aon Asian Oncology Nursing Asian Oncol Nurs 2287-2434 2287-447X Korean Oncology Nursing Society 10.5388/aon.2018.18.1.30 aon-18-30 Original Article Factors Influencing Posttraumatic Growth in Cancer Survivors ParkJeong-Sook 1 KimYou-Jeong 2 RyuYoung-Seun 2 ParkMi-Hyang 3 College of Nursing, Keimyung University, Daegu, Korea College of Nursing, Graduate School of Keimyung University, Daegu, Korea Department of Nursing, Suseong University, Daegu, Korea Address reprint requests to: Park, Mi-Hyang Department of Nursing, Suseong University, 15, Dalgubeol-daero 528-gil, Suseong-gu, Daegu 42078, Korea Tel: +82-53-749-7350 Fax: +82-53-749-7240 E-mail: pmhss@sc.ac.kr 32018 532018 181 3039 19Feb2018 08Mar2018 26Mar2018 Copyright © 2018 Korean Ophthalmological Society 2018 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose

The purpose of this study was to identify the level of post-traumatic growth (PTG) and the factors affecting the PTG of cancer survivors.

 Methods

Data were collected from 147 cancer patients who were admitted to hospital to two hospitals, P and B city during July and September, 2017 using the PTG Inventory, Multidimensional Scale Perceived Social Support, Event-Related Rumination Inventory, Korean Cancer Coping Questionnaire, Resilience Scale, and Self-Esteem Scale. Data were analyzed using t-tests, ANOVA, Pearson-correlation coefficient, and multiple regression.

 Results

The mean score for PTG in cancer survivors was 3.20 points. PTG had significant correlation with social support, deliberate rumination, coping, and resilience. Factors that had an influence on PTG in multiple regression were social support (β=0.25, p<001), personal coping (β=0.22, p=.008), resilience (β=0.21, p=.006), recognizing the need for religion (β=0.17, p=.015), religion (β=0.17 p=.011), and deliberate rumination (β=.15, p=.022). These factors explained 60.0% of the variance in the PTG of cancer patients.

 Conclusion

In order to effectively promote PTG of cancer survivors, it is necessary to develop and apply programs that can improve social support, coping (personal), resilience, religion, and deliberate rumination.

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Difference in Post-traumatic Growth by General Characteristics (N =147)

Variables Categories n (%) M ± SD t or F (p) Scheffé
Age (year) 25~34 6 (4.1) 56.83 ± 15.47 1.52 (.199)
  35~44 25 (17.0) 70.16 ± 19.53  
  45~54 56 (38.1) 71.29 ± 21.16  
  55~64 46 (31.3) 63.04 ± 22.74  
  ≥ 65 14 (9.5) 63.07 ± 24.62  
Gender Male 41 (27.9) 60.44 ± 23.64 -2.36 (.019)
  Female 106 (72.1) 69.74 ± 20.48  
Education level ≤ Middle school a 18 (12.2) 55.39 ± 23.62 5.00 (.008)
  High school b 61 (41.5) 65.02 ± 21.35 a＜ c
  ≥ College c 68 (46.3) 72.16 ± 20.31  
Marital status Single 14 (9.5) 57.57 ± 24.67 2.18 (.117)
  Married 109 (74.2) 69.16 ± 20.36  
  Bereavement/divorce 24 (16.3) 63.58 ± 24.88  
Have job Yes 54 (36.7) 70.74 ± 20.79 1.54 (.127)
  No 93 (63.3) 65.50 ± 22.10  
Average monthly ＜100 a 19 (12.9) 62.53 ± 17.96 4.57 (.015)
family income 100~＜300 b 63 (42.9) 62.59 ± 24.11 a＜ c
(10.000 won) ≥ 300 c 65 (44.2) 72.91 ± 19.60  
Cancer insurance Have 122 (83.0) 67.87 ± 21.27 0.89 (.373)
  Don't have 25 (17.0) 63.60 ± 24.02  
Religion Yes 93 (63.3) 74.09 ± 18.56 -5.58 (＜.001)
  No 54 (36.7) 55.19 ± 21.75  
Recognizing Absolutely needed a 60 (40.9) 79.97 ± 15.36 17.83 (＜.001)
the need for religion Occasionally needed b 45 (30.6) 63.04 ± 21.13 a＞ b,c,d
  Not needed c 14 (9.5) 53.21 ± 19.23  
  Not know d 28 (19.0) 53.21 ± 20.93  
Recognizing A lot a 50 (34.0) 80.92 ± 16.74 25.31 (＜.001)
religious influence A little b 38 (25.9) 67.58 ± 18.56 a＞ b＞ c
  Not recognized c 59 (40.1) 55.19 ± 20.57  
Diagnosis Hepatobiliary-pancreatic cancer 7 (4.8) 61.00 ± 16.30 1.34 (.243)
  Thyroid cancer 10 (6.8) 78.00 ± 15.30  
  Colorectal cancer 20 (13.6) 61.85 ± 25.88  
  Uterine/ovary cancer 13 (8.8) 64.77 ± 23.92  
  Stomach cancer 23 (15.6) 62.48 ± 26.90  
  Breast cancer 61 (41.5) 71.02 ± 19.38  
  Lung cancer 13 (8.9) 62.69 ± 16.98  
Period elapsed ＜2 92 (62.6) 65.47 ± 22.08 1.57 (.212)
since diagnosis (year) 2~＜5 32 (21.8) 66.75 ± 23.81  
  ≥ 5 23 (15.6) 74.39 ± 15.90  
Relapse Yes 36 (24.5) 66.33 ± 23.15 -0.26 (.798)
  No 111 (75.5) 67.41 ± 21.36  
Cancer pain Yes 39 (26.5) 64.03 ± 23.09 -1.05 (.298)
  No 108 (73.5) 68.27 ± 21.22  
         
Treatment method Only surgery 21 (14.3) 66.33 ± 24.85 4.65 (.629)
  Only chemo/radiation therapy 32 (21.8) 64.13 ± 22.55  
  Combination of surgery and chemo/ra adia- 94 (63.9) 68.35 ± 20.84  
  tion therapy      
Cancer stage 1 45 (30.6) 71.78 ± 19.53 1.38 (.253)
  2 41 (27.9) 67.41 ± 22.73  
  3 46 (31.3) 64.50 ± 22.43  
  4 15 (10.2) 60.60 ± 22.23  

Post-traumatic Growth, Social Support, Rumination, Coping, Resilience, Self-esteem

Variables Min~Max M ± SD Mean score
Post-traumatic growth 9~105 67.14 ± 21.73 3.20 ± 1.03
Social support 12~60 42.76 ± 8.95 3.56 ± 0.75
Rumination      
Intrusive rumination 10~40 23.22 ± 9.37 2.32 ± 0.94
Deliberate rumination 10~40 26.62 ± 7.77 2.66 ± 0.78
Coping      
Personal 20~56 40.86 ± 7.27 2.92 ± 0.52
Interpersonal 9~36 26.75 ± 5.41 2.97 ± 0.60
Resilience 16~98 70.20 ± 17.60 5.01 ± 1.26
Self-esteem 13~40 27.99 ± 5.21 2.80 ± 0.52

Correlations between Post-traumatic Growth, Social Support, Rumination, Coping, Resilience, Self-esteem

Variables Post-traumatic growth Social-support Intrusive rumination Deliberate rumination Coping (personal) Coping (inter-pe,!,!rsonal) Resilience Self-esteem
r (p) r (p) r (p) r (p) r (p) r (p) r (p) r (p)
Social support .56 1            
  (＜.001)              
Intrusive rumination -.02 -.05 1          
  (.769) (.523)            
Deliberate rumination .46 .34 .45 1        
  (＜.001) (＜.001) (＜.001)          
Coping (personal) .66 .48 -.06 .51 1      
  (＜.001) (＜.001) (.496) (＜.001)        
Coping (interpersonal) .36 .54 .07 .33 .43 1    
  (＜.001) (＜.001) (.409) (＜.001) (＜.001)      
Resilience .56 .46 -.19 .23 .65 .28 1  
  (＜.001) (＜.001) (.021) (.004) (＜.001) (.001)    
Self-esteem .42 .42 -.22 .15 .42 .31 .67 1
  (＜.001) (＜.001) (.007) (.071) (＜.001) (＜.001) (＜.001)  

Factors Influencing PTG in Cancer Survivors

Variables B SE β t p
(Constant) -21.72 7.29   -2.98 .003
Coping (personal) 0.66 0.25 .22 2.67 .008
Social support 0.61 0.15 .25 4.03 ＜.001
Recognizing the need for religion* 7.31 2.96 .17 2.47 .015
Resilience 0.25 0.09 .21 2.80 .006
Religion* 7.49 2.90 .17 2.58 .011
Deliberate rumination 0.41 0.18 .15 2.32 .022
    Tolerance=.40~.71, VIF=1.41~2.50, Durbin-Watson=1.72
    Adj.R2=.60, R2=.62, F=37.60, p＜.001

PTG= Posttraumatic growth; *Dummy variables.