Psychosocial care of people with cancer : the 'victim's' perspective
Most psychosocial services for people with cancer remain under-utilised. This phenomenon disturbs the logic of two facts: that people with cancer do experience psychosocial problems, and that most interventions are capable of alleviating psychological distress and improving quality of life. This dissertation approached the above problem using a multi-modal methodology. First, a multi-choice questionnaire survey was conducted at the out-patient oncology clinic, Groote Schuur Hospital, showing that interest in the more professionalised services such as psychiatry, psychotherapy, coping skills courses, and social work was low, while interest in less professionalised services such as self-help groups and veteran patient visits was relatively high. In the context of the narrative and discursive approaches to understanding human experience, it was argued that psychosocial oncology presents a particular view of the person 'ith cancer, rooted in positivist and medical frameworks, which may be out of sink with patients' own understandings of themselves. A discourse analytic study, using two focus group interviews and four individual interviews with people with cancer, served as an alternative approach to understanding the coping process and patients' attitudes towards psychosocial care. Two contrasting discourses were highlighted in this way: an individualistic discourse and a psychological discourse. Respondents employed various rhetorical strategies in order to ensure domination of the rational, individualistic, and coping 'I' over the emotional, psychologized mind. Taken together, these results suggest that less professionalised services, based largely on fellow patient support, should be central to a more consumer-friendly system of psychosocial care. An action research approach was recommended as a possible means of developing such a system of care.
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