Perceived growth following gynecological cancer and its associated factors from the perspectives of Chinese women, spouses, couples and registered nurses

Sammanfattning: Gynecological cancer (GC) is the most common cancer diagnosis among women, globally, including China. Women who experience a diagnosis of GC, their spouses, the couples as a unit, as well as registered nurses (RNs) caring for these women, all face different challenges during this cancer trajectory. Prior to this study, few studies have explored the factors associated with perceived growth among women diagnosed with GC, their spouses, and couples, as well as RNs caring for these women, based on a growth-related theory and model. The overall aim of this thesis was therefore to explore perceived growth and its associated factors, based on these persons’ perspectives.Four studies (Study I–IV) ) were conducted, each using a cross-sectional and descriptive study design. In Study I, women’s posttraumatic growth (PTG) and its associated factors were explored. Data were collected through 344 questionnaires and analyzed by using binary stepwise logistic regression. In Study II, spouses’ PTG and its associated factors were explored. Data were collected through 312 questionnaires and analyzed by using multiple regression analysis. Study III explored the actor effects and partner effects of perceived social support on PTG among couples where the woman had been diagnosed with GC. Data were collected with 126 couples using questionnaires and analyzed by using Structural Equation Modeling. Study IV described the perceived professional benefits and explored the association between perceived professional benefits, sense of coherence, and coping strategies in RNs caring for women diagnosed with GC. Data were collected with 250 RNs using questionnaires and analyzed by using multiple regression analysis.The results indicate that women’s self-disclosure was positively associated with their PTG. Confrontation coping strategies, avoidance coping strategies, problem-focused coping strategies (e.g., active coping, instrumental support, and planning), and dysfunctional coping (e.g., denial, behavioral disengagement, self-distraction, and venting) were positively associated with perceived growth. Perceived social support was positively associated with PTG in both women diagnosed with GC and their spouses. Spouses’ perceived social support was positively associated with women’s perceived social support and women’s PTG. In addition, sense of coherence was positively associated with RNs’ perceived professional benefits.Based on the findings from this thesis, it is concluded that RNs need to encourage these women and their spouses to communicate their feelings, concerns, and supportive care needs, with other family members and loved ones. RNs also needs to pay more attention to the spouses’ supportive care needs, so that they are able to better support these women. It was shown that integrating effective coping strategies into existing cancer care practice may help couples to cope with the challenges related to GC. Furthermore, RNs should consider women and their spouses as a whole unit to provide effective care, and to help couples as a unit to re-evaluate their understanding of what really matters in their life. In addition, there is a need to help RNs to promote the nurse–patient relationship and a sense of belonging to the work team in their nursing practice.