Introduction
Stoma or Cool-rectal Cancer
Several studies have indicated that colorectal cancer is a cancer type that is high in frequency among both the male and female population (1999 2003). According to Parker, et al (1997), colorectal cancer is the second highest cancer disease (lung cancer being the most prevalent case) and the leading cause of cancer-related disease in the United States wherein an estimated 131, 000 Americans were diagnosed with colorectal cancer and 55, 000 died of the disease.
A number of medical researches and studies have claimed that proper screening and treatment of colorectal cancer can alleviate and decrease the statistics pertaining to the suffering and deaths of the disease. Medical studies have found out that detecting and removing adenomatous polyps can prevent the development of colorectal Aden carcinoma while detecting and treating early-stage cancers can lower the cases of deaths for colorectal cancer (Newcomb, et al, 1992).et al (1997) recommended that by 50 years of age, most persons at average risk for colorectal cancer should begin regular screening for polyps and malignancies (http://www.aafp.org).
Colorectal cancer is a disease in the digestive evident in the parts of the large intestine such as the colon or the rectum. As such, tumors form in the lining of the large intestine which is also called the large bowel. Colorectal cancer is common both among the male and female population as development of the disease normally arises at the age of 50. Colorectal cancer can be metastasis in which cancer spreads from its original location in the colon to other parts of the body like the liver or lungs (National Institute of Health, 2005). Figure 1 below presents the four sections of the colon where cancer can start or in the rectum. The walls of the colon and that of the rectum are composed of several tissue layers where cancer starts. From the inner layer, the cancer can grow to some or all of the layers. As such, the degree or stage of colorectal cancer is popularly screened and investigated through the examination of these tissue layers (American Cancer Society, Inc., 2005).
According to Burke (2003) “colorectal cancer arises from a series of histopathology and molecular changes caused by complex interactions between genetic susceptibility and environmental factors”. In this regard, the molecular changes are identified as (a) the multiple, acquired genetic alterations within colonist ontogenesis that promote malignant transformations and (b) the tumor suppressor genes which cause loss in the inhibition of cellular proliferation. Researches on carcinogenesis discovered mutations in the genes that are responsible for the repair of mismatched DNA pairs. These mismatched-gene-repair inactivation cases are found to be common among 15% of sporadic colorectal cancers.
The patient, having undergone polyps colonoscopy before complaining the symptoms of his rectal cancer increased his chance of experiencing the results of his latest medical examination and operation. As stated, polyps or the benign growths in the inner wall of the colon and rectum that increase a person’s risk of developing colorectal cancer. Familial polypus’s causes hundreds of polyps to form in the colon and rectum which lead to colorectal cancer if not treated early (Baddish, 2003).
Although it was his colon that has been previously operated, the inseparability of colon and rectal cancer is very thin that most people are diagnosed with both, simultaneously or consequently. His rectal examination revealed no masses but a strongly haemoccult-positive stool indicated the seriousness of the patient’s condition as a rectal cancer symptom. It is also obvious in this case that cancer in the colon spreads and has the tendency to recur to a person who has been treated.
Aside from his medical history of polyps operation, his age also contributed as a factor that increased his risk of colorectal cancer as the disease is more likely to occur as people get older, usually individuals who are over the age of fifty (2003). Patient RM is 63 years old which included him in the category of people with high risk of colorectal cancer.
The latest medical condition of the patient is indicative of his early cancer stage in the rectum. The abdominoperineal resection made in his body is the usual medical procedure when diagnosed with rectal cancer.
The physical and psychological impact of cancer to its patients have been an important issues in the field of medicine (National Cancer Policy Board:2006). However, it is only recently that survivorship is coming to be recognized as a distinct phase of the can trajectory. Findings from research studies that have tracked the health and well-being of patients after cancer treatment has ended have identified risks that both survivors and their health care providers should recognize. Advances in knowledge of how to manage conditions that arise in the post-treatment period have led to the development of some guidelines for health care providers. The coping period gives many chances to progress the health and quality of life of cancer survivors.
Background of the Study
Qualitative Study
The complex and often idiosyncratic nature of the methods and the narrative style of findings from qualitative studies make using the traditional format for reporting quantitative work awkward at best (Roskos:2000). In quantitative studies, research designs, sampling strategies, and statistical analysis procedures have been standardized and codified in ways that make it possible to summarize these in very few words. Similarly, findings are reported using terms and numbers that are relatively brief and straightforward (at least to those inside the quantitative research community). Qualitative methods are frequently adapted to the settings under investigation, and questions often emerge or change as studies progress, making codified descriptions of data gathering and analysis procedures difficult. Further, since understanding the contexts of a study is essential to interpreting the findings of a qualitative report, collapsing these into a few words in a review can distort important meanings generated in the study. Finally, since qualitative findings are descriptive in nature, shorthand versions like those found in traditional reviews of research are likely to leave out a great deal of the descriptive power.
Quality of Life Research
The principal criteria guiding the patients’ acceptance of treatment are most often the patients’ subjective feelings i.e. the quality of their lives (Glise:1993). As the surgery asks patients to trade present discomfort and risk for future gains, in gauging the achievements of surgical treatment it is important to try to measure the quality of functional result vouchsafed to the patient. Another reason is that “surgery is forever” and cannot be undone. Broadening the choice of endpoints beyond traditional, so-called “hard” variables, and including SOL in surgical studies has advantages for both surgeons and patients. Because the impairments of function that may occur after different operations vary considerably, an operation-specific assessment of SOL for each type of surgical procedure is essential. Until now most of the SOL studies have been performed by non-surgeons with psychometric support, but it is time for the surgeons to provide leadership in SOL studies. Performing these studies will allow the surgeons to bridge another divide, open doors to showing more sensitivity, leading to better communication with their patients. A free and frank discussion, about SOL gains, as a benefit of surgery, at the time of counseling will go a long way in ensuring that the patients’ perspectives get their rightful place in decision-making. So the answer to the question, SOL measurements: who benefits? is that everyone benefits, surgeons as well as patients.
Aims and Objectives of the Study
The aim of this is to be able to identify and examine the patient’s perspective on the psychological impact of a stoma or cool-rectal cancer: The subject can be basically generalized and can be conducted using qualitative research method. The aim of the proposed study is:
“to explore and describe the psychological impact of stoma in the perspective of the patients.”
The following are the objectives of the research:
· To have in depth knowledge about stoma or cool-rectal cancer.
· To identify the psychological impact of stoma to its patients after the treatment.
· To examine the different issues of the stoma patients after their treatment.
· To know how the stoma patients cope with the psychological impact of stoma after their treatment.
Methodology
The methodology of the study is qualitative in nature. The complex and often idiosyncratic nature of the methods and the narrative style of findings from qualitative studies make using the traditional format for reporting quantitative work awkward at best (Roskos:2000). In quantitative studies, research designs, sampling strategies, and statistical analysis procedures have been standardized and codified in ways that make it possible to summarize these in very few words. Similarly, findings are reported using terms and numbers that are relatively brief and straightforward (at least to those inside the quantitative research community). Qualitative methods are frequently adapted to the settings under investigation, and questions often emerge or change as studies progress, making codified descriptions of data gathering and analysis procedures difficult. Further, since understanding the contexts of a study is essential to interpreting the findings of a qualitative report, collapsing these into a few words in a review can distort important meanings generated in the study. Finally, since qualitative findings are descriptive in nature, shorthand versions like those found in traditional reviews of research are likely to leave out a great deal of the descriptive power.
In order to come up with the most suitable research approaches and strategies for this study, the research process “onion” is used. This is because conducting a research is like peeling the back layers of an onion—in order to come to the central issue of how to collect the necessary data needed to answer the research questions and objectives, important layers should be first peeled away. With the said process, the researcher was able to create an outline on what measures are most appropriate to be applied in the study.
Saunders et al (2003) said that while it is not unusual for a researcher to first think of his research undertaking by considering whether one should, for instance, administer a questionnaire or conduct interviews, thoughts on this question should belong to the centre of the research ‘onion’. That is, in order to come to the central issue of how to collect the data needed to answer one’s research questions, there are important layers of the onion that need to be peeled away: the first layer raises the question of the research philosophy to adopt, the second considers the subject of research approach that flows from the research philosophy, the third examines the research strategy most applicable, the fourth layer refers to the time horizon a researcher applies to his research, and the fifth layer is the data collection methods to be used.
The researcher conceptualized the research approach to be applied in this study by Saunders et al (2003), in order to come up with the pertinent data needed to answer the research questions stated in the first chapter, as well as to arrive to the fulfillment of this research undertaking’s objectives.
Then again, the research philosophy that is reflected in this study is positivism. With this research philosophy, a researcher prefers to work with an observable social reality in order to come up with law-like generalizations similar to those produced by the physical and natural scientists (Remedy et al, 1998), and in this tradition, the researcher becomes an objective analyst, coolly making detached interpretations about those data that have been collected in an apparently value-free manner (Saunders et al, 2003). In addition, the emphasis is on a highly structured methodology to facilitate replication (Gill & Johnson, 1997) and on quantifiable observations that lend themselves to statistical analysis (Saunders et al, 2003). In here, the assumption is that the researcher is independent of and neither affects nor is affected by the subject of the research (Remedy et al, 1998; Saunders et al, 1998).
Meanwhile, the second layer shows that this study has undertaken a deductive approach. Accordingly, this approach has five sequential stages: deducing a hypothesis; expressing the hypothesis in operational terms; testing this operational hypothesis; examining the specific outcome of the inquiry to either confirm the theory or indicate the need for its modification; and finally, modifying the theory in the light of the findings (if necessary) (Robson, 1993, p. 19).
Further, the deductive approach has a number of important characteristics. First, this approach is a search to explain causal relationships between variables, which consequently leading to the development of a hypothesis. Second, it involves the collection of a quantitative data (although it can, as well, use qualitative data), and these data are important to test a hypothesis that has been previously developed. The third characteristic of a deductive approach is that it controls to allow the testing of hypothesis. However, one must remember that with this approach, it is important that the researcher is independent of what is being observed—that is, the researcher should be objective and not subjective—so that the principle of scientific strictness will be pursued, as this approach emphasizes scientific principles. (Saunders et al, 2003)
Also, it is important that concepts are operationalisation, which will enable facts to be measured quantitatively. Finally, the deductive approach is generalization (e.g., to be able to generalize about regularities in human social behaviour, one must be able to select a sufficient numerical size of samples). (Saunders et al, 2003)
Data Collection and Strategies
In order to obtain the desired data, the researcher has chosen to use the primary research data, which is to collect firsthand the data to be used for the outcome of the research. In able to do this, the researcher must have a data collection instrument to be presented to the respondents. Thus, the researchers have chosen obtaining data through the questionnaire. The questionnaire is administered by writing questions on a page and distributing it to the respondents, expecting them to return the paper with their answers on it. This is easier than other methods of data-collection (e.g., interview, observation, etc.) as particular details may be hard to talk about during interviews and cannot be drawn out from observation.
The advantage of using the questionnaires method is that the respondents have time to think of their answers, thus allowing smaller rate of errors. Also, concerning delicate matters, the respondents may feel more at ease when answering questionnaires as they are not required to speak with someone else in order to give information. The disadvantage of the questionnaire method is when the respondents are unable to read or write; then the questionnaire will be rendered useless by the respondents as they may need interpreters for the questionnaires. Thus, in case such that unlikely event may happen, then the researcher will have no choice but to quickly switch to the interview method, wherein the researcher will be allowed to interact with the respondent and ask the questions based on the prepared questionnaire.
During the interview, the interviewer encouraged the interviewee to clarify vague statements or to further elaborate on brief comments. More importantly, the interviewer was objective and did not attempt, in any way, to influence the interviewer’s statements. In order to do this, the interviewer did not share his/her own beliefs and opinions. Also, the questions thrown at the interviewees had been phrased clearly, so that interviewees can understand them, and they were delivered in neutral tone of voice. The researcher also avoided long questions, or those that are really made up of two or more questions, because as Robson (2002) said, by asking long-questions, the tendency to obtain a response for each aspect a researcher wants to explore will be lost. The researcher also avoided too many theoretical concepts or jargons, as the researcher’s understanding of such terms may vary from that of the interviewees. Also, during the interview, the researcher was determined to establish trust by not being too assertive and by being attentive to the interviewees’ responses. Finally, the researcher made sure that the interview did not last too long and did not consume much of the respondents’ time, as this may instigate uncooperativeness from the respondents
Data Analysis
Data will be analyzed based on the descriptive statistics performed in data processing. What’s more, the content analysis of documentary materials in this study was qualitative because the interpretations and conclusions from the findings depend almost entirely on the output in processing the frequency counts of the perceptions of the respondents. So, the occurrences of the perception of the respondents were tallied one by one, upon the frequency of the occurrences depends the analysis and interpretation. To further enhance the perception of the respondents, they were also given time for an interview that is subjected to their respective insight to the topics. The interview results were then used to justify their answers.
As has been mentioned above, content analysis of the documentary materials of this study was systematic. Hence, it follows scientific methods of research. The steps follow:
· Recognizing the Problem-
· Forming hypothesis-
· Doing the library research.
· Designing the study.
· Developing the instrument.
· Collecting the data.
· Analyzing the data.
· Making conclusions
· Making recommendations
Access and Sampling
The study will consist of 10 stoma patients from different hospitals within the area. Respondents will be chosen randomly through stratified-random sampling approach. The researcher, in choosing subjects or respondents for the topic at hand, is usually thought of to have the power over who the respondents of the study will be. Such a task would have been easier, except a researcher cannot simply choose out of whim; the subjects must be selected carefully with the intention of having subjects who each posses characteristics that, when put together, will represent a community. It is not only themselves, whom these subjects will represent, but the bigger whole or the whole population. The characteristics which the researcher has chosen them for will determine which part of the community they belong and what part of the community they are representing. Thus, the choosing of the subjects must be based on their characteristics.
Ethical Consideration
Because the respondents of the study will be cancer patients, ethical considerations should be observed strictly. First, the researcher will make sure that the time and place of the survey will be convenient to the patients and will be approved by their assigned specialist. Confidentiality of the respondents’ identity will also be ensured, as well as their responses. The objectives of the study will also be read and explained to the respondents so as they will understand why it is being conducted.
Conclusion
In conclusion, this proposal has identified the different issues on the psychological impact of stoma in the perspectives of the clients. The study will focus on the quality of lie, body image, sexuality and sexual concerns, psychological adjustment, coping and practical adjustment of the patients.
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