تحلیل پدیدارشناسانه سرطان زیسته (مورد مطالعه بیماران بیمارستان آیت الله کاشانی شهرکرد) (مقاله علمی وزارت علوم)
درجه علمی: نشریه علمی (وزارت علوم)
آرشیو
چکیده
سرطان، به مثابیه بیماری ای لاعلاج، به شدت زندگی افراد مبتلا را از جنبه های گوناگون بدنی، روان شناختی و اجتماعی متحول می سازد. سرطان را می توان از منظرها و با رویکردهای مختلفی بررسی کرد. از مهم ترین روش های بررسی این پدیده، بررسی و تحلیل آن از منظر کسانی است که سرطان را می زیند و با آن دست و پنجه نرم می کنند. برای شناخت و واکاوی سرطان زیسته، هدف این مقاله توصیف و تحلیل پدیدارشناسانیه سرطان در بین 12 نفر از بیماران مبتلا به سرطان بستری شده در بیمارستان آیت الله کاشانی شهرکرد بوده است. رویکرد پدیدارشناسی ون منن برای مطالعه انتخاب شد. نمونه گیری از نوع غیراحتمالی و هدفمند بود و از تکنیک مصاحبیه باز و نیمه ساختاریافته برای گردآوری داده ها استفاده شد. براساس یافته های تحقیق، بیماران وضعیت زیستیه خود را در حالات بدنی متناقض به همراه احساس غریبگی، انقطاع و پیش بینی ناپذیری زمانی، روابط اجتماعی مبتنی بر حمایت تا طرد همه جانبه و مرگ اندیشی و مرگ هراسی مداوم تا چنگ انداختن به نیروهای ماورای طبیعی توصیف و تفسیر کردند.Phenomenological Analysis of Lived Experience of Cancer: A Case Study of Patients at Ayatollah Kashani Hospital in Shahrekord
IntroductionCancer is undeniably one of the most alarming terms in the fields of medicine and health sciences. The prospect of developing this disease can be one of the most daunting experiences in human life. Rather than being a single disease, cancer is a general term that encompasses a wide range of conditions characterized by the rapid proliferation of abnormal cells that multiply and spread beyond normal tissue boundaries. Beyond its biological effects and lethal consequences, cancer also has significant individual and social implications, which are often explored in non-medical disciplines, including sociology. From a sociological perspective, cancer can profoundly alter individuals' daily lives, reshape their social identities, and affect their relationships with others. More specifically, it can lead to a disruption of identity in the context of ordinary living. The incidence and prevalence of cancer, along with its diverse effects, can be examined from two perspectives: an "external" viewpoint that relies on objective statistics and data and an "internal" viewpoint that reflects the experiences and perceptions of cancer patients themselves. It is important to note that doctors and patients may perceive and evaluate the disease differently, highlighting various aspects as more significant. Given the complexity of the cancer phenomenon and the necessity for a comprehensive understanding, this article aimed to describe and interpret the lived experiences of cancer from the internal perspectives of those who are directly affected by it. Materials & MethodsThis study was conducted using a phenomenological approach, specifically employing Van Manen's descriptive-interpretive methodology. The participants included male and female cancer patients, who were hospitalized in the oncology ward of Ayatollah Kashani Hospital in Shahrekord during the year 2021. To access the patients, necessary permissions were obtained from both the university and the oncology department. Upon entering the ward and gaining access to the patients, interviews were conducted with 12 individuals selected based on their physical and mental capabilities, as well as criteria, such as willingness to cooperate and participate in the interview process. Consequently, a non-random, purposeful sampling method was employed. Data collection involved two primary techniques: comprehensive observation and semi-structured interviews. The unit of analysis consisted of the sentences and contents of the participants' statements, which were initially categorized thematically and then interpreted using Van Manen's analytical framework, focusing on the four dimensions of lived body, lived space, lived time, and lived social relationships. To enhance the validity of the findings, the researchers engaged in multiple discussions regarding the processes of naming, extracting, and categorizing the collected data. Additionally, significant verbatim quotes were included to substantiate the themes and findings derived from the analysis. Discussion of Results & ConclusionThe results of the study revealed that with the initial appearance of cancer symptoms and subsequent intensification of these signs, both the patients' self-image and self-evaluation underwent significant transformation. Furthermore, the perceptions and behaviors of others toward the patients also changed markedly. Additionally, the quantity and quality of the patients' interactions with others were fundamentally altered. It could be stated that the first and perhaps most crucial dimension of their lived experience with cancer emerged within the "incarnate subject". This concept represented the intersection of the patients' self-conception and their evolving relationships with themselves and others. Upon realizing they had cancer, patients often felt as if they were caught in a state of "disruption and discontinuity", which was accompanied by a range of adverse psychological, physical, cognitive, and behavioral consequences. In general, participants described their lived experiences as encompassing intense feelings of anxiety and despair, changes to and denial of their physical appearance, self-imposed isolation, and unpleasant emotions, such as loneliness, indifference, depletion, and a lack of sympathy and empathy. They also reported re-evaluating past experiences and viewing the future as uncertain and unpredictable, leading to an increased focus on health-oriented behaviors. In terms of lived time, most participants identified the moment they were first informed of their cancer diagnosis as the "most terrible" experience of their lives. Other challenging moments included waiting for chemotherapy and contemplating the futures of their children or loved ones, which they described as "the most unpleasant moments". Some participants reported heightened fear and stress at certain times, particularly at night, while conversely feeling calmer and less anxious in the presence of relatives and friends. The discontinuity and unpredictability of time could be seen as the essence of the participants' lived experience. In terms of the spatial dimension, as cancer progressed, patients often perceived themselves as weak, helpless, unstable, and at risk of sudden death. Consequently, they tended to focus their attention on more comfortable and familiar spaces, such as their homes, while vehemently rejecting and avoiding unpleasant environments like hospitals. These hospitals were often viewed as stressful places associated with disrespectful encounters and negative relationships. Participants described the hospital environment as a symbol of dependence, representing "the end of one's life and the world" and characterized by "unpleasant experiences during chemotherapy", "inappropriate treatment by doctors", and "a place filled with sick and ill patients". In contrast, the atmosphere of home and time spent with family were depicted as sources of peace, joy, and positive experiences. Regarding the dimension of lived social relationships, participants noted a significant decline in the breadth of their interactions following their cancer diagnosis, along with a noticeable weakening of the strength of their relationships. Importantly, their abilities to cope with the emerging challenges and their evolving identities were largely influenced by how both close and distant individuals responded to them. In other words, whether a cancer patient's new identity was "validated and acknowledged" by those closest to them—such as spouses and parents—or by more distant acquaintances, including doctors and strangers, it had a profound impact on their abilities to manage their situations. Overall, these patients often felt alienated, lonely, and abandoned within the socio-physical spaces of their environment. In conclusion, the interconnected dimensions of lived body, lived time, lived space, and lived social relationships collectively shaped the essence of the participants' experiences of living with cancer.
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