tabulated and analyzed in terms of objectives of the study by
using descriptive and inferential statistics .The plan of data analysis is as follows
Descriptive statistics
a. Frequency and percentage distribution will be used to identify the demographic
variables.
16
b. Mean; mean percentage and standard deviation will be used to assess spiritual
wellbeing and level of depression.
Inferential statistics
a) Karl pearsons coefficient of correlation will be used to find out the relationship
between spiritual wellbeing and level of depression.
b) “Chi-square” test will be used to find the association of spiritual wellbeing score
and level of depression with selected demographic variables.
7.3 Does the study require any investigation or intervention on patient or human
/animal .if so describe briefly
Yes, with prior consent study will be conducted on cancer patients for assessing the
spiritual wellbeing and depression level at selected cancer hospital, Bangalore.
7.4 Has ethical clearance been obtained from the institution?
Yes, ethical clearance from the institution will be obtained from concerned authorities
and written consent will be taken from subject. Confidentiality and anonymity of the
subject will be maintained.
17
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nursing ,Elsevier publications limited New Delhi. p.1033-5.
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17];17(3):32-7. Available from URL: http://www.cancerlynx.com/spiritheal.html.
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from: URL:http://www.medscape.com/
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advanced breast cancer. Reling Health .2011 Mar; 50(1):36-5.
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21
SIGNATURE OF CANDIDATE
9.
‘Where there is no hope for healthy
REMARKS OF THE GUIDE
life, then the only hope is God to
10.
lead peaceful life’. This study
explores the relationship between
spirituality and depression. The
study will be a good contribution to
the nurses while handling the
chronic ill patients.
NAME AND DESIGNATION OF
Mrs. S. Jayasree
Assoc. Prof.
Medical Surgical Nursing
11.1. GUIDE
SIGNATURE
11.2.
CO-GUIDE
11.3.
SIGNATURE
11.4.
HEAD OF THE DEPARTMENT
Mrs. S. Jayasree
Assoc. Prof.
Medical Surgical Nursing
11.5.
SIGNATURE
11.6.
REMARKS OF PRINCIPAL
It is a relevant study to provide
evidence based research in
implementing spirituality among
chronically ill patients.
12.1.
12.2
SIGNATURE
22