Introduction
Cancer causes physical disabilities and psychosocial
problems. There are short- and long-term compliance
difficulties and periods of aggravation. According to
the World Health Organization’s (WHO) International
Agency for Research on Cancer (IARC) data for 2012, there were 14.1 million new cancer cases and 8.2 million
cancer deaths around the world. Some 8 million
cancer cases occurred in developing countries.[–]
In Turkey, roughly 175000 people were diagnosed
with cancer in 2012. Of the newly diagnosed cases,
two-thirds occurred in men and one-third occurred in
women.[]
The most common urinary tract cancers in Turkey
are prostate cancer, bladder cancer and renal cancer.
The most frequent types of cancer diagnosed in males
are prostate, lung and bladder cancers, respectively.
However, breast cancer is more common than urinary
tract cancers among females. The frequency of urinary
tract cancers in males is 36.1 in 100000 for prostate
cancer, 21.4 in 100000 for bladder cancer and 6.3 in
100000 for renal cancer. While the frequency of urinary
tract cancers is 28.3 in 100000 for men, this frequency
is only 6.5 for women.[,]
Cancer affects people physically, emotionally, and
socially, and it causes important compliance problems
and disorders. Cancer patients experience fear, despair,
guilt, helplessness, excruciating pain, and fear of abandonment
and death. These experiences vary with the
progress of the stage of disease and individual reactions.
Patients’ individual care, maintenance of autonomy in
terms of role functions, analysis of psychological and
social compliance problems, individual patient support
systems (family, friends, and healthcare workers), and
improvement of functionality should all be included in
the general principles and methods of teaching patients
to live with cancer.[,]
Cancer diagnosis causes serious psychological social
problems and workforce loss, not just for cancer
patients, but also for their relatives and for society.
Social support plays an important role in health promotion
and in reducing pressure on cancer patients.
Social support positively affects wellbeing, feelings of
belonging, overcoming stress, physical health, and selfconfidence.[,]
The feelings that cancer patients experience are
traumatic. This disease shakes patients’ adaptation
mechanisms and disrupts their expectations and plans.
[] During this traumatic experience, positive reactions
of cancer patients affect their recovery period
positively, and hope is an important positive reaction.
[] Hope has an important place in the adaptation
of cancer patients to the disease and their compliance
with treatment.[] Hope can prevent pessimism and
feelings of despair by improving cancer patients’ motivation
and contributing positive life energy.[]
Professional healthcare workers have an important
and vital role in cancer patients’ acceptance process.
This role in treatment and care facilitates patients’ acceptance
of treatment, accelerates their recovery, and
positively affects their quality of life (QOL) by improving
motivation and morale.[] Psychosocial support
is important to help cancer patients comply with treatment
and improve their QOL.[] To help patients effectively, interventions that respond to the problems
and needs of cancer patients should be planned using
teamwork. Nurses who care for cancer patients should
know that psychosocial support is an indispensable
part of treatment and care, and they should be able to
plan interventions to meet these needs.
This study was conducted to determine the social
support perceptions and hope levels of uro-oncology
patients in treatment for cancer, and to analyze how
they vary according to sociodemographic variables
such as age, gender, marital status, education, and employment
status.
Methods
Type of research
This descriptive research using regression was carried
out in the urology polyclinic of a hospital in Konya,
Turkey, between June and August 2013.
Population and sample of the study
The study population included 160 uro-oncology patients
being treated in the hospital unit. Of those, 143
were over 18 years of age, had no communication difficulties,
agreed to participate in the research, and were
included in the study sample.
Data collection tools
A questionnaire to record patients’ socio-demographic
characteristics and opinions on their disease, the
Multidimensional Scale of Perceived Social Support
(MSPSS), and the Hope Scale were used as data collection
tools.
Questionnaire: The researchers developed the questionnaire
after a review of the literature. It includes
questions about patients’ socio-demographic characteristics
and information about their disease.[,] Patients’
age, gender, marital status, education, employment
status, disease duration, number of dependents
and belief about their disease being treatable were recorded
using this form.
The Multidimensional Scale of Perceived Social
Support (MSPSS): This scale was developed by Zimet
et al. (1988).[] This 12-item self-assessment scale
measures the sufficiency of individuals’ sources of social
support. It is a 7-point Likert-type scale on which
responses can range from “Strongly Disagree” (1) to
“Strongly Agree” (7). This scale measures perceived
sources of social support in 3 sub-dimensions including
family, friends and significant other. The minimum possible score on the sub-scales is 4, and the maximum
is 28. The minimum possible score on the entire scale
is 12, and the maximum is 84. Higher scores indicate
high levels of perceived social support. Validity and reliability
analyses of the scale in Turkey were performed
by Eker and Arkar (1995).[] The Turkish version of
the scale also consists of three sub-scales for sources of
social support (family, friends, and significant other)
and 12 items. The reliability factors of scale revised by
Eker et al. (2001) were found to have high consistency
levels, ranging from 0.80-0.95. It is a valid and reliable
tool.[]
The Hope Scale: The Hope Scale was developed
by Snyder et al. (1991) to measure the hope levels of
people and was adapted to Turkish by Akman and
Korkut (1993).[,] A study was conducted to determine
reliability of the scale. Its internal consistency
was assessed according to responses received by a
group of 103 students at Hacettepe University, and its
internal consistency coefficient was .65 (p<001). This
coefficient value was found adequate and the scale
was administered twice, four weeks apart, to a group
of 74 students at Hacettepe University Faculty of Education
in the spring term of the 1991-1992 academic
year. This 4-point Likert-type scale consists of 12 items.
When scoring the scale, the filler items (3, 5, 6, 11) are
ignored and a single score for each participant is obtained
by adding scores on other items. Assessment is
made using these scores. The minimum possible score
on the scale is 8, and the maximum is 32.[]
Ethical considerations
Verbal consent was obtained from the uro-oncology
patients after explaining the aim of the research to
them. This study adhered to the principles of confidentiality
and voluntary participation. The necessary permissions
and ethics committee consent for the research
were obtained from the hospital administration.
Data assessment
Statistical analyses were performed using SPSS software
(version 21.0; SPSS Inc., Chicago, IL, USA). Percentages,
averages and standard deviations were used
to assess patients’ sociodemographic characteristics
and opinions on their disease. Mann-Whitney U test
and Kruskal-Wallis test were used to assess their levels
of social support and hope. Pearson’s correlation
test was used to examine differences between mean
scores, and p<0.05 was used as the threshold for significance.
Results
Men made up 84.6% of the participants, and 94.4%
were married. Of the total, 64.4% had education level
of primary school or less, and 68.5% were unemployed.
It was found that 72.4% of the patients had dependents
residing in their home, and 63.6% thought their cancer
was treatable. The study found that in 90.9% of
cases, the period of disease duration was in the 1 to
24 months interval, and that 81.1% of patients received
the most support from their families (Table 1), compared
to other sources of support.
Table 1: Descriptive characteristics o fthe patients
The patients’ mean MPSS multidimensional perceived
social support score was 62.14±14.99, and
their mean hope level score was 20.62±4.50. The male
mean multidimensional perceived social support score
and hope level mean score were determined to be
62.51±15.40 and 21.14±4.40, respectively. The female
mean multidimensional perceived social support score was found to be 60.09±12.61, and their mean hope level
score was 17.77±4.04. The mean scores on the MSPSS
were 23.60±5.17, 19.94±6.74 and 23.60±5.17 for family,
friends, and significant other sub-dimensions, respectively
(Table 2).
Table 2: Total sub-group mean scores on the MSPSS
(n=143)
The study did not find a significant difference between
patient gender, marital status, education, duration
of disease, belief that their cancer is treatable, employment
status, number of dependents and support,
and their multidimensional perceived social support scores (p>0.05). Univariate analysis of mean hope level
score found it to be significantly higher in male patients
(Z=-3.354; p=0.001) than female patients. It was
also higher for patients with dependents (Z=-2.422;
p=0.015) and for patients who believed their cancer
was treatable (Z=-3.987; p=0.000) (Table 3).
Table 3: The distribution of patients’ scores on the multdimensional scale of perceived social support and the hope scale
by their sociodemographic characteristics (n=143)
According to the distribution of sub-dimension
scores by sociodemographic characteristics, perceived
social support levels of both patients with dependents
and patients who believed their cancer was treatable were significantly higher (Z=-2.071, p=0.038; Z=-
4.020, p=0.000) (Table 4).
Table 4: The distribution of patients’ sub-dimension scores on the MSPSS by their sociodemographic characteristics
A very slight correlation was found between the
uro-oncology patients’ multidimensional perceived social
support scores and their hope level scores (r=0.132;
p=0.115) (Table 5).
Table 5: The distribution of the relationship between
patients’ hope scores and multidimensional
perceived social support scores
Discussion
Patients’ mean multidimensional perceived social support
score was relatively high at 62.14±14.99 on a scale
of 12 to 84. Dedeli et al. (2008) conducted a study that
found cancer patients’ scores on a social support scale
to be high.[] Similarly, Tan et al. (2005) carried out
a study with hemodialysis patients, and Arslantas et al.
(2010) conducted a study with in-patients, and they
both found that patients’ mean social support scores
were more than moderate and close to the high level.
[,] Social support for cancer patients was mostly
provided by their families. Although there is currently
a transition from extended to nuclear families, strong
family ties and the participants’ characteristics may
be a factor in high scores on perceived social support
scale. Social support is an important variable, especially
for physical and psychological adaptation of cancer
patients. Landmark et al. (2002) carried out a study of
women with breast cancer and determined that their
most important sources of social support were their
families and their friends.[] A similar study found
that Iranian cancer patients’ perceptions of social support
were at high levels, and that their main source of
support was family members.[]
The current study also determined that hope level
scores of uro-oncology patients were more than moderately
high. Aslan et al. (2007) conducted a study to
determine hope levels of cancer patients and found that
their hope scores were higher than moderate level.[]
Jo and Son’s study (2004) of cancer patients’ QOL, hope,
and uncertainty found a similar result.[] Arslantaş et
al. (2010) also found moderate levels of hope in a study
conducted with in-patients.[] The results of the present
study and other research are similar.[,,]
Hope levels of patients are higher than moderate level
when they were expected to be low. Hope scores may
have been higher than moderate level because hope is a
factor that improves motivation for treatment.
Hope scores of male patients were higher than
those of female patients, and the difference was significant.
Most studies have similarly found that hope
levels of cancer patients did not differ by gender.[,]
Moreover, patients’ mean hope level scores were high
for those with dependents and those who think their
cancer is treatable. Knowledge about cancer is important to reduce patient fears and to eliminate doubts.
Patients who think they will die from cancer will understand
that cancer is treatable if they are given accurate
information. Most studies show that hope levels
of cancer patients who have adequate knowledge about
cancer are high. This makes knowledge important for
coping with cancer and the emotional problems it
causes.[,]
Social support is one of the most important factors
in the hope levels of cancer patients. Social support and
hope are important sources of positive thinking. There
are some studies showing that as patient social support
levels increase, so do their hope levels.[–] Unlike
these studies, Fadiloğlu et al. (2006) conducted a study
of the relationship between hopelessness levels of women
with breast cancer and their coping behaviors and
determined that social support had no effect on levels of
hopelessness.[] The present study found a very slight
correlation between multidimensional perceived social
support scores and hope scores, although both are above
moderate level. This result may be due to the characteristics
of the participants and the small sample size.
Conclusion
The uro-oncology patients’ high levels of perceived social
support, their positive attitude about cancer and
their responsibilities positively affect hope levels. The
study determined a positive and slight relationship between
patients’ perceived social support and hope levels.
Thus, the study suggests that:
• social support and hope levels of cancer patients
should be determined and programs should be
implemented to improve them;
• cooperation with patient’s family should be promoted
and family members should be included
in treatment;
• patients should be informed about disease process,
treatment, and coping strategies, and sharing
groups should be formed;
• studies of the relationship between cultural features,
hope, and perception of social support,
and qualitative studies that thoroughly research
these issues should be planned and conducted.
Conflict of interest: None declared.
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