Dissertation to receive master's degree
(community health orientation)
Abstract
Title:
"Couples' understanding of family functioning when one of them has cancer, Tabriz, 1391"
Introduction: Cancer disease can affect the family functioning of patients. Implementation of support programs for these patients requires the identification of aspects of family life that are disturbed after being diagnosed with cancer. Therefore, the present study was conducted in order to understand the views of people with cancer and their spouses on family functioning after cancer. Methodology: In this descriptive-correlation study, 101 couples with cancer participated in the inpatient departments and clinics of Shahid Ghazi Tabatabaei Hospital in Tabriz. In order to collect data, a family performance questionnaire was used, which examines the performance of families in the dimensions of problem solving, communication, roles, emotional companionship, emotional intercourse, behavior control and overall performance. Some characteristics of the patients were also checked with a checklist.
Results: All the couples participating in this study reported their family functioning in all dimensions relatively appropriate. There was a significant statistical relationship between the patients' views on the overall family function and the age of marriage (r=0.02, p=0.20) and the age of the oldest child (r=0.01, p=0.21), but such a relationship was not observed regarding the way of life, occupation, age, education level, number of children, and the time elapsed since the diagnosis of the disease.
Conclusion: Although the family function of cancer patients is relatively good, we should not neglect the services of counselors for the family and their family members. Because the family is the primary source of care and support for cancer patients. In general, the need to consider the whole family unit as a client is one of the necessities of providing family-oriented nursing care and support to cancer patients. Keywords: cancer, family function, family function measurement questionnaire. This chapter is compiled in relation to the research field. The scope of the research includes the title of the research, introduction of the problem, definition of words, research objectives, assumptions and presuppositions.
The title of the research: couples' understanding of family functioning and the occurrence of cancer in one of them in the city of Tabriz, 1391
Research context (problem statement):
Cancer as a bitter reality and an important stress factor (1) is a complication that changes a person's life path and causes an increase in vulnerability and a decrease in people's quality of life, changes daily functions, social activities and a person's ability to perform usual roles (2). In today's world, one of the common causes of morbidity and mortality caused by diseases is cancer (3). According to the prediction of the World Health Organization, the number of cancer deaths in the world will increase by 45% from 2007 to 2030 (from 7.9 million to 11.5 million deaths). More than half of cancer cases occur in developing countries. Also, in most developing countries, cancer is the second cause of death after cardiovascular diseases (4).
In Iran, as a developing country, cancer is the third cause of death after heart diseases and road accidents. According to the results of Mousavi's study in 2006, the annual incidence of cancer among Iranian men and women is 98 and 110 per 100,000 people, respectively (5). Although from the medical point of view, cancer happens to one person, but family members share in the psychological and social problems of the disease. A cancer diagnosis creates a major change in family life that Rolland refers to as an "uninvited guest" that must be accepted by the family or couple. At each stage of the disease, the family faces challenges that threaten their stable relationships and quality of life (6).
It is widely accepted that fighting cancer is a family affair. Not only the patient, but also everyone who loves him is faced with the consequences of the disease and treatment, which may include disruption of daily life, anxiety, worries about cancer recurrence, fear of loss and death (7). When the family is faced with a stressful factor, the family first mobilizes its resources to solve the problem. When efforts to solve the problem fail, the family is in crisis. When the family's resources are insufficient or exhausted, the family's functioning deteriorates and symptoms of family turmoil such as parenting problems and conflict between people occur. Also, when the family does not receive any help from outside the system, the result appears in the form of lower levels of family functioning or perhaps separation and loss of a member (8). Experiencing a stressful life makes people prone to vulnerability. Vulnerable families, such as families with a sick member, are more likely to develop health problems as a result of exposure to risk or more serious consequences as a result of health problems (9).
As mentioned, families with a member with a severe illness that causes stress to the family are considered vulnerable families and therefore, are considered as a target group for community health nurses. One of the main approaches to working with vulnerable families in community health nursing is the approach of the family as a client. In this approach, the primary focus is on the family and the secondary focus on individuals. In this approach, the focus is on how the family as a whole reacts when family members experience a health problem (10). In the family unit, any dysfunction (illness, separation, etc.) that affects one member affects the other members in various ways, as well as the family unit as a whole, which is often called a "ripple effect". There is also a strong reciprocal relationship between the family and its health status. Therefore, the role of the family is very decisive in any form of care from the stage of health promotion to rehabilitation (8).
Family function means the family's ability to coordinate with the changes made during life, resolve conflicts, solidarity between members, and implement the rules governing this institution, with the aim of preserving the entire family system(3). Examining family performance shows how well the family works as a unit and also measures the family's ability to adapt and judge in different situations (11). The requirement to evaluate families is to have a theoretical model about how they function. One of the most useful models for examining the family is McMaster's model of family functioning and was designed by Eptein [1] and Lawrence [2] in 1960 (12). Although this model does not cover all dimensions of family functioning, it considers important dimensions that often manifest clinically (13). This model considers six aspects of family functioning: 1- Problem solving, 2- Communication, 3- Roles, 4- Emotional responsiveness, 5- Emotional engagement, 6- Behavioral control. This model divides the duties of families into three parts. Basic duties such as providing food, security, health care for its members. Transformative tasks such as taking care of the baby and paying attention to the family's teenager, critical tasks that include the family's skills during crises and unexpected events such as the severe illness of a family member (12). Northouse (2010), in a meta-analysis study that he conducted on families of cancer patients in America, mentioned four reasons for the necessity of working with families in cancer patients: 1- When a member is diagnosed with cancer, his family members are significantly stressed. 2- Family members often do not talk about their thoughts and feelings about cancer. 3- Families try to adapt to the impact of cancer and the tension in the family that is mainly caused by cancer. 4- Family members try to maintain their main function (14).