Are Gender Differences Exhibited in the Self-directed Learning Experiences of Prostate and Breast Cancer Patients?

A secondary analysis was conducted using data from two qualitative studies regarding the self-directed learning of prostate and breast cancer patients.Of interest were differences that appear to relate to gender. The findings indicate the men and women differed in regard to privacy, seeking connections, handling emotions, and perspectives on the personal impact of their self-directed learning and cancer experiences. Introduction and Theoretical Foundation Self-directed learning is the most common form of adult learning (Merriam & Caffarella, 1999). Tough (1971/1973) estimated that 70 % of adults participate in self-directed learning whereas more recently Livingstone (1999) gages participation at over 95 %. The works of Houle (1961/1993), Knowles (1975), and Tough (1971/1973), are generally credited with generating keen interest in this form of learning that has been identified as one of the hallmarks of the field of adult education (Merriam & Caffarella, 1999). Synonyms for self-directed learning are self-education, independent learning, and selfteaching. However, the most commonly cited definition of self-directed learning comes from Knowles (1975, p. 18), who calls it “a process in which individuals take the initiative, with or without the help of others, in diagnosing their learning needs, formulating goals, identifying human and material resources, choosing and implementing learning strategies and evaluating learning outcomes. ” The link between self-directed learning and personal health is gaining in importance. Studies suggest that more and more patients are assuming responsibility for their own information searches and are not relying purely on the advice of health professionals. According to Gray, Fitch, Phillips, Labrecque, & Klotz (1999, p. 134), “This seems to be the result of converging influences, including a growing distrust of medical authority, historical failures by the healthcare system to provide adequate information, and the ascension of a consumerist philosophy. ” Prostate and breast cancer are common types of cancer that are for the most part gender specific. The exception is that, although rare, it is possible for men to develop breast cancer. The American Cancer Society (2007) estimates that 218,890 new cases of prostate cancer will be diagnosed in the US in 2007 and that 27,050 men will die of the disease. For breast cancer, the projection is for 178,480 cases with 40,460 deaths. Although a tremendous amount of research has been conducted regarding prostate and breast cancer, few studies beyond the work of this researcher (Rager, 2003; Rager, 2004; Rager, 2006) have focused on either of these cancers and the self-directed learning process as defined in the adult education literature. In regard to gender, the publication of In A Different Voice by Carol Gilligan (1982) made a significant contribution to the understanding of female psychology and of women’s learning as distinct from that of men. Gilligan characterized women’s lives as reflecting interdependence as opposed to independence and connection rather than separation. She found that female identity is defined in the context of relationship and is measured against a standard of responsibility and care. Belenky, Clinchey, Goldberger, and Tarule (1986) further suggested that women have characteristic ways of knowing and of constructing knowledge. They coined the term “connected knowing” to characterize their findings. More recently, the notion that men and women differ in regard to their experiences with illness, including cancer, is supported in the literature (Nicholas, 2000; Volkers, 1999). Kiss and Siegfried (2001, p. 1055) state, “Being male or female is an important basic human variable that affects health and illness throughout life. ” Methodology A qualitative research paradigm was used for both studies involved in this secondary analysis. Purposeful sampling (Patton, 1990) was employed for each study to locate informationrich subjects. Selection criteria for the prostate cancer study included being male, English speaking, within five years of prostate cancer diagnosis, and having engaged in a minimum of seven hours of self-directed learning about prostate cancer. For the breast cancer study the criteria were the same with the exception of being female and within three years of breast cancer diagnosis. The time since diagnosis was extended from three to five years for the men because of the protracted nature of prostate cancer treatment and decision making. For both studies, interviews were conducted by this researcher with participants from Wichita, Kansas. The strategies used to insure the credibility of the findings of these studies were prolonged engagement, peer debriefing, referential adequacy, and member checking (Lincoln and Guba, 1985). Sample size for both studies was determined by the researcher’s sense that the point of saturation had been reached (Lincoln & Guba, 1985). Data was gathered from 13 breast cancer and 12 prostate cancer patients. Specifically, the following research questions guided this secondary analysis: Are there differences in the descriptions of the self-directed learning experiences of breast and prostate cancer patients that appear to relate to gender? If so, what are they? Interviews with the participants ranged in duration from one to three hours with the average length being one hour and thirty minutes. Follow-up meetings, emails, or telephone calls to the participants were used to verify information and for member checking. A semi-structured interview format following an interview guide was used to gather data for these studies with each interview tape recorded and professionally transcribed. The constant comparative method (Patton, 1990) was used in analyzing the data in order to identify common patterns related to gender, if they existed. Findings The secondary analysis of the interview transcripts of the breast and prostate cancer patients revealed categories of differences that appear to relate to gender. The differences related to privacy, seeking connections, handling emotions, and perspectives on the personal impact of their self-directed learning and cancer experiences. Men Prefer Privacy Both groups of cancer patients indicated that they used multiple resources in learning about their cancer such as books, the Internet, networking, support groups, survivors, and medical professionals. However, the self-directed learning experiences of the participants in the breast and prostate cancer studies appear to differ considerably in regard to accessing some of these resources because of the issue of privacy. The prostate cancer participants indicated that many men are reluctant to talk about health problems, including prostate cancer. Since gathering information from survivors was identified as key to their self-directed learning efforts, this reluctance was seen as a stumbling block. Brent referred to this as one of the main problems regarding prostate cancer, “. all of us men out there and we’re all afraid to talk about it! ’ The issue of privacy was also exhibited in the participants’ approach to helping newly diagnosed men. Almost all of these prostate cancer patients indicated that they were interested in using what they had learned to help other men. However, even in this regard, most were willing to be responsive when called upon but appeared to want to protect their privacy. For example, Kevin explained, “You don’t basically walk around with a sign on you that says, ‘I have prostate cancer. ’ It’s just one of those macho things. ” Women Want to Connect Privacy did not emerge as an issue for the breast cancer patients. On the contrary, they expressed a strong desire to connect with others. Their stories revealed that their self-directed learning efforts had facilitated meeting not only their cognitive needs but also their need to counteract the loneliness and isolation that can accompany the diagnosis. As Diane said, “The education part is what people need early on, but as you get further out you need the connections and the interaction and just the sharing of your fears and everything. ” For many of the participants, the need for connections was met in support groups. This was particularly powerful for Fran. “I really did need the support group because the first time I went there I totally fell apart. I had not ever cried about the diagnosis and yet I bawled my eyes out that night. That was over a year since my diagnosis. I had finally found a spot where I felt supported. ” Women Openly Express Emotions The women in the breast cancer study were more open about their emotions in this context and appeared to be more comfortable discussing their feelings. The emotional component appeared to be an integral part of the descriptions of their experiences. Gloria explained, “The biggest problem was time. I didn’t feel like I had a lot of time. In that process, I wasn’t dealing with emotions and every once in a while, they would surface and get in the way. The vast amount of information and the quickness that I had to absorb it were problems. I had too much information. I became overwhelmed by ‘paralysis of analysis. ’ That was all complicated by emotions I think. ” Both the breast and prostate cancer participants indicated that their motivations for learning included the need to make informed treatment choices and the desire to understand what they were going to experience so that they could best help themselves cope. However, unlike the men, overcoming the fear of dealing with cancer was commonly identified as a motivation for the self-directed learning of the breast cancer participants. From the women’s descriptions, emotions appeared to influence their motivation to learn, their process of selecting learning resources, the importance they placed on support groups and connecting with survivors and, at times, on their ability to focus on learning at all. Further, their interviews indicated th