University Research Proposal: Psychological Impact on Cancer Patients

This report presents a research proposal for a qualitative study investigating the psychological impact of cancer on patients. The study aims to explore the coping strategies adopted by individuals diagnosed with advanced-stage cancer and their families. Grounded theory will be used to analyze data collected through interviews with cancer patients in Queensland, Australia. The research questions focus on the strategies used, the psychological effects of cancer, and the effectiveness of these strategies. The literature review highlights existing research on emotional stress, coping mechanisms, and the role of social support in cancer patients' quality of life. The research will involve structured interviews with patients diagnosed with breast, prostate, or bowel cancer. The findings are expected to contribute to a better understanding of the psychological challenges faced by cancer patients and to inform the development of interventions to improve their well-being.

Running head: QUALITATIVE RESEARCH
Research proposal for assessment of psychological impact on cancer patients
Name of the Student
Name of the University
Author Note

1QUALITATIVE RESEARCH
Executive summary
Several studies have been carried out in the concept of emotional stress and inhibition in cancer
populations. Emotional, physical and social disturbances are regarded as potential risk factors in
the onset and recurrence of cancer. It has been found that patients diagnosed with cancer report
or exhibit negative emotions and high levels of distress. A major conceptual issue that lies with
care approaches taken by healthcare professionals and researchers lie in the fact that coping
strategies are largely ignored. These coping strategies are generally adopted by patients who
have been diagnosed with advanced stage of cancer. Some of the strategies such as support and
acceptance are also adopted by the informal carers such as family members and peers. This
creates positive outcomes on their psychological outcomes. This report aims to propose a
research study that will evaluate the psychological experiences of cancer patients by using the
grounded theory of approach.

2QUALITATIVE RESEARCH
Table of Contents
Introduction......................................................................................................................................2
Literature review..............................................................................................................................2
Research question............................................................................................................................5
Theoretical framework.....................................................................................................................5
Research site....................................................................................................................................6
Sample.............................................................................................................................................7
Data generation................................................................................................................................7
Data analysis....................................................................................................................................8
Ethical issues...................................................................................................................................9
Conclusion.......................................................................................................................................9
References......................................................................................................................................10

3QUALITATIVE RESEARCH
Introduction
Social relationships are one of the most studied factors that contribute to quality of life
(QoL) among cancer patients. It is a well recognised fact that cancer diagnosis and its exhaustive
treatment are stressful events and create extreme emotional burden on the patient the family
members. Recent studies have focused on the different psychosocial characteristics of cancer.
Psycho-oncology has shown rapid developments in the past two decades and has led to the
creation of a model that associates oncology with the psychological domain (Crist & Grunfeld,
2013). Being diagnosed with cancer is likely to create severe physical and emotional stress.
Research studies predominantly focus on individual coping mechanisms such as inhibition and
fighting spirit. Coping is therefore considered as the response to a perceived self-threat, such as
life-threatening diseases like cancer. Coping involves several strategies that focus on the problem
such as seeking instrumental support and planning, and targets the emotional distress caused due
to the illness. Strategies like searching for emotional support and acceptance also work to reduce
the distress. These coping techniques lead to the establishment of positive outcomes among
cancer patients and enhance their overall well-being and quality of life (Schmidt et al., 2012).
This research proposal aims to develop a qualitative study based on the grounded theory that will
help to assess how cancer patients cope with their health status.
Literature review
Coping with cancer diagnosis and its treatment is therefore characterized as a dyadic
affair. Several notable researches have been done to evaluate the mechanisms by which cancer
patients cope in their life and the subsequent effects on their quality of life. The PICO framework
was utilized to find clinically relevant evidences (Cooke, Smith & Booth, 2012). For this

4QUALITATIVE RESEARCH
literature review, electronic databases like SCOPUS, MEDLINE and Cochrane Library were
used. The review includes peer reviewed journals that were published in English and contained
information on coping strategies among cancer patients. The journals with date of publishing not
before 2012 were selected. Exclusion criteria contained journals that were published prior to
2012, non-English articles, and dissertations and published abstracts. The search terms were
‘cancer’, ‘coping’, ‘quality of life’, ‘psychosocial’, ‘grounded theory’, and ‘coping strategies’.
One study investigated the coping strategies that were utilized by young adults diagnosed with
advanced cancer and also examined the relationship between psychological distress and the
identified coping strategies. 53 YA participants were recruited and their informed consent was
taken prior to starting the research. On statistical analysis of the Brief COPE 24 item scale and
the Prolonged Grief Disorder Scale (PG-12), it was found that 6 coping factors were associated
with the factor analysis. The factors identified were proactive coping, distancing, support
seeking, respite seeking, acceptance and negative expressions. On the other hand, physical
wellbeing and dependent children were found to be confounding variables that predicted grief
among such patients. Physical wellbeing showed negative correlation with respite seeking and
grief (rs=-0.33, p<0.05). Thus, the study successfully identified the most effective coping
strategies related to cancer among young adults. Support-seeking, acceptance coping and
proactive coping were found to be the most frequently used coping strategies (Trevino et al.,
2012).
Another study illustrated the grounded theory with respect to survivorship among breast
cancer patients. The electronic mailing list software, LISTSERV was used to make an
announcement, which was posted on the SHARE Web site. The primary aim of this
announcement was to recruit women who were known to be diagnosed with breast cancer and

5QUALITATIVE RESEARCH
were presently undergoing treatment. 15 respondents were recruited for the study. The
experiences and perceptions of the enrolled women revealed that diagnosis of breast cancer acted
as a turning point in their life. They recognized breast cancer as a part of their lives, learned to
live with the disease and gradually worked towards creating a new life in the long run. Results
showed that survivorship in breast cancer was marked by time, support and coming to terms with
the associated trauma and treatment aftermath. Self-healing, developing new perspectives,
creating new mindset and experiencing wellbeing and growth through all adversities enhanced
the survivorship (Sherman, Rosedale & Haber, 2012).
Evidences from a meta-analysis and systematic review, which measured the psychosocial
interventions among couples coping with cancer, showed that couple-based interventions play a
significant role in improving quality of life aspects in both patients and their partners. A total of
43 randomized controlled trial studies were used. Couple-based interventions were found to
create beneficial effects on the patients who had been diagnosed with cancer (Badr & Krebs,
2013). Another study was conducted to inquire about the social context of communication and
lived experiences of cancer patients, based on the grounded theory. Potential participants were
made to complete an interview that would assess their suitability for the study. All participants
were aged 18-74 years and did not have any intellectual disabilities. The Mini-International
Neuropsychiatric interview was used to measure Axis 1, which provided a description of the
distress nature and level among the respondents. Results from the studies revealed that the Axis 1
diagnostic criteria were met by 50 participants. Three models were obtained from the research;
the first model described the ways of quality of care evaluation by patients. On the other hand,
the remaining 2 models referred to cancer-coping process where coping attempts via

6QUALITATIVE RESEARCH
communication and the associated loss or distress were described. It created avenues for further
research on cancer interventions (Knott et al., 2012).
Another meta-analytic review was conducted that focused on measuring self-efficacy
coping strategies and evaluated their association with psychosocial outcomes among cancer
patients. The CBI scale was used to measure the distress level. It was found that self-efficacy
was negatively correlated with distress outcomes. Positive correlations were displayed by
between coping with cancer and self-efficacy. Therefore, the study helped in establishing the fact
that people with high efficacy showed less anxiety and was better able to adjust to stressful
situations upon diagnosis of cancer (Chirico et al., 2017). Results from another qualitative
interview, conducted among patients with lung, prostate and breast cancer showed that people
suffering from advanced cancer and their family members develop coping strategies that help
them to effectively manage the psychological wellbeing. The major coping strategies that
contribute to wellbeing of the individuals are support, indulgence and learning from peers
(Walshe et al., 2017).
Research question
The aims of this research are as follows:
 What strategies are adopted by people to cope with their life at an advanced stage of
cancer?
 What are the psychological impacts of cancer on the patient and the family members?
 When are these coping strategies thought to be effective and why?

7QUALITATIVE RESEARCH
Theoretical framework
The grounded theory principles will be used to conduct the research. It refers to a series
of systematic inductive methods that are used to conduct qualitative research, which is aimed
towards development of the theory. The methodological strategies that are involved in this theory
aim to develop middle-level theories from the obtained results directly. Strong empirical
foundations are used to build the power of the analyses. A focused, conceptual and abstract
theory will be obtained to explain the empirical phenomena being studied (Charmaz & Belgrave,
2012). This theory has been used by several other research studies to explore how family
members utilize coping strategies during cancer diagnosis and treatment. The
grounded theory will be used owing to its significance in providing sequential guidelines that
will help to conduct the research (Wolfswinkel, Furtmueller & Wilderom, 2013). Moreover, the
theory will offer strategies to handle the inquiry phases; will assist in streamlining data collection
and analysis. The research will also get legitimized on application of this theory.
Research site
3 cancer hospitals in Queensland, Australia will be selected as the research site. Site
selection plays a significant role in successful conduction of clinical or qualitative research.
Improper selection of the research site can lead to compromise of the results that the research
aims to achieve. On matching the criteria for research site selection to the specific requirements
and features of the proposal, the likelihood of efficient conduction of the research study will
increase. Moreover, it will lead to availability of sufficient amount of superior quality data to
achieve the study outcomes. 3 cancer hospitals will be selected as the site owing to the huge
prevalence of cancer in Australia. Cancer was the leading cause of death in Australia (Torre et
al., 2015). It was reported to be the second leading death cause in the year 2014. The hospitals

8QUALITATIVE RESEARCH
that provide screening and treatment facilities for breast, bowel and prostate cancer will be
selected due to greater incidence of these 3 cancer types in Australia.
Sample
Detailed sheets that contained information on the proposed study will be distributed at the
waiting areas and to oncologists practicing at each of the 3 selected hospitals. All potential
participants will be screened for meeting the eligibility criteria before being recruited for the
study. The participants should meet the following criteria:
 They should be aged above 18 years. There will be no upper age limit.
 They should have received a diagnosis for breast, prostate or bowel cancer.
 They should be able to speak fluent English.
 There should be no intellectual impairment in the participants.
 They should be residents of Queensland.
 They should be available for undergoing psychological treatments on a weekly basis if
required.
The exclusion criteria would include:
 Physically unwell patients.
 Those with DSM-IV psychotic disorder.
Data generation
Informed consent will be taken separately from each participant before commencing the
study. A moderator trained in the qualitative research methods will carry out structured
interviews for individual participants. They will be welcomed by the moderator and their

9QUALITATIVE RESEARCH
permission will be taken before audio recording their responses to the interview questions. They
will then be asked to respond to the questions without any apprehensions. The interview
transcript will be coded, using the NVivo 10 software, to make the study more sensitive
theoretically (AlYahmady & Alabri, 2013). The interview would contain several questions, some
of which are stated below:
 How long have you been diagnosed with cancer?
 What were your immediate reactions?
 Do you know how the cancer developed?
 What did you find about your illness?
 What makes you feel that you had a good day?
 How do you manage to make terms with the illness?
 How do you communicate with your friends and family after the diagnosis?
 Does the oncologist effectively communicate with you?
 Are your family and friends supportive?
 Do you feel pessimistic ever since the disease has been detected?
 Are you happy with the treatment?
Data analysis
The obtained results will be analysed using Glaser’s framework of grounded theory. The
limited codes obtained during the interview phase would be collected and applied to a larger data
(Kolb, 2012). This will be followed by a comparison of the coded data with the larger set. This
constant comparison method would lead to continuous verification of the responses and will lead

10QUALITATIVE RESEARCH
to the formation of a rich and detailed theory on the psychological effects on cancer patients
(Thornberg & Charmaz, 2014).
Ethical issues
Some major ethical concerns that should be taken into account before carrying out the
research are: confidentiality, anonymity and informed consent of the participants. No personal
information of the patients should be shared or revealed. All possible efforts should be taken to
reduce intrusion into patient autonomy (Damianakis & Woodford, 2012). Moreover, it is of
utmost importance to taken informed consent of the participants prior to data collection. They
should be given a detailed explanation of the nature of the research, their role, the objectives of
the study and how the results would be published and utilized.
Conclusion
Thus, it can be concluded that people who suffer from cancer often find the physical,
social and emotional effects of the disease to be extremely stressful. Patients who successfully
attempt to manage this stress with indulgence into behaviors or those who start following
sedentary lifestyle, after cancer treatment often report poor quality of life. In contrast, people
who efficiently utilize coping strategies such as relaxation, emotional support and acceptance
display positive health and psychological outcomes. This report therefore aimed to propose a
study that would evaluate the psychological impacts on cancer patients with respect to the coping
strategies they follow, using the grounded theory approach.

11QUALITATIVE RESEARCH
References
AlYahmady, H. H., & Alabri, S. S. (2013). Using NVivo for data analysis in qualitative
research. International Interdisciplinary Journal of Education, 2(2), 181-186.
Badr, H., & Krebs, P. (2013). A systematic review and meta‐analysis of psychosocial
interventions for couples coping with cancer. Psycho
‐Oncology, 22(8), 1688-1704.
Charmaz, K., & Belgrave, L. (2012). Qualitative interviewing and grounded theory analysis. The
SAGE handbook of interview research: The complexity of the craft, 2, 347-365.
Chirico, A., Lucidi, F., Merluzzi, T., Alivernini, F., De Laurentiis, M., Botti, G., & Giordano, A.
(2017). A meta-analytic review of the relationship of cancer coping self-efficacy with
distress and quality of life. Oncotarget, 8(22), 36800-36811.
Cooke, A., Smith, D., & Booth, A. (2012). Beyond PICO: the SPIDER tool for qualitative
evidence synthesis. Qualitative Health Research, 22(10), 1435-1443.
Crist, J. V., & Grunfeld, E. A. (2013). Factors reported to influence fear of recurrence in cancer
patients: a systematic review. Psycho
‐Oncology, 22(5), 978-986.
Damianakis, T., & Woodford, M. R. (2012). Qualitative research with small connected
communities: Generating new knowledge while upholding research ethics. Qualitative
health research, 22(5), 708-718.
Knott, V., Turnbull, D., Olver, I., & Winefield, A. (2012). A grounded theory approach to
understand the cancer‐coping process. British journal of health psychology, 17(3), 551-
564.

12QUALITATIVE RESEARCH
Kolb, S. M. (2012). Grounded theory and the constant comparative method: Valid research
strategies for educators. Journal of Emerging Trends in Educational Research and Policy
Studies, 3(1), 83.
Schmidt, S. D., Blank, T. O., Bellizzi, K. M., & Park, C. L. (2012). The relationship of coping
strategies, social support, and attachment style with posttraumatic growth in cancer
survivors. Journal of Health Psychology, 17(7), 1033-1040.
Sherman, D. W., Rosedale, M., & Haber, J. (2012, May). Reclaiming life on one's own terms: a
grounded theory study of the process of breast cancer survivorship. In Oncology nursing
forum (Vol. 39, No. 3).
Thornberg, R., & Charmaz, K. (2014). Grounded theory and theoretical coding. The SAGE
handbook of qualitative data analysis, 153-169.
Torre, L. A., Bray, F., Siegel, R. L., Ferlay, J., Lortet‐Tieulent, J., & Jemal, A. (2015). Global
cancer statistics, 2012. CA: a cancer journal for clinicians, 65(2), 87-108.
Trevino, K. M., Maciejewski, P. K., Fasciano, K., Greer, J., Partridge, A., Kacel, E. L., ... &
Prigerson, H. G. (2012). Coping and psychological distress in young adults with
advanced cancer. The journal of supportive oncology, 10(3), 124.
Walshe, C., Roberts, D., Appleton, L., Calman, L., Large, P., Lloyd-Williams, M., & Grande, G.
(2017). Coping well with advanced cancer: a serial qualitative interview study with
patients and family carers. PloS one, 12(1), e0169071.

13QUALITATIVE RESEARCH
Wolfswinkel, J. F., Furtmueller, E., & Wilderom, C. P. (2013). Using grounded theory as a
method for rigorously reviewing literature. European journal of information
systems, 22(1), 45-55.