Breast Cancer: Research Proposal

Background and Significance of the Problem

Breast Cancer develops when cells which are usually produced in an orderly fashion, begin to multiply or divide uncontrollably (National Health Service, 2012). This disease exhibits diversity comprising of many biological physiognomies. From the 20th century, there has been an increasing prevalence of breast cancer across the globe. According to the World Cancer Research Fund (2018), breast cancer is the most common cancer among women and is the second most prevalent cancer overall. In 2018, 2 million new breast cancer cases have been reported (World Cancer Research Fund, 2018).

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Even though the prevalence of breast cancer is high, it has been reported that breast cancer mortality has been decreasing over the years (O 'Sullivan & Mansour, 2015). For instance, in Europe, a 15.8% decrease in breast cancer-related deaths have been reported since the 1980s (Watts, 2013). It is also worth noting that the survival rate of breast cancer has improved from 54% in 1971 to 84% in 2012 (Office for National Statistics, 2013). Decreased mortality and improved survival rates have been attributed to early detection and diagnosis as well as advancement in treatment (Schopper & de Wolf, 2009).

Despite increased survival rates, cancer treatments decrease the quality of life of the patient leading to psychological and emotional distress. A cancer diagnosis has also been reported been reported to be a crisis period for both the patients and their families because of its emotional effects (Schopper & de Wolf, 2009). Consequently, the proposed research is essential because it helps in the identification of the emotional problems faced by breast cancer patients and their families. Knowledge of emotional difficulties is vital in ensuring that both the patients and their families are provided with appropriate psychological and emotional support services.

Statement of the Problem and Purpose of the Study

Breast cancer mortality and survival rates keep decreasing. However, despite these promising improvements, declined patients' quality of life has been reported to have emotional consequences on the patients and their families. Consequently, it is important to investigate what these emotional effects entail. Because of this, the proposed study is aimed at examining the emotional impacts of breast cancer on the patients and their families.

Theoretical Framework

Overview and Guiding Propositions

The proposed study will be guided by Restorative Model of Well Being. This model is based on the assumption that the process via which individuals maintain their sense of well-being undergoes destabilization when an individual face a problematic external event (e.g., when he or she becomes sick) or internal states, e.g. mood states (Hoffman, Lent, & Raque-Bogdan, 2013). The model integrates many variables that have been associated with coping and emotional recovery, starting with the acknowledgement of significant stressors and related coping strategies, self-efficacy beliefs, environmental supports, and personality factors that may influence psychosocial adjustment. In this model, the key dependent variables are satisfactory problem coping indicators (Hoffman et al., 2013).

Application of Theory to Study Focus

In apply the restorative model of subjective well-being to breast cancer, the problematic events start when the patient is diagnosed with breast cancer. Diagnosis of the patient with cancer is regarded as the focal event. However, based on the type and stage of cancer, many other problematic events can follow leading to a redefinition of the initial event and altered internal states. For instance, in women with stage 1 breast cancer, diagnosis may, immediately, be followed by a lumpectomy (which signifies the end of the treatment and the start of recovery). For other people living with breast cancer, the initial problematic event (symptoms of the disease of diagnosis) may undergo redefinition depending on biopsies indicating a more advanced cancer (Hoffman et al., 2013).

Literature Review

According to Conley, Bishop, and Andersen (2016), emotional distress in cancer patients is an important outcome in cancer survivors. Different types of emotions may be shown by cancer patients; positive and negative emotions. Some of the examples of positive emotions include hope and gratitude. On the other hand, negative emotions may be manifested through mental disorders, e.g. anxiety and depression (Conley et al., 2016). Emotional problems of cancer patient survivors are also diverse. They include stress management, defining a new sense of normal, living with uncertainties, and recurrence of the disease (Ness et al., 2013). It has also been established that major depressive disorder is prevalent in breast cancer patients (Su et al., 2017).

The diagnosis of cancer has also been reported to be a family experience that alters the lives of all its members. According to Wozniak and Izycki (2014), diagnosis of a family member with cancer brings a lot of stress and difficulties to the whole family. Specifically, the family's daily schedule, common activities, and sharing of duties changes following diagnosis of cancer. Family members follow all the stages of the disease, usually exhibiting comparable suffering or can even experience more distress than the patient. Cancer can also traumatize the adolescents and the children and leads to physical and psychological impairments on the family members (Wozniak & Izycki, 2014).

Moreover, in a study conducted by Kucko (2011) aimed at examining the effect of breast cancer diagnosis on patients' inter-relationships, it was established that cancer diagnosis made the relationship between the patient and the family members stronger. It also enhanced communication between the patient and family members. Following the diagnosis, it was also established that 63% of the women diagnosed with cancer received emotional support from their husbands. More than 96% of women diagnosed with cancer reported having received excellent support system. Lastly, most of them (75.8%) reported having had satisfying relationships after being diagnosed with cancer.

Research Questions, Hypothesis, and Variables

The following research question will guide the proposed study: Does breast cancer has a psychological and emotional impact on the patients and their families? On the other hand, the research hypothesis is that breast cancer has psychological and emotional effects on both the patients and their families. In this case, the independent variable of the study is breast cancer while the dependent variables are psychological and emotional impacts.

Methodology

Sample/Setting

The prospective participants will comprise of women who have been diagnosed with cancer. The participants will be recruited from cancer hospitals, which will be the setting of the proposed study. The sample will be picked purposefully.

Sampling Strategy

The participants will be selected for the study through purposive sampling technique. Purposive sampling is a non-probability sampling technique in which the participants are selected for a study based on the possession of the characteristics of attributes needed to address the objectives of the study. This sampling approach is useful in identifying and selecting information-rich cases related to the phenomenon being studied. Using a purposive sampling technique, only participants who have been diagnosed with breast cancer, and not any other type of cancer, will be chosen for the study.

Research Design

The proposed study will employ a prospective cross-sectional design to examine the association between breast cancer and emotional/psychological factors.

Extraneous Variables

The extraneous variables in the proposed study include the presence of psychological disorders among the family members or the patients that are not linked to the current diagnosis of breast cancer. Examples of these disorders include anxiety, depression, and stress.

Instruments

The effect of breast cancer on the emotional and psychological aspects of the patients and family members will be assessed using the Perceived Stress Scale (PSS) and the Hospital Anxiety and Depression Scale (HADS). The PSS, which has a Cronbach's a of 0.82, will be used to assess participants' stress levels (Yeh & Lee, 2016). On the other hand, HADS, which has a Cronbach's a between 0.74 and 0.70 will be used to assess participants' anxiety and depression (Yeh & Lee, 2016).

Description of the Intervention

There will be no intervention in the proposed study. This is because the variables of the study (breast cancer and psychological/emotional factors) cannot be manipulated for ethical reasons. Also, it is impractical to manipulate these variables.

Data Collection Procedures

The first step of data collection will involve explaining to the participants why the current study is being conducted. After explaining the study protocol, participants will be asked to complete both the PSS and the HADS questionnaires.

Data Analysis Plans

Statistical analysis will be performed using SPSS (Statistical Product and Service Solutions) version 20.0. A level of significance of 5% will be used to determine the validity of the data. Descriptive statistics, especially the mean and the standard deviation, will be conducted in SPSS to determine the participants'' stress, anxiety, and depression level following the diagnosis of breast cancer.

Ethical Issues

The proposed study will be conducted in strict adherence to the ethics of research study involving human participants. First, before the study is carried out, ethical approval will be sought from the University's Institutional Review Board and the study hospital. Secondly, participation in the proposed study will be voluntary. Consequently, the participants will be free to withdraw from the study at any time. Thirdly, the subjects' data will be kept confidential and anonymous. Lastly,

Limitations of the Proposed Study

The proposed study is not without flaws. One of the limitations of the proposed study is the use of non-probability sampling techniques in the recruitment of the participants in the study. The main drawback of purposive sampling is that because it is a non-probability sampling approach, the findings of the study will not be generalizable or will have low external validity. Additionally, non-probability sampling is associated with sampling bias.

Implications for Practice

The findings of the proposed study will be useful in developing effective strategies for alleviating the negative psychological or emotional impacts that may be associated with breast cancer diagnosis. Because of the presence of various psychological problems, both on the patients and their families, following a diagnosis of breast cancer, nurses should be trained to offer the necessary counselling. Additionally, hospitals should have counselling departments with support staff who are ready, at all times, to provide support services to families and patients of breast cancer.

References

Ali, A., Fergus, K., Wright, F. C., Pritchard, K. I., Kiss, A., & Warner, E. (2014). The impact of a breast cancer diagnosis in young women on their relationship with their mothers. The Breast, 23(1), 50-55. https://doi.org/10.1016/j.breast.2013.10.004

Conley, C. C., Bishop, B. T., & Andersen, B. L. (2016). Emotions and emotion regulation in breast cancer survivorship. Healthcare, 4(3). https://doi.org/10.3390/healthcare4030056

Hoffman, M. A., Lent, R. W., & Raque-Bogdan, T. L. (2013). A social cognitive perspective on coping with cancer: theory, research, and intervention. The Counseling Psychologist, 41(2), 240-267. https://doi.org/10.1177/0011000012461378

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