The effects of psychoeducation on problem solving skills of cancer patients

What is known about this subject? • Cancer is one of the most common health problems faced today. What is the contribution of this study to the literature? • It is thought that this study will contribute to the literature in terms of creating samples of holistic treatment of patients. What is the contribution of this study to the practice? • The study results can make an important contribution to nurses working in clinical fields and as a psychoeducation program which can provide a good example for nursing care. 76 Psikiyatri Hemşireliği Dergisi Journal of Psychiatric Nursing their immune system. [2,7–9] These problems reduce the life quality of cancer patients, and the increasing emotional and social difficulties extends the recovery period and increases treatment costs. That is why nurses should provide education, social support and counseling services to their patients. Cancer patients reported to use coping methods such as socializing with family or friends, resting, doing regular exercise, having a healthy diet, sharing their feelings and experiences with social support groups, talking with others about their fears, doing fun things and starting a hobby. [10–16] However, cancer patients sometimes use inefficient coping methods during the cancer process such as failure to fulfill role expectations, destructive behaviors towards themselves and others, worries about making plans for the future, fear about their cancer treatment and the side effects, anxiety, reduction in participation in social activities, and insufficiency in meeting basic needs. [15,16] It is important for cancer patients to improve their problem-solving skills during this treatment process. The factors affecting a cancer patient’s ability to cope with these problems include treatment factors such as type, stage, symptoms and of the cancer itself. [2,7] It also depends on psychological factors such as the patient’s ability to adapt to previous diseases, physical and mental resilience, personality traits, current life situations and their methods of coping with problems. This process is also affected by interpersonal factors such as the patient’s cultural and spiritual attitudes and the presence of social, emotional or healthcare team support for the patient. [2,7] The effects of procedures such as psychosocial interventions, cognitive behavioral therapy, individual and group counseling, psychoeducation and support groups were evaluated in the literature for cancer patients. [17–30] There have also been studies conducted abroad in which cancer patients were provided with psychoeducation programs, telephone consultancy and booklet information. [17,31–33] The psychoeducation program supports patients in recognizing and understanding themselves, meeting individual needs, increasing their level of wellness, preventing potential adversities and improving the quality of life. Psychoeducation programs are helpful for patients to contend with anxiety and fear, express their thoughts and emotions, get information, feel less isolated, and to strengthen their concept of self. Psychoeducation practices are effective in reducing the symptoms of depression[7] and anxiety[9] as well as helping cancer patients solve problems. [24,8,34] Psychoeducation aims to help patients to better understand their own situations, to develop their problem-coping skills by increasing their knowledge and incentives for making behavioral changes, to create motivation in performing self-care activities, to prevent complications, to increase the general level of well-being, adaptation and quality of life. [35,36] An important point to consider while structuring a psychoeducation intervention program is that post-treatment stressors trigger more stresses and the problems experienced physically also affects patients socially and psychologically, which in turn threatens their biopsychosocial integrity and ability to problem solve. [37,38] There are only a few studies on nursing interventions for problem-solving in cancer patients and studies mostly only focuses on physical problems of the patients. The present study may contribute to the literature by creating an example of holistic treatment of patients. In addition, the study results may have a significant contribution to nurses and nursing care in clinical areas. This study was conducted to examine the effects of psychoeducation on the problem-solving skills of cancer patients. Materials and Method This study was conducted as a quasi-experimental research with pretest and posttest design. The study was carried out in the radiation oncology department of Manisa State Hospital between April and December 2016. The study population consisted of cancer patients hospitalized in the radiation oncology clinic of Manisa State Hospital. The study sample size was calculated using the Power Analysis. According to the Central Limit Theorem, the study sample size needed to include at least 30 people, but was planned to be 32, taking into account possible drop-outs. Therefore, the study sample consisted of 32 patients who were hospitalized in the radiation oncology clinic and volunteered to participate in the study. Data Collection Tools The data was collected in two stages as pretest and posttest, using the Introductory Information Form developed by the researchers and the Problem Solving Inventory (PSI) developed by Heppner and Peterson (1982). [39] The pretest was performed at the end of the introductory meeting, and the posttest was performed after the 6-week interview period. 1. Introductory Information Form The information form consists of questions about patients’ sociodemographic and disease characteristics, family history of cancer and coping strategies. 2. Problem Solving Inventory (PSI) This 35-item inventory developed by Heppner and Peterson (1982) measures individuals’ perception of their problem-solving skills and can be applied to adolescents and adults. [39] It is a six-point Likert type scale with item options ranging from “I always behave like this” to “I never behave like this”. The items numbered 9, 22 and 29 are excluded from the scoring. The items numbered 1, 2, 3, 4, 11, 13, 14, 15, 17, 21, 25, 26, 30 and 34 are scored in reverse. The Turkish validity and reliability of the scale was performed by Şahin and Heppner (1993). [11] The scale consists of six factors; hasty approach (13, 14, 15, 17, 21, 25, 26, 30, 32), thinking approach (18, 20, 31, 33, 35), avoiding approach (1, 2, 3, 4), evaluating approach (6, 7, 8), self-confidence approach (5, 23, 24, 27, 28, 34) and planned approach (10, 12, 77 Gülsüm Üzüm, Psychoeducatıon in patients with cancer / dx.doi.org/10.14744/phd.2018.74508 16, 19). The total PSI score was used in this study. The minimum and maximum scores to be obtained on the scale are 32 and 192, respectively. There is no cutoff point in the evaluation of the scale. Low scores on the scale indicate greater perception of effective problem-solving ability, or vice versa. [39]