The Effect of-the Social Context on Young People's Stress and Coping with Cancer

This thesis investigated whether the social context in which young people who have cancer are treated influences the types of stressors that they face and the coping mechanisms that they use. The investigation was carried out in Japan, where there is a great deal of concern about whether or not young people should be told that they have cancer, and where they are treated mostly as in-patients. The main aspects of the social context investigated were a) whether or not they were told their diagnosis by the medical team or their parents and b) whether their treatment was predominantly as an in-patient or out-patient. A comparison was made in the latter case between Japanese inpatients and English out-patients in order to clarifY how stressors might be different in these different contexts. Three interlinked studies using both qualitative and quantitative metilOds were conducted. A total of 59 Japanese young people with cancer and their parents participated in the investigation. Firstly, a preliminary content analysis of newspaper articles revealed that social representations of cancer in Japan and in England were negative and often associated with 'death' in both societies. The Japanese media contained more discussions regarding disclosure of diagnosis to the patients and the articles were impersonal in nature. In a second study, parents were interviewed about their perceptions of disclosing tile diagnosis to their children. The findings showed the pervasiveness of the negative representations, as parents also associated cancer Witll 'death' and perceived it as a 'lifethreatening illness'. Parents had different ideas on how their children would understand and cope, and held different views about telling the child or not about their diagnosis. Some parents thought informing them would help the children to take good care of themselves, while others feared that it may frighten them and they would not be able to cope well. Finally, young people were interviewed to investigate what they knew about their diagnosis and tile revised Kidcope Checklist (Spirito, Stark, & William, 1988, Pretzlik, 1997) was used to examine their stressors and coping. Stress levels and coping mechanisms were compared between young people who knew their diagnosis and those who did not. Surprisingly, no differences were found in the type of stressors, distress level, or coping strategies used. There were, however, differences in how they referred to their illness: non-informed patients did not use words such as 'cancer', 'leukaemia', or 'chemotllerapy', even thOUgll they equalled those informed in how much they could explain about treatments and changes in their bodies. Small differences in stress levels between those treated as in-patients in Japan or out-patients in the UK were found: inpatients reported more medical related stressors as part of their everyday life and higher distress with respect to the illness than out-patients. The findings from the children challenge some of the parents' views, in the sense tlmt not being informed did not mean that they did not know anything about their illness and also that there was no evidence for a connection between stressors and coping and being informed or not of the diagnosis.EThOS - Electronic Theses Online ServiceGBUnited Kingdo