Gynecological cancer (GC) is the most common cancer diagnosis among women, globally, including China. Women who experience a diagnosis of GC, their spouses, the couples as a unit, as well as registered nurses (RNs) caring for these women, all face different challenges during this cancer trajectory. Prior to this study, few studies have explored the factors associated with perceived growth among women diagnosed with GC, their spouses, and couples, as well as RNs caring for these women, based on a growth-related theory and model. The overall aim of this thesis was therefore to explore perceived growth and its associated factors, based on these persons’ perspectives.

Four studies (Study I–IV) ) were conducted, each using a cross-sectional and descriptive study design. In Study I, women’s posttraumatic growth (PTG) and its associated factors were explored. Data were collected through 344 questionnaires and analyzed by using binary stepwise logistic regression. In Study II, spouses’ PTG and its associated factors were explored. Data were collected through 312 questionnaires and analyzed by using multiple regression analysis. Study III explored the actor effects and partner effects of perceived social support on PTG among couples where the woman had been diagnosed with GC. Data were collected with 126 couples using questionnaires and analyzed by using Structural Equation Modeling. Study IV described the perceived professional benefits and explored the association between perceived professional benefits, sense of coherence, and coping strategies in RNs caring for women diagnosed with GC. Data were collected with 250 RNs using questionnaires and analyzed by using multiple regression analysis.

The results indicate that women’s self-disclosure was positively associated with their PTG. Confrontation coping strategies, avoidance coping strategies, problem-focused coping strategies (e.g., active coping, instrumental support, and planning), and dysfunctional coping (e.g., denial, behavioral disengagement, self-distraction, and venting) were positively associated with perceived growth. Perceived social support was positively associated with PTG in both women diagnosed with GC and their spouses. Spouses’ perceived social support was positively associated with women’s perceived social support and women’s PTG. In addition, sense of coherence was positively associated with RNs’ perceived professional benefits.

Based on the findings from this thesis, it is concluded that RNs need to encourage these women and their spouses to communicate their feelings, concerns, and supportive care needs, with other family members and loved ones. RNs also needs to pay more attention to the spouses’ supportive care needs, so that they are able to better support these women. It was shown that integrating effective coping strategies into existing cancer care practice may help couples to cope with the challenges related to GC. Furthermore, RNs should consider women and their spouses as a whole unit to provide effective care, and to help couples as a unit to re-evaluate their understanding of what really matters in their life. In addition, there is a need to help RNs to promote the nurse–patient relationship and a sense of belonging to the work team in their nursing practice.

Aim: The aim of this study was to explore the factors that are associated with posttraumatic growth among spouses of women diagnosed with gynaecological cancer.

Design: A cross-sectional descriptive study.

Methods: A convenience sample of 312 spouses of women diagnosed with gynaecological cancer was recruited from two comprehensive hospitals in China, from March 2018 to March 2020. Demographic characteristics, cancer-related characteristics, posttraumatic growth, perceived social support and coping were assessed using self-reported questionnaires. Descriptive statistics and multiple linear regression analysis were performed. The methods were guided by the STROBE checklist.

Results: The mean score of posttraumatic growth was 46.7 (standard deviation = 16.7). The associated factors of posttraumatic growth were spouses' age, perceived social support, problem-focused coping, dysfunctional coping (e.g. denial) and cancer treatment received by partners, which accounted for 34% of total posttraumatic growth score.

Patient or public contribution: All participants contributed to the conducting of this study by completing self-reported questionnaires.

Purpose: The experience of cancer could lead to positive psychological changes following the struggle with diagnosis and treatment. Understanding post-traumatic growth and its influencing factors in women affected by gynecological cancer is essential to enhance their possibility of achieving positive changes. The purpose of this study was to describe the post-traumatic growth level and explore the influencing factors of post-traumatic growth in Chinese women diagnosed with gynecological cancer. Method: A cross-sectional survey with a convenience sampling method was employed to collect data using the Post-traumatic Growth Inventory (PTGI), Distress Disclosure Index (DDI), Medical Coping Modes Questionnaire (MCMQ), and Multidimensional Scale of Perceived Social Support (MSPSS). The questionnaires were administered to 344 participants recruited from two hospitals in Hefei City, the capital of Anhui Province in China, between March 2018 and March 2019. All statistical analyses were performed using nonparametric tests. The Mann-Whitney U Test was used to distinguish the intergroup differences. Correlations were evaluated with Spearman rank correlation coefficients. Results: Total score for PTGI was 56.5 (range 48.0–68.0). The subscale with the highest centesimal score in the PTGI was appreciation of life and the lowest was spiritual change. The top five items with the highest scores of PTGI belonged to appreciating life, personal strength, and relating to others. Self-disclosure, confrontation, avoidance, acceptance-resignation, perceived social support, education level, cancer type and the place they lived had significant influence on post-traumatic growth. Conclusions: The findings indicate that women who have high levels of perceived social support, confrontation, avoidance, self-disclosure and education level tend to experience more post-traumatic growth, while, conversely, high levels of acceptance-resignation have a negative influence on promoting post-traumatic growth. These meaningful findings propose new perspectives for promoting post-traumatic growth in Chinese women diagnosed with gynecological cancer.

Propose

Registered nurses (RNs) are considered to be a major source of professional supportive care for women diagnosed with gynecological cancer (GC). This study described the level of perceived professional benefits and explored association between perceived professional benefits, sense of coherence (SOC), and coping strategies in Chinese RNs caring for women diagnosed with GC.

Method

A cross-sectional survey was employed to collect data using the Nurses' Perceived Professional Benefits Questionnaire (NPPBQ), Sense of coherence scale (SOC-13), and Brief Coping Orientation to Problems Experienced (Brief COPE). The questionnaires were administered to 250 RNs in China. The correlations between NPPBQ, SOC-13, and Brief COPE were evaluated with Pearson's correlation coefficient. Multiple regression analysis was performed to assess the relative contribution of each possible factor in explaining variance in the increased NPPBQ.

Results

Total score for NPPBQ was 142.4 (range 33.0–165.0). SOC, dysfunctional coping strategies, and problem-focused coping strategies were recognized as predictors of RNs' perceived professional benefit, while, emotion-focused coping strategies were not significantly associated with RNs’ perceived professional benefits.

Conclusions

The findings indicate that RNs who have high levels of SOC, dysfunctional coping strategies, and problem-focused coping strategies tend to experience more perceived professional benefit. These findings propose new perspectives for nursing managers to promote RNs' perceived professional benefit by helping RNs to find meaningfulness when caring for women diagnosed with GC, increasing RNs’ communication skills to improve their relationship with patients, and training RNs to use coping strategies effectively.