A Survey of social support and psychosocial compliance in patients with breast cancer

Author(s): Gülsüm Nihal Çürük*, Pnar Tekinsoy Kartin and Arzu entürk Objective: The aim of the study was to investigate social support and psychosocial compliance in patients with breast cancer. Methods: The research was carried out on 131 patients diagnosed with breast cancer. The forms containing patients’ demographic information were prepared by the researcher and Multidimensional Scale of Perceived Social Support (MSPSS) and Psych ... Abstract View Full Article View DOI: 10.17352/2581-4265.000043

Citation: Çürük  When psychological problems are experienced and psychosocial adjustment is impaired, the course of the illness and the individual's response to the treatment are negatively affected. For this reason, health professionals should consider psychosocial support as an integral part of treatment for the patient in a holistic approach and should constitute a treatment plan that includes psychosocial dimensions [4,7].
Cancer diagnosis has deep effects not only on psychological state but also on the cognitive, emotional, spiritual and social features of the individual. Both the cancer diagnosis and the treatment process changes self-esteem, the perception of the body, the quality of life, the daily life activities, the sexual life, personal and social roles, the family and the environment of the patient and in response to that the need for social support is increased [3,4]. In general, social support, perceived as a physical and psychological help provided to an individual in a diffi cult situation, is one of the most important sources that can help coping with the psychological stresses experienced by cancer patients. Individuals with social support are able to adapt more easily, heal more easily, improve their quality of life and increase their ability to cope with illnesses [8]. As it has been reported before by many researchers, social support provided by health professionals, health care institutions and society has positive effects on wellness of the cancer patients and strengthening of the coping strategies [9,10].
Since breast cancer diagnosis and treatment brings multiple problems in women, nurses should take a holistic approach to breast cancer patients, thoroughly evaluate the psychosocial needs and adjustment of patients, identify psychosocial problems, and exercise counseling in the mobilization of appropriate social support systems [6,11].
Aim of this study is to investigate the level of social support and psychosocial adjustment in patients with breast cancer.

Study design
A descriptive research design was used in the current study.

Subjects
The study sample was 131 patients with breast cancer receiving chemotherapy between July 2013 and December 2013 at Mehmet Kemal Dedeman Oncology Hospital.

Inclusion criteria
Patients who received chemotherapy, had no psychiatric disorders, no communication problem, and be able to speak and understand Turkish are included in the study.

Tools for data collection
The data were collected by using Personal Description Form, Multidimensional Scale of Perceived Social Support (MSPSS) and Psychosocial Adjustment of Illnes Scale-Self Report Scale (PAIS-SR) in the study. Data were collected through individual interviews.

Personal description form
There are a total of 17 questions in the form containing socio-demographic characteristics of the patients, and information about the disease. The questions of the form were prepared by the researcher by revising the literature.

Multidimensional scale of perceived social support
MSPSS was used as a measure of the patients' perceived social support. The scale yields three subscale scores for family, friends and significant other. The perceived social support is graded on a 7-point likert-type scale (from "1-very strongly disagree" to "7-very strongly agree") as follows: respondents are required to circle 1, very strongly disagree; 2 strongly disagree; 3 mildly disagree; 4 neutral; 5 mildly agree; 6 strongly agree; 7 very strongly agree. The complete scale ranges from 12 to 84. Higher scores indicate higher social support. Eker, Arkar, and Yaldız [12] translated the measure to Turkish and provided validity and reliability information. For the validity and reliability of the inventory, Cronbach alpha coeffi cient was determined as 0.80-0.95 [12].

Psychosocial adjustment of illnes scale-self report scale
The PAIS-SR was used to evaluate the psychological and Higher scores indicate a weaker adjustment. Scores lower than 35 represents well psychosocial adjustment, scores between 35 and 51 represents medium-level psychosocial adjustment, and higher than 51 represents poor psychosocial adjustment. The Turkish version of the PAIS-SR was prepared by Adaylar [13].
For the validity and reliability of the inventory, Cronbach alpha coeffi cient was determined as 0.80-0.95 [13].

Ethical considerations
Ethical approval for this study was obtained through a Erciyes University Clinical Trials Ethics Committee. All participants provided written informed consent.

Data analysis
Statistical analyses were performed with SPSS. In the evaluation of the data obtained from the research, independent samples t-test and Mann-Whitney U-Test were used for the comparison of two groups and analysis of variance and Kruskal Wallis test were used for comparing more than two groups. Since the relationship between two numerical variables was not distributed normally, it was examined by Spearman Correlation Analysis.

Results
In total, 131 cancer patients participated in this study; the mean age of the subjects was 52.0 years old (SD = 10.9), 49.6% had graduated from primary school and 57.2% lived in a town.
Citation: Çürük  The majority of participants were married (87.0%) and had child (90.0%). It was found that 45.0% of the patients had metastases, 55.0% had surgery and 65.0% had cancer for 1 years.
Patients with breast cancer had a PAIS-SR score of 29-78, with a mean score of 56.0 ± 9.5 (Table 1). It was found that 3.8% of the patients had good adjustment, 22.2% had moderate adjustment and 74.0% had poor adjustment ( Table 2). The best adjustment of the patients on the PAIS-SR scale was found to be broad family associations (1.6±1.5) and family environment (4.6±2.8), however the worst adjustment was to the health care (17.5±2.8) and sexual life adjustments (11.51 ± 4.3) ( Table 1).
It was found that the psychosocial adjustment of the patients who were single (p= 0.010), who lived in the village (p=0.011) and who had metastasis (p=0.005) were signifi cantly worse in our study. The mean score of the social support scale of the patients with high income level was found to be signifi cantly higher than the other patients (p=0.002). It was determined that the variables such as age, education level, family type, number of children, duration of diagnosis and surgery had no signifi cant effect on the score obtained from both psychosocial adjustment and social support scale (p>0.05) ( Table 4).
In our study, it was determined that there was a statistically signifi cant negative correlation between the average total scores of perceived social support and psychosocial adjustment of the patients (Table 5).

Discussion
New treatment options have provided prolongation of survival of the cancer patients, as well as the need for good psychosocial adjustment to increase patients' quality of life [14]. In our study, the mean score of PAIS-SR on patients with breast cancer was 56.0 ± 9.5. Similarly, in other studies conducted with breast cancer patients, the PAIS-SR scale score average of the patients was similar; 56.15 ± 14.02 in the *Psychosocial Adjustment to the Illness Scale-Self-Report, **Standard deviation.    [5,20]. It is therefore important that nurses working with patients with breast cancer should evaluate psychosocial adjustment of their patients and undertake initiatives to strengthen adjustment.
Social support, often referred to as help provided by people around the stressed or individual in diffi cult situation, aids to protect the wellbeing by alleviating or compensating for the damages caused by stress. It is stated that the social support provided by family and friends is very important in the psychosocial adjustment of the patients [8]. In accordance with this information, we found that the social support scores of the patients were above the average, and the patients stated that they receive adequate social support from the family. In cancer patients, families constitute a large proportion of social support [9,21]. Particularly support originated from family has been found to be helpful for the patients with their psychological problems [9]. In our study, patients also had the highest score from family support, which is the subscale of the social support scale. This can be interpreted as a sign of strong family ties. in coping with illness and disease [24]. In our study, the psychosocial adjustments of the patients living in rural areas were signifi cantly worse, and logistical diffi culties may be the result of social and cultural barriers. Thus, we can conclude that it is important for nurses, especially those living in the rural areas, to know that there is a need for more information and counseling on this subject, and proper counseling for these individuals is necessary. In the literature, it is emphasized that as the education level of the individual increases, the understanding of health will improve, individuals will take more responsibility for matters related to their health, they will learn more and use more effi cient strategies to manage disease symptoms, so that they will deal with the problems caused by the disease more easily, and that their adjustment will be better [25]. In our study, it was determined that patients with higher educational level, although not statistically signifi cant, had higher psychosocial adjustment. new friendships, feeling useful to society and social cohesion [26]. In our study, the mean score of the social support scale of the individuals with high income level was found signifi cantly higher than the other patients.

Low
While the high score of Multidimensional Scale of Perceived Social Support (MSPSS) indicates a high level of perceived social support [13], the high score obtained from the psychosocial adjustment-self report scale indicates poor psychosocial adjustment . It was determined that the average level of psychosocial adjustment scores decreased as the social support level of the patients increased because of the negative correlation between the perceived social support total score average and the psychosocial adjustment total score average in our study, in other words, it was determined that the level of psychosocial adjustment was increased and the relationship between them was statistically signifi cant. Social support affects the health both directly and by protecting them from the negative consequences of stressful events [7,8]. It is emphasized that the social family support, conceptualized as the support provided by family members, relatives and / or other social relations, has an impact on both physical health and psychological well-being of the individual in diffi cult situation or the distressed. The function of social support, so called "positive social interaction" or "socialization", has a positive effect on the psychological adjustment of individuals through sharing a common interest or entertainment with a group of people, such as having a dinner and going to a movie [8]. Similar to Rizalar Ozbas, Akyolcu and Gungor [15], we also found that the psychosocial adjustment of patients with breast cancer was found to be better as the social support level of the patients increases. In studies conducted by Turten Kaymaz and Akdemir [27] in patients with diabetes, it was found that social support was effective in psychosocial adjustment and the presence of social support positively infl uenced adherence to the disease. In the study conducted by Babacan Gümüş and Çam [28], it was determined that nursing interventions focused on emotional support increased psychosocial adjustment in cancer patients.

Conclusions
In our study, it was determined that the psychosocial adjustment of the patients with breast cancer was below the average and the social support levels were above the average.
Psychosocial adjustment of the majority of the patients was found to be at a "poor level" and it was determined that the patients' best adjustment area in the psychosocial adjustment subscale was extended family relationships and in the social support subscale, the most supported area was family support.
In addition, as the social support level of the patients increases, it has seen that the psychosocial adjustment also improve.
In line with the results from our study it has been recommended that;  Having adequate social support resources affects psychosocial adjustment positively, it is recommended that appropriate social support resources should be identifi ed to increase psychosocial adjustment of breast cancer patients.

Limitations
The limitation of this study was the relatively small sample size.