Cancer as a Life Transition: A Relational Approach to Cancer Wellness in Women

Receiving a diagnosis of cancer is a traumatic event and changes one's life forever. The period of initial diagnosis and treatment is indeed a life transition, regardless of the prognosis. It precipitates a change in self-perception, physically, emotionally, and interpersonally. It changes how a woman sees herself, her family, and her world. Simultaneously the woman is confronted with many decisions to make regarding treatment options and the management of personal, familial, and work related responsibilities. People have the opportunity to reflect on old decisions and to make new decisions. Inevitably one is confronted by mortality. The management of this illness is done in the context of a complex network of relationships with family, friends, coworkers, doctors, other medical personnel, and clergy. Often it is the clinical social worker who is in the position of facilitating access to and participation in resources for care. Many women join healing communities or wellness centers to find a model of care and achieve a state of well-being that utilizes and encourages the support of these relationships. Understanding the importance and impact of these relationships can help clinical social workers facilitate cancer wellness in their clients and advocate better on their behalf. The intent of this paper is to understand the concept of cancer wellness as a relational approach and to promote its place in integrative clinical social work practice.     

Yoga,quality of life,anxiety, and trauma in low-income adults with mental illness: A mixed-methods study

We used a mixed-methods convergent parallel design to explore the effect of yoga on quality of life, trauma, and anxiety in low-income adults with mental illness. Participants included a convenience sample (N = 18) of parents at a community mental health agency who participated in a six-week yoga intervention. Participants completed standardized measures of quality of life, anxiety, and post-traumatic stress disorder (PTSD) pre- and post-intervention. Focus groups were conducted to further explore barriers to and the effects of participation in the yoga intervention. Wilcoxon Signed Ranks Tests indicated a statistically significant decrease in anxiety and PTSD after the yoga intervention, but no significant changes in quality of life or trait anxiety. Qualitative results reveal five themes related to participation in yoga classes, including barriers to participation and ways to improve the class. Qualitative results corroborate quantitative findings, suggesting improved relaxation and anger management for participants who strongly endorsed the benefits they experienced.     

The Overlooked Side of the Experience: Personal Growth and Quality of Life Among Grandparents of Children Who Survived Cancer

This study adopted the theoretical framework of Schaefer and Moos (1992) to identify the resources that contributed to the personal growth and quality of life of 56 grandparents of childhood cancer survivors and compare them with 60 grandparents of healthy children. Participants filled out questionnaires addressing sense of coherence, social support, personal growth, and quality of life. A significant difference was found only with regards to personal growth. Hierarchical regressions revealed that health, economic status, higher levels of sense of coherence, and support contributed to quality of life, whereas being a grandparent of a child who survived cancer, lower sense of coherence, support, and past experience of the Holocaust contributed to personal growth. It seems that though they are both positive dimensions, quality of life and personal growth represent different entities in grandparents’ lives. This study sheds light on the experiences and perspectives of grandparents, indicating that alongside the physical and emotional toll taken by their grandchild’s illness, there are also positive implications that can lead to personal growth. Strengthening grandparents could enable families to take advantage of the potential contribution of one of the most committed support providers in the family.     

Testosterone and men's quality of life

As the worldwide population ages, the emphasis on having a reasonable quality of life in old-age is increasing. In men, age-associated testosterone decline is one of the major factors that reduce quality of life. In patients and the physicians treating them, decreased energy levels and impairments to sex-life are perceived as the most important effects of hypogonadism. Two quality of life scales, the Aging Males' Symptoms (AMS) and the Age-Related Hormone Deficiency-Dependent Quality of Life (A-RHDQoL) scales, have recently been developed to specifically assess this patient population, and the A-RHDQoL found that memory, energy and physical capabilities, and sex-life were the factors most adversely affected by low testosterone levels. Unfortunately, there are limited data on the effects of testosterone on the quality of life of men with hypogonadism, but the information that exists suggests that testosterone can improve the quality of life significantly (to the same level as men with normal testosterone levels) and the more severe the symptoms before treatment, the greater the benefits of testosterone replacement. These promising early results need to be confirmed in more detailed quality of life studies.     

Spirituality and Ethics in Long-Term Care

Abstract

The issues of spirituality and ethics are evoked in a case of an 89-year-old woman resident in a nursing home who refused nutrition and hydration. Clergy representing Catholicism, Protestantism, Judaism, Hinduism and Islam were asked to respond to questions regarding the choice to end life and spiritual resources to help the patient. The clergy agreed that the patient is in a spiritual crisis but her autonomy should be respected, and spiritual resources should be expended to enhance meaning. The ethical dilemma for the social worker, as for the clergy, is whether to support the patient's freedom to end her life or persuade her to continue to live. The dilemma is based on conflicting social work values of self-determination and the preservation of life. Three ethical principles are in conflict: respect for autonomy, the duty to prevent harm, and beneficence. At the end of the process of ethical deliberation, the social worker must be prepared to accept the patient's decision.     

“I'm Not Going to Leave Her High and Dry”: Young Adult Support to Parents during the Transition to Adulthood

The transition to adulthood is a critical time in the life course, and the role of parental support during the transition has been one of the most prominent discussions in this literature. Yet while research has focused attention on the support passed from parents to young adult children during the transition, it has generally ignored the support that young adults may provide their parents. Utilizing qualitative interviews, this article explores the types of support one group of young adult children provide to their families during this time in the life course. It then examines how this assistance to parents intersects with young adults' ability to meet their own social and human capital goals.     

Children's Perceptions of Their Relationships with Coresiding and Non-Coresiding Fathers

In this study the perceptions of children who reside with their fathers and children who live apart from their fathers are compared on a number of relationship qualities. Residential status significantly affected the likelihood of a father being named as some- one who was important in thc life of the child, as well as the likeli- hood of the father being named as someone the child went to for help with a reccnt srressful event. However, for those fathers who were named by their children, the child's perception of the general quality of the relationship and the amount of social support it provided did not differ by residential status. In addition, noncoresiding fathers were seen as filling the functional roles of teacher, supporter, and challeng- er at a higher level than co-residing faUiers. It appears that residential status may reduce the child's access to his or her father, but that those fathers who maintain contact remain important, functional people in their children's lives and important sources of support in times of stress. The need to change the common rception that noncoresid- ing fathers are unimportant in the lives o P" their children is discussed.     

Divorce:

This article approaches divorce from a combined family systems, individual life cycle and stage theory of development perspective. It posits that the choice of what kind of therapy is apt to be most efficient and most efficacious for any patient/couple should be made after identifying at what stage in the divorce process the person(s) is/are in when they enter treatment and what their respective ego strengths, cognitive functioning, and social and resource networks are. There is an assumption of flexibility in the therapist's style and philosophic orientation. It is recommended that therapy encompass interventions that are likely to be the most effective in the various stages rather than be a rigid adherence to one dogma. Several illustrative case vignettes are presented.     

An Exploratory Needs Analysis of Parents Diagnosed with Cancer

The purpose of this study was to explore the experiences of parents and co-parents where one parent was diagnosed with cancer with specific interest in the impact of the disease on their role as a parent and the supports that were found to be useful in managing the ongoing care of their children. A qualitative research method using semi-structured interviews and thematic network analysis techniques was used. Participants included adult English-speaking parents receiving treatment for a new diagnosis of cancer at a major tertiary oncology research and treatment centre, with prior social work involvement. Participants reported multiple, complex layers of need. Four salient themes were evident: (a) emotional impact of a cancer diagnosis on the patient, (b) accessing professional supports, (c) children’s understanding, and (d) meeting children’s needs. Parents described difficulties in managing emotionally, physically, and existentially. Accessing supports within the healthcare service and community was paramount, as was guidance around communicating with children. Receiving a proactive service from a social worker was highly regarded. The results demonstrate that it is essential to respond to the needs of parents with cancer in order to minimise prolonged emotional distress.     

Multilevel Factors Influencing Maternal Stress During the First Three Years

This prospective study applies family stress theory to the influence of personal, child, and familial factors on a mother's parenting stress during the first 3 years of her infant's life. Participants included 134 mothers and their infants at ages 1, 6, 15, 24, and 36 months from one site of a multisite, longitudinal study. Mother's personality was most predictive of parenting stress cross‐sectionally and longitudinally. Intimacy with partner reduced parenting stress early in the infant's life and at 36 months, whereas general social support was more important in the second year. Child temperament was influential at 1 and 36 months. Counterintuitively, mothers who were more satisfied with work or school choices were more likely to be chronically stressed. Implications are discussed.     

Everyday Violence in Central America as Seen Through the Life of One Woman

Everyday violence in Central America assumes diverse forms, with the structural violence intrinsic to the poverty and inequality in the region being the most predominant. The life story of Andrea embodies many elements of that violence, as it led to her entering the labor force as a child, to her having her own children early, and to her employment in the service sector. But, Andrea came of age during a revolution in her country—that waged by the Sandinistas in the 1980s—which provided her family with resources of both a material and non-material nature. The changes it wrought, however, were not deep enough to transform the opportunities of the next generation and were undercut in its aftermath. Hence, Andrea’s aspiration for her children to have different lives from her own required her emigration to achieve it. Yet, it was also the revolution, in the form of a network that emerged from it, that made possible her work abroad in Italy. She was able to earn enough there to provide the education for her children that she sought. Drawing on an oral history I collected from Andrea, this article portrays the challenges she confronted, the ways she addressed them, and how her life course has been produced by the interaction between these phenomena. In addition to telling her story and describing the ways in which structural violence colored it, the article highlights the broader social, economic, and political dynamics that make this about more than just one woman.     

Cancer in the Family: Review of the Psychosocial Perspectives of Patients and Family Members

As advances in cancer care have led to more treatment options and longer survival for cancer patients, a focus on quality of life for patients and their families has gained importance. This review provides a discussion of stress and coping theory, documents the relevance of this topic area for social work practice, and illuminates the results of a literature review by emphasizing the perspective from which research was collected within the family system. Recognizing the impact of cancer on the lives of patients, their partners, children, and the family as a whole is an essential factor in providing appropriate and adequate psychosocial services to families facing cancer.     

Reflections on the Work of Professor Selma Fraiberg

This paper reviews the work of Professor Selma Fraiberg who became a leading figure in the field of infant mental health. Born in 1918 she first received an MSW in Social Work and then undertook her Analytic Training in Detroit Michigan. While she maintained her identity as a social worker throughout her life, she integrated insights from the fields of social work, psychoanalysis and developmental and ego psychology in her research and practice. This paper traces her development as a clinician, researcher, and educator. Three cases describe her ability to integrate social work methodologies with analytic insights. The cases describe the treatment of a latency age child at a time of social change, a clinical research study of the developmental risk of children blind from birth, and a groundbreaking study in the field of infant mental health. Her study of infants at developmental risk focused on the parent /infant relationship and parents were included in the treatment process so that they could become more attuned to their young child. Her work highlighted the intergenerational issues that shaped the parental capacity for empathic nurturance between parent and child. The article Ghosts in the Nursery incorporated the major theoretical concepts of the new theoretical approach to treatment and is still much read in graduate programs today. Although extensive new research has added to the field of infant mental health, her contributions are still relevant to research and practice today.     

The Paradox of the Quality of Life of Adults with Learning Difficulties

This paper is based on an empirical survey conducted in 1995 in Hungary. Data came from a stratified random sample of about 1300 adults with learning difficulties from all over the country. The author combines qualitative and quantitative methods in analysing the quality of life of people with learning difficulties and takes into consideration that their quality of life is as much determined by sociological factors as by the biologically and educationally understood level of difficulties. The paper shows that success in education and in the labour market does not equate to successful social integration. The quality of life of adults with learning difficulties is sometimes better in social circumstances which are less favourable for high achievement in education and in the labour market. Though the people from more privileged backgrounds may seem to lead a more active and social everyday life than those with working class origins they are still considerably less integrated in their social environments.     

Narratives and self-identity in later life: Two rural American older women

Older adults often draw on memories to construct stories about themselves that help them to retain and validate their self-identities, doing this within the cultural contexts that have shaped their lives. In this paper, we examine the life history narratives of two working class, rural American older women and the ways in which those narratives are similar despite one major difference: one has dementia. In both cases, major themes that are consistent with gender-based, working class, rural American cultural values are dominant, including closeness of family, hard work, ties to the land, and religious faith. In the first case, she reconstructs memories of her life in accordance with dominant cultural and personal values, downplaying the ways in which her experiences were “out of step” with these values. In the second case, her sense of identity remains and is expressed through her co-constructed memories although she is experiencing cognitive loss.     

Self and other: The importance of social interaction and social relationships in shaping the experience of early-stage Alzheimer's disease

Various factors influence how individuals experience illness. Especially important, however, is the reaction of others whose response shapes the meaning of the illness for the person who is ill, and the impact it will have on her or his sense of self. Adopting a symbolic interactionist perspective, and drawing on data obtained from in-depth interviews conducted with nine individuals living with early-stage Alzheimer's disease, this paper examines how others’ reactions to and treatment of persons living with the condition can influence how they experience dementia. The findings reveal that the majority of the participants did not believe others’ treatment of them had substantially changed, nor did most express the level of concern about the possible negative response of others reported in other studies. Within their relationships and social interactions participants received the essential support, cooperation, and encouragement that enabled them to create meaning in life and sustain identity.     

Dementia at the Intersections: A unique case study exploring social location

Research exploring the experiences of persons living with dementia has been criticized for failing to situate individual experience in a broader socio-cultural context. In particular, little attention has been devoted to examining how social location shapes the subjective experiences and responses of persons with dementia. This paper examines how one woman's position as a younger, aboriginal woman of lower socio-economic status living with a same-sex partner, helped construct her experiences with dementia. Data for this unique case study are based on in-depth personal and family interviews and video-taped participant observation. Three themes dominated her story. First, receiving a diagnosis of dementia triggered this woman's desire to connect with her cultural heritage. Through this claiming of her cultural identity as an aboriginal woman, the dementia was reinterpreted as facilitating a closer connection with her ancestors and this released for her a sense of creativity, productivity and peacefulness. Second, the refusal of this woman to adopt a more conventional interpretation of dementia, compounded by her younger age and atypical presentation, resulted in a tendency by others to discount the impact of the dementia in her life. Finally, the lack of recognition afforded to her female partner increased her partner's isolation and created challenges for their relationship. This paper will focus on embedding this woman's lived experience within a broader socio-cultural context in order to demonstrate how aspects of one's identity and social location interact to construct one's subjective experience.     

A game of three monkeys: Kadazan Dusun villagers and violence against women

Based on detailed and long-term anthropological research among rural Kadazans, the paper sets out the social history of domestic violence in one Sabah village. In more than 30 per cent of the households, there is a woman who has experienced repeated spousal abuse during her life. Adding those men who abused earlier spouses, and adults who lived through the abuse of their mothers in childhood, it is clear that violence is and has long been part of everyday — yet secret — village experience. For various reasons, researchers appear to have colluded in ignoring the issue. To help those women and their children whose lives are blighted by fear and fearful memories, it would be wise to assume domestic violence is as present in rural as in urban settings.     

Letters from the future: an exercise with child welfare predictions

Abstract

The article presents an empirical exercise about predictions in child welfare. In the exercise, social workers imagined letters which they could receive from a child and his/her parents in five years’ time. The children had been in care for one year at the moment of letter-writing. When the social workers wrote the imaginary letters, they used their professional imagination, based on practice knowledge and experience, and were involved in a role-play. The analysis of the letters (34 from ‘children’ and 33 letters from ‘parents’) demonstrates four themes shared by the letters: ordinary life, family contacts and return home, social problems as shadows and assessment of the placement. Two narratives were performed: the narrative of future of ordinary life and that of the troubles. It is suggested that imaginary letters are helpful in highlighting practitioners’ sense of the future, professional imagination as well as the empowering and critical points in practice.