Karen Fergus

To tell or not to tell: patterns of disclosure among men with prostate cancer

This paper draws on the results of a longitudinal, qualitative study of men with prostate cancer (treated with prostatectomy) and their spouses. Interviews were conducted separately and simultaneously with men and their spouses, at three points in time (pre‐surgery, 8–10 weeks post‐surgery and 11–13 months post‐surgery). The primary focus in the paper is on mens responses to questions about their decisions to share information (or not) with others about their diagnosis and ongoing medical situation. Most men with prostate cancer avoided disclosure about their illness where possible, and placed great importance on sustaining a normal life. Factors related to limiting disclosure included mens low perceived need for support, fear of stigmatization, the need to minimize the threat of illness to aid coping, practical necessities in the workplace, and the desire to avoid burdening others. This study contributes to an understanding of disclosure issues related to prostate cancer, and raises issues about how best to be helpful to men, given their tendency to minimize the impact of illness, and the need for support. Copyright

Managing the Impact of Illness: The Experiences of Men with Prostate Cancer and their Spouses

This qualitative study explored issues of support and coping for couples where the man had been diagnosed with prostate cancer. Thirty-four men with prostate cancer and their spouses were interviewed separately at three points in time: prior to surgery; 8 to 10 weeks post-surgery; and 11 to 13 months post-surgery. The core category for the couples’ experience with diagnosis and treatment for prostate cancer was Managing the Impact of Illness. Five major domains emerged, including: dealing with the practicalities; stopping illness from interfering with everyday life; keeping relationships working; managing feelings; and making sense of it all. While it was clearly important for couples to manage illness and to reduce its potential intrusion into everyday life, this strategy had psychological costs as well as benefits. Men struggled to stay in control of their emotions and their lives, typically vacillating between the pulls of fierce self-reliance and fearful neediness. Women were constrained from employing their usual strategies of coping and were distressed by the complicated requirements of being supportive while also honoring their partners’ need for self-reliance.

Sexual Dysfunction and the Preservation of Manhood: Experiences of Men with Prostate Cancer:

This study explored the experiences of men living with sexual dysfunction as a consequence of having been treated for prostate cancer. An ethnoculturally diverse sample of 18 men (14 heterosexual, and four homosexual) participated in a series of four to five in-depth interviews. These one-on-one interviews were designed to elicit information pertaining to their beliefs, values and performances regarding masculinity vis-a-vis prostate cancer and its treatment. Interview transcripts were analyzed using the grounded theory method. The core category of ‘Preserving Manhood’ incorporated five major themes: enhancing the odds; disrupting a core performance; baring an invisible stigma; effortful-mechanical sex; and working around the loss. We conclude that men’s performances of sexuality and masculinity were highly interwoven; that loss of sexual functioning constituted a focal disruption for participants; and in some instances, posed a significant threat to their masculine identities.

Hegemonic Masculinity and the Experience of Prostate Cancer: A Narrative Approach

Prostate cancer is a major health problem—one that inevitably challenges mens notions about themselves and their expressions of masculinity. As part of a larger study investigating linkages between masculinity and prostate cancer, this article focuses on the narratives of three men with prostate cancer—all of whom shed light on contemporary forms of hegemonic masculinity. Multiple interviews were conducted with study participants, capturing experiencesboth prior to and following cancer diagnosis. Analysis of individual narratives showed how social factors such as work and family influenced (and were influenced by) mens experiences with illness. All three men were forced to renegotiate their performances of masculinity—with this renegotiation mostly occurring within the parameters of performance consistent with hegemonic masculinity. However, there was also some evidence of shifts into new socialterritory and new expressions of masculinity. In contrast to more traditional, trait-based approaches to studying mens experiences, a narrative approach allows social scientists to do justice to the temporal realities and contextual complexities of mens lives. Men will be better understood as more attention is paid to the actual shape of individual lives.

Embodied Categorizing in the Grounded Theory Method Methodical Hermeneutics in Action

In this article it is argued that attention to embodied experiencing enhances the quality of categorizing in the grounded theory method of qualitative research. George Lakoff and Mark Johnson’s model of experiential cognition is applied to the structural features of embodied categorizing, while Eugene Gendlin’s philosophy of experiential phenomenology is extended to use of embodied experiencing in the process of creating and evaluating categories. This use is demonstrated. The method’s procedure of categorizing is connected more tightly with its methodology, seen by the authors as methodical hermeneutics, and with its epistemology, seen as an accommodation of realism and relativism. The article concludes with practical implications for the practice of categorizing in the grounded theory method.

Efficacy of telephone-administered behavioral therapy for panic disorder with agoraphobia

The purpose of this study was to determine the efficacy of a structured exposure-based behavior therapy program delivered by telephone to agoraphobic individuals who were isolated from specialized treatment centres. Forty-two individuals with a DSM-III-R diagnosis of panic disorder with agoraphobia who were living in rural areas of Ontario were assigned to either an eight-session telephone behavior therapy program or wait-list control condition. There were significant treatment x time interaction effects on several outcome variables. Patients originally in the wait-list group then received the same type of therapy and they also significantly improved. All treatment gains were maintained at three-month and six-month follow-up. Telephone behavior therapy appears to be a cost-effective and efficacious treatment for agoraphobics living in remote regions where specialized anxiety disorder services are not readily available.

Active Consideration: Conceptualizing Patient-Provided Support for Spouse Caregivers in the Context of Prostate Cancer

In this study, the authors examine the under-investigated topic of patient-provided support for spouse caregivers. Thirty-four men with prostate cancer and their female partners were interviewed separately three times: before the man’s radical prostatectomy, 8 to 10 weeks postsurgery, and 1 year postsurgery. The core category of active consideration encompassed 4 dimensions: easing spousal burden, keeping us up, maintaining connection, and considering spouse. Patient-provided support entails two overlapping tasks: minimizing the practical and emotional impact of the illness and tending to the caregiver’s social-emotional needs. A theory expounding on the double bind of being both a patient and an agent in light of masculine socialization practices is articulated and brought to bear on the phenomenon of patient-provided support.

Patient satisfaction with behavioral treatments for panic disorder with agoraphobia

Abstract A Treatment Satisfaction Questionnaire was constructed and administered to 69 panic disorder with agoraphobia (PDA) patients who completed either group behavior therapy (n=28) or telephone behavior therapy (n=41). In general, patients were found both to like and to find useful the various treatment components, and reported improvement in several areas. In both samples there were significantly higher usefulness ratings for self-directed in vivo exposure, compared to “personally liked” ratings, suggesting that patients may perceive exposure as a type of “bitter medicine.” In general, psychoeducational components (both useful and liked) on the nature of panic and fear were positively and significantly correlated with panic severity and frequency, whereas in vivo and interoceptive exposure (both useful and liked) were positively and significantly correlated with avoidance behavior. These findings suggest that cognitive (psychoeducational) and behavioral components can be combined in a complementary treatment package for PDA that is both efficacious and cost-effective.

Evaluation of CancerChatCanada: a program of online support for Canadians affected by cancer

BACKGROUND Professional-led cancer support groups can improve quality of life and address unmet needs, but most Canadians affected by cancer do not have access to or do not make use of cancer support groups. A collaborative interdisciplinary team developed, operated, and evaluated Internet-based, professional-led, live-chat support groups (osgs) for cancer patients, caregivers, and survivors across Canada. OBJECTIVE Our study aimed to report participant and participation characteristics in the pan-Canadian initiative known as CancerChatCanada, and to understand participant perspectives about the quality of communication and professional facilitation, overall satisfaction, and psychosocial benefits and outcomes. METHODS Participants in osgs provided informed consent. Participant and participation characteristics were gathered from program data collection tools and are described using frequencies, means, and chi-squares. Patient, survivor, and caregiver perspectives were derived from 102 telephone interviews conducted after osg completion and subjected to a directed qualitative content analysis. RESULTS The 55 professional-led osgs enrolled 351 participants from 9 provinces. More than half the participants came from rural or semirural areas, and more than 84% had no received previous cancer support. The attendance rate was 75%, the dropout rate was 26%, and 80% of participants were satisfied or very satisfied. The convenience and privacy of osgs were benefits. Meaningful communication about important and difficult topics, kinship and bonding with others, and improved mood and self-care were perceived outcomes. CONCLUSIONS Our results demonstrate that this collaborative initiative was successful in increasing reach and access, and that pan-Canadian, professional-led osgs provide psychosocial benefit to underserved and burdened cancer patients, survivors, and family caregivers.

A survey of anxiety disorders clinics in canadian hospitals

A questionnaire on anxiety disorder services was sent to 240 Canadian hospitals, of which 117 responded. Eighteen of the responding hospitals had anxiety disorder clinics and saw an average of 208 patients a year. These clinics appear to be scarce although, according to epidemiological studies, there is a high prevalence of anxiety disorders in the community. The specific diagnoses of the patients seen in the specialty clinics and the treatments offered generally followed international patterns.