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Table of contents
1. Living With a Malignant Musculoskeletal Tumor: Experiences of Family Caregivers..................................

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Document 1 of 1

Living With a Malignant Musculoskeletal Tumor: Experiences of Family Caregivers

Author: Demiralp, Meral; Hatipoglu, Sevgi; Iyigun, Emine; Demiralp, Bahtiyar; Cicek, Engin Ilker; Basbozkurt,
Mustafa
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Abstract: To describe the experiences of the family caregivers of patients with malignant musculoskeletal
tumors. Descriptive qualitative approach using a semi-structured interview guide. Orthopaedics Department of
the Gulhane Military Medical Academy in Ankara, Turkey. A total of 11 family caregivers aged 25-62 years were
recruited. The analysis revealed 5 themes: religious attributions in terms of the cause and treatment of the
tumor, the effect of malignant tumor on daily life, the tendency to think positively and constructively and find
meaning through caregiving, the anxiety about the prognosis of the malignant tumor, and the support received
from significant others. It is important to develop effective nursing care to family caregivers of patients with
malignant musculoskeletal tumor to understand the physical, emotional, and spiritual experiences in their lives.
Full text: Headnote
PURPOSE: To describe the experiences of the family caregivers of patients with malignant musculoskeletal
tumors.
DESIGN AND METHODS: Descriptive qualitative approach using a semi-structured interview guide.
SETTING: Orthopaedics Department of the Gulhane Military Medical Academy in Ankara, Turkey. A total of 11
family caregivers aged 25-62 years were recruited.
RESULTS: The analysis revealed 5 themes: religious attributions in terms of the cause and treatment of the
tumor, the effect of malignant tumor on daily life, the tendency to think positively and constructively and find
meaning through caregiving, the anxiety about the prognosis of the malignant tumor, and the support received
from significant others.
CONCLUSION: It is important to develop effective nursing care to family caregivers of patients with malignant
musculoskeletal tumor to understand the physical, emotional, and spiritual experiences in their lives.
Introduction
Cancer and how it is experienced is not limited to the patient, but also affects the physical and psychological
health of family caregivers (Blanchard, Albrecht, &Ruckdeschel, 1997; Kozachik et al, 2001; Mellon
&Northouse, 2001; Weitzner, McMillan, &Jacobsen, 1999). Living with illness poses psychological and physical
challenges for patients and their family members, which may negatively affect daily routines and quality of life.
Primary musculoskeletal malignant tumors are rarely seen and constitute less than 1% of all neoplasms
(Dorfman &Czerniak, 1995). According to the data of the American Cancer Society for the year 2008, it is
estimated that there were 2,380 new cases of bone and articulation tumors and 10,390 new cases of soft-tissue
tumors (including heart) in the U.S. population. It is estimated that 1,470 of those with bone and articulation
tumors and 3,680 of those with soft-tissue tumors will die (Jemal et al., 2008). Turkish statistics regarding these
tumor types are not as current. For the year 2003, reported statistics by the Ministry of Health of the Turkish
Republic show 555 cases of bone and articulation tumors and 336 cases of connective tissue tumors (Ministry
of Health, 2003).
Many patients with malignant musculoskeletal tumors suffer from chronic disabilities and conditions with lifealtering and/or life-threatening sequelae. Musculoskeletal malignancies affect the patient's functional ability and
quality of life. The patient's daily activities may be possible only with another's help (National Association of
Orthopaedic Nurses , 2005).
Numerous qualitative and quantitative research studies have explored the personal cancer experience, coping
strategies, and adaptation to illness of patients with breast, colon, and prostate cancer and experiences of their
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family caregivers (Couper et al., 2006; Howard, Balneaves, &Bottorff, 2007; Ko et al, 2005; Lindholm, Mkel,
Rantanen-Siljamki, &Nieminen, 2007; Resendes &McCorkle, 2006; Tuinstra et al., 2004). Knowledge about
the personal experience of those with malignant musculoskeletal tumors is very limited and the different aspects
of caregiving for malignant musculoskeletal tumors are unexplored when compared with caregiving for the other
cancer types. There are no published studies of the experience of caregiving for family members with
musculoskeletal tumors among Turkish family caregivers.
NAON Palliative Care Consensus (2005) guidelines that family caregivers of patients with malignant
musculoskeletal tumors may be at high risk for fatigue, physical illness, and emotional distress. Better
understanding this experience will guide nurses hi providing comprehensive care.
The purpose of this study was to describe the personal experiences of Turkish family caregivers of patients with
a confirmed diagnosis of malignant musculoskeletal tumor.
Methods
A descriptive qualitative design with a semistructured interview guide was the approach selected.
STUDY SETTING AND PARTICIPANTS
A purposive sample of family caregivers of patients with musculoskeletal malignancies was drawn from the
Orthopaedics and Traumatology Inpatient Clinic of the Gulhane Military Medical Academy in Ankara, Turkey.
Inclusion criteria stipulated that the condition had been diagnosed and treatment begun at least 3 months in the
past, ensuring that families had experience in the caregiving role. The study was approved by the ethics
committee of the Gulhane Military Medical Academy.
The sample consisted of 11 family caregivers of malignant musculoskeletal tumor patients admitted to our
institution either for definitive treatment or for followup, between January 2003 and January 2004. Demographic
profiles of the family caregivers are presented in Table 1. Of the 1 1 patients, 7 were being followed for
osteosarcoma, 2 for malignant fibrous histiocytoma, 1 for liposarcoma, and 1 for fibrosarcoma. The time since
diagnoses was between 5 months and 13 months. The average age was 41.36 (SD = 12.16; range, 25-62
years) for family caregivers and 24.72 (SD = 9.33; range, 14-44 years) for the patients.
DATA COLLECTION
Individual, in-depth, open-ended interviews guided by a semistructured interview schedule were conducted with
each caregiver. Open-ended questions facilitated a dialogue and helped us get family caregivers to describe
their experiences of the disease. All interviews were conducted in Turkish. Interviews began with a broad
openended introductory question specific to the purpose of the study: "What was the experience of malignant
skeletal tumor like for you?" This was followed by some more open-ended questions such as "What did you feel
when you first learned that your spouse/child/sibling had a malignant musculoskeletal tumour?" "How does the
disease affect your daily life as you cope with your (your wife's/child's/sibling's) disease?" and "Could you
explain something that supported/supports you in your caregiving?" The introductory question and the other
openended questions were formulated in the interview guide, which were generated from issues identified in the
investigators' clinical practice, an extensive review of the literature, and consultation with both methodological
and clinical experts.
Participants included in the study were informed about the study, and written permission was obtained to
interview and make audio recordings. The same researcher conducted the audiotaped interviews for family
caregivers in a quiet and private room. Each interview took approximately 40-50 min to complete.
DATA ANALYSIS
Interviews were transcribed verbatim. Analysis of narrative transcriptions drew from Colaizzi's phenomenologie
data analysis approach. During the analysis, family caregivers' oral descriptions were read separately by the
researchers to gain a general understanding. Significant statements and phrases that pertained to the study
objectives were identified. Meanings were formulated from these significant statements and phrases. The
formulated meanings were then organized into clusters of themes. Results of the data analysis were integrated
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into a description of the experience.

To ensure credibility of data analysis, the transcripts were examined repeatedly by each researcher. Two
researchers worked independently to identify the major categories of the transcripts. The researchers compared
the separate coding, and there was general congruency of the coding with minor differences primarily due to
choice of words. Differences were discussed until a final agreement was reached. Common themes were
created by merging similar statements for every category. Five major themes were formulated from the analysis,
reflecting common experiences of caregivers of loved ones with malignant skeletal tumors.
To achieve final validation (Colaizzi, 1978), member checking was used. Three informants (one mother, one
sibling, and one spouse) were selected randomly and contacted again to read the descriptions; they agreed that
the analyses had accurately represented their personal experiences.
After data analysis in Turkish, the family caregivers statements were then translated into English, retaining the
original meaning. The English translation was then back-translated into Turkish by a bilingual speaker to make
sure that the translation was accurate. Finally, the two translations were matched for the original meaning of the
Turkish version.
Results
The five main themes that were identified were as follows:
1. religious attributions in terms of the cause and treatment of the tumor,
2. the effect of malignant tumor on daily life,
3. the tendency to think positively and constructively and find meaning through caregiving,
4. anxiety about the prognosis of the malignant tumor, and
5. support received from significant others.
THEME 1: RELIGIOUS AHRIBUTIONS IN TERMS OF THE CAUSE AND TREATMENT OF THE TUMOR
Family caregivers of patients who had malignant musculoskeletal tumor diagnosis expressed that this period
was an exceptionally difficult experience. The diagnosis was experienced as a huge shock for all, and the
period of diagnosis was acknowledged to be very stressful and emotional.
The importance of religion/spirituality in coping was evident in the verbal responses and in the fact that some
came to the interview carrying a prayer book. The diagnosis was viewed as a test by God, and informants
spoke of the need to be patient, pray for a cure, and believe and trust in God. This sense is illustrated by one of
the informants' words: "... we cried so much, we were so sad but we didn't revolt against something. It came
from God, and also God will give the cure, we ask his indulgence...." (60-year-old mother). Another said, "... I
had difficulty in breathing, it was the second month of our marriage, we were undergoing a hard trial and we had
to be patient. The only thing I could do was to take her to the best doctors and to pray for her recovery ... I still
do pray, I can think calmer and easier when I pray...." (28-year-old spouse).
Informants referred to the malignant tumor as a mass rather than using the terms malignant or tumor. A mother
expressed her feelings as:
... I couldn't believe it when I heard the mass. Why has this happened to us? I thought that I was going to die at
that moment. The childhood of my son was in front of my eyes. But you cannot avoid destiny, I should endure
these bad days. I always pray to God my son will get over.... (51 -year-old mother).
THEME 2: THE EFFECT OF MALIGNANT TUMOR ON DAILY LIFE
The treatment of malignant musculoskeletal tumors may cause disability and limitation of movement for
patients, often necessitating assistance with daily activities such as personal hygiene, dressing, and mobility.
Consequently, going to the bathroom, going to bed, and getting up may be possible only with another's help. In
our study, all participants stated that the progress of the treatment was difficult both physically and emotionally.
Most reported that these strenuous physical demands of caregiving caused physical symptoms such as fatigue,
backache, headache, stomachache, physical exhaustion, anorexia, and insomnia. The level of fatigue and
somatic complaints are captured in the following statements:
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. . . usually I take him up from the bed and then put him back to bed again. I usually get tired and have
backache ... I cannot leave him alone.... (46-yearold mother).
... my sister has difficulty in going up and down the stairs. I carry her in my arms. I have to help her with every
task that she has to do standing up. I feel exhausted.... (32-year-old sibling).
... I have backache and headache. For the last two weeks, I feel dizzy ... I have been exhausted since I have
come to the hospital. I do not feel hungry, I cannot eat.... (37-year-old sibling).
... it is really hard to go to the hospital for his radiation therapy because he cannot walk.... (62-yearold mother).
... the main difficulty was during chemotherapy. I lost sleep during treatment. My wife couldn't eat much. I also
had difficulty swallowing my food.... (39-year-old spouse).
The uncertainty of the surgical experience was emotionally stressful, and prayer was a major coping response
in their attempts to be strong and feel secure. A spouse said, "... I cannot think anything. I pray to the God all
the time that everything goes well, hopefully it does not reoccur after the operation..." (28-year-old spouse).
The caregivers, especially those whose loved one had been treated with surgical amputation, stated that their
own emotional states change according to their loved ones' emotional states. A mother expressed her feelings
as: "... I am very sad. When he is fine I am also fine, when he is bad, I am bad as well, when he smiles, we
smile too..." (39-year-old mother).
THEME 3: THE TENDENCY TO THINK POSITIVELY AND CONSTRUCTIVELY: FINDING MEANING
THROUGH CAREGIVING
In our study, the family caregivers reported that caregiving engendered several positive emotions, including
confidence, love, belonging, honor, happiness, and appreciation. They stated that they recognized an increase
in spiritual presence in their lives and that their family relationships gained more strength. Positive thinking
made caregiving easier and generally gave them renewed hope. Their positive spirit and hope along with a
positive response by the patient energized and renewed them, making the ongoing caregiving demands more
manageable. This is reflected in the following words of the informants:
... it was the birthday of my spouse when he was hospitalized. I prepared a surprise party for him. I also took my
daughter to the hospital. He was very happy and he did not expect such a party ... it made me very happy....
(36-year-old spouse).
... looking after her, being with her is a very nice feeling ... I am very pleased to look after her ... I feel much
better when she has a good day; I believe that she will recover when she is good. So I thank God each healthy
day for her.... (28-year-old spouse).
... It isn't difficult for me to look after my son ... my friends say that I am very patient and strong. He is my dear, I
will look after him as long as I can . . . God willing, there will be no need to something else after the operation,
my God helps to all patients, I want my son get over, we have the hope, and he will get over. . . . (51-year-old
mother).
. . . when he eats with a full appetite and smiles, I become very happy ... I don't feel tired of looking after him
any more.... (25-year-old sibling).
THEME 4: ANXIETY ABOUT THE PROGNOSIS OF THE MALIGNANT TUMOR
Most of the family caregivers expressed anxiety over the prognosis. They wanted information. Had the entire
tumor been removed? What was the risk of relapse? What effects could be expected with the treatment
approach? Would the patient walk again? Fear of functional disability and spread of the disease was evident as
captured in the following words:
... I am really worried whether the tumour is totally removed or not, if it will recur or not, and if my son will be
able to walk again.... (39-year-old mother).
... to get rid of all tumour cells, will chemotherapy destroy all tumour cells...? (46-year-old mother).
... I am afraid that the tumour will disseminate and I am worried about losing her and I try to get rid of that
idea.... (39-year-old spouse).
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... I received all necessary information about the process of disease from the physician. I can easily ask
questions of our doctor. I also try to search on the internet myself.... (32-year-old sibling).
... what will the prognosis be? Will he be able to walk again or not? Will he be able to get up from the bed
alone? I really worried about this.... (37-year-old sibling).
THEME 5: SUPPORT RECEIVED FROM SIGNIFICANT OTHERS
Family caregivers expressed their appreciation of the visits of relatives, neighbors, and close friends. These
visits were pleasant and lifted their spirits. This support had positive effects on coping with the disease both for
the patients and for themselves. Encouragement and support gave them emotional strength.
... my friend's frequent visits made me very happy and so did my brother. My brother loves apple pie so my
friend made apple pie one day, we ate it all together, my brother was very happy, we spent a nice couple of
hours, I never felt tiredness that day.... (25-year-old sibling).
... my neighbors and my friends are great. We couldn't go outside after the operation and they never left us
alone ... talking with them energises us and gives us moral support. They say that we will get over these bad
days together, we don't feel ourselves alone.... (62-year-old mother).
Discussion
Previous studies reported that being confronted with a cancer diagnosis produces intense fear, despair, and
anxiety in the patients and their relatives (Cameron, Franche, Cheung, &Steward, 2002; Fang, Manne, &Pape,
2001; Friedrichsen, Strang, &Carlsson, 2001; Iconomou, Vagenakis, &Kalafonos, 2001). This was also a finding
in this study. Almost all family caregivers described their responses at the time of diagnosis as fear, despair, a
huge shock, and hopelessness. Fear of death loomed over them and the period was emotionally traumatic. The
tumor was referred to as a mass instead of malignant tumor, perhaps softening the harsh reality of the disease.
The family caregivers viewed the experience as a test by God. They believed that God would provide the cure
for the illness and they used religious - spiritual coping mechanisms such as praying and reading from the Holy
Scripture. Families had patients wear blue beads. The blue bead (a nazar or evil eye stone) is an amulet that is
meant to protect against the evil eye. It is usually made by hand from colored glass and used as a necklace or
attached to bracelets or anklets. Typically, it is composed of concentric circles or droplet shapes - from inside
out: dark blue (or black), light blue (or yellow), white and dark blue - and is sometimes referred to as blue eye.
As well as being worn by people, including babies, it can be seen on cars, doors, horses, and even cell phones.
These responses are consistent with the fatalistic worldview in the Turkish culture and the strong religious
beliefs of its people.
Other studies that have examined response to cancer among people with a fatalistic worldview showed similar
findings. Tarn Ashing, Padilla, Tejero, and Kagawa-Singer (2003) reported that Asian American patients with
breast cancer believed that their disease was destiny and in the control of God. Similarly, in another study by
Akyuz, Guvenc, Ustunsoz, and Kaya (2008), it was reported that gynecologic cancer patients in Turkey used
worship and prayer as disease-control methods for feeling good and psychological help. Religiosity facilitated
emotional coping and enhanced positive thinking and hope and mediated emotional and physical burnout.
Change in living standards and difficulties in daily routines were the common experience for these family
caregivers, a consistent finding in other studies of caregivers of cancer patients. Chen, Chu, and Chen (2004)
reported that global functioning and quality of life decreased in the family caregivers of patients with breast,
head, neck, or esophagus cancer due to stage of disease. In their pilot study, Passik and Kirsh (2005) indicated
that spouses who were identified as having elevated burden experienced more personal fatigue, reported poor
energy levels, and tended to engage in fewer work and social activities.
The presence of physical caregiving burden and somatic responses to the burden was more prevalent in this
study than in other studies. Unlike other cancer treatments, in patients with musculoskeletal tumors, the initial
treatment is surgical incision with endoprosthesis or amputation. The resulting impairment in mobility
necessitates physical support from caregivers, which often caused physical symptoms such as backache,
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excessive fatigue, and headache. Although chemotherapy and radiation are a challenge for all patients and
families, when superimposed upon the physical caregiving needs, the experience was very difficult. With this in
mind, it is important that the requirements of the patients and their caregiving family members be identified and
the family caregivers be included in the nursing care plans. Furthermore, periodic respite periods should be
arranged for the family caregivers.
Family members in this study turned to prayer not only at the time of diagnosis but also as an ongoing coping
strategy. Under conditions of intense emotional stress, prayer and spiritual activities left them feeling more
confident. Family caregivers felt that it was important to remain strong and control their emotional reactions in
order to support their loved ones in dealing with their losses. Maintaining a strong stance can create an
emotional burden that healthcare providers should be aware of. Family caregivers should be assessed for
depression and anxiety.
An important finding was the identification of positive meaning in the caregiving experience. In the Turkish
family structure, the values of respect, love, belonging, solidarity, and cooperation are very strong and essential
for every member of the family (Ergan Gngr, 2007; Tezcan, 2007). Melin-Johansson, Axelsson, and
Danielson (2007) emphasized that family caregivers experienced "a sense of belonging" and that this was
essential to the quality of life during terminal illness. Caregiving strengthened the relation between the ill
spouses and the caregivers as well as other family members such as children and grandchildren. Meaning was
described in another study as an important existential issue for very ill persons (Bolmsj, 2000). We found that
the family caregivers conducted their caregiving role willingly and described the caregiving role as "a case
having very special meaning." The family caregivers' positive attitudes about the caregiving role increased hope
and coping ability during treatment.
Uncertainty and anxiety regarding the prognosis was a recurrent concern. In most forms of cancer, the
uncertainty of the prognosis and individual variations in the progress of disease cause an increase in the need
for enlightenment (Courtens, Stevens, Crebolder, &Philipsen, 1996; Kristjanson &Ashcroft, 1994; Noyes, Holt,
&Massie, 1998; Shell &Kirsch, 2001). Hallstrm and Blander (2007) performed a meta-analysis of studies
published between 1999 and 2004 that investigated the requirements of parents of children with chronic
disease. They reported that the parents expressed a greater need to be informed about the disease (diagnosis
and prognosis, medical complications and side effects, how to cope with the pain, etc.) as the severity of the
illness advanced. A Japanese study (Fukui, 2002) researched the need for information in family caregivers of
patients with cancer and emphasized that more than 70% of the participants needed information about the
disease. In our study, the participants did not speak of the need for information about the diagnosis, but rather
focused on the information about treatment approaches and prognosis of the disease. This may be because the
patients with the musculoskeletal tumors were 5 to 13 months after the diagnostic period of the disease. Nurses
play a critical role in keeping families informed at every stage of the treatment.
Social support was a major factor in energizing the caregiver. This support assisted family caregivers to find
meaning in their caregiving role and made them feel stronger. Hallstrm and Blander (2007) suggested that the
support of close friends with similar sociocultural backgrounds is an important factor in developing hope.
According to our results, arrangement of visits, in which the friends and family caregivers can be together for the
purpose of assisting the caregiving, increased the hope, positive thinking, and attitude of family caregivers. This
reliance on social support may be strengthened by family support group organizations, which enable sharing of
common experiences and mutual information exchange.
This study has shown several findings significant for the meaning of the caregiving experience from the
perspective of Turkish family member. Caregiving for a loved one with a diagnosis of a malignant
musculoskeletal tumor diagnosis is both stressful and meaningful for family caregivers. In addition to the
emotional stress, there were significant physical Stressors in caregiving that resulted in somatic complaints on
the part of the caregiver. The importance of traditional values such as love and belonging were important
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elements giving meaning to the caregiving experiences. Spirituality and prayer were primary coping strategies
that brought calmness and peace. Social support enhanced the sense of belonging and energized caregivers
allowing them to continue in their role.
References
ACKNOWLEDGMENTS
The authors thank the participants.
REFERENCES
Akyuz, A., Guvenc, G., Ustunsoz, A., &Kaya, T. (2008). Living with gynecologic cancer: Experience of women
and their partners. Journal of Nursing Scholarship , 40(3), 241-247.
Blanchard, C. G., Albrecht, T. L., &Ruckdeschel, J.C. (1997). The crisis of cancer: Psychological impact on
family caregivers. Oncology (Williston Park), 11(2), 189-194
Bolmsj, I. (2000). Existential issues in palliative care: Interviews with cancer patients. Journal of Palliative
Care, 16, 20-24.
Cameron, J. L, Franche, R. L., Cheung, A. M., &Steward, D. E. (2002). Lifestyle interference and emotional
distress in family caregivers of advanced cancer patients. Cancer, 94, 521-527.
Chen, M. L., Chu, L., &Chen, H. (2004). Impact of cancer patient's quality of life on that of spouse caregivers.
Supportive Care in Cancer, 12, 469-475.
Colaizzi, P. (1978). Psychological research as the phenomenologist views it. In R. Valle &M. King (Eds.),
Existential phenomenological alternative for psychology (pp. 48-71). New York: Oxford University Press.
Couper, J., Bloch, S., Love, A., Macvean, M., Duchesne, G. M., &Rissane, D. (2006). Psychosocial adjustment
of female partners of men with prostate cancer: A review of the literature. Psychooncology, 75(1 1), 937-953.
Courtens, A. M., Stevens F. C., Crebolder, H. F., &Philipsen, H. (1996). Longitudinal study on quality of life and
social support in cancer patients. Cancer Nursing, 19(3), 162-169.
Dorfman, H. D., &Czerniak, B. (1995). Bone cancers. Cancer, 75(1), 203-210.
Ergan Gngr, N. (2007). Turk ataszleri ve deyimlerinde aile ve akrabahk anlayii, ukurova niversitesi
Trkoloji Aratirmalan. Retrieved August 10, 2007, from http:// www.turkoloji.cu.edu.tr
Fang, C. Y., Manne, S. L., &Pape, S. J. (2001). Functional impairment, marital quality, and patient psychological
distress as predictors of psychological distress among cancer patients' spouses. Health Psychology, 20(6), 452457.
Friedrichsen, M. J., Strang, P. M., &Carlsson, M. E. (2001). Receiving bad news: Experiences of family
members. Journal of Palliative Care, 17(4), 241-249.
Fukui, S. (2002). Information needs and the related characteristics of Japanese family caregivers of newly
diagnosed patient with cancer. Cancer Nursing, 25(3), 181-186.
Hallstrm, L, &Blander, G. (2007). Families' needs when a child is long term ill: A literature review with
reference to nursing research. International Journal of Nursing Practice, 13(3), 193-200.
Howard, A. F., Balneaves, L. G., &Bottorff, J. L. (2007). Ethnocultural women's experiences of breast cancer: A
qualitative meta-study. Cancer Nursing, 30(4), 27-35.
Iconomou, G., Vagenakis A. G., &Kalafonos, H. P. (2001). The informational needs, satisfaction with
communication, and psychological status of primary caregivers of cancer patients receiving chemotherapy.
Supportive Care in Cancer, 9, 591-596.
Jemal, A., Siegel, R., Ward, E., Hao, Y., Xu, J., Murray, T., et al. (2008). Cancer statistics. CA: A Cancer
Journal for Clinicians, 58,71-96.
Ko, C. M., Malcarne, V. L., Varni, J. W., Roesch, S. C., Banthia, R., Greenbergs, H. L., et al. (2005). Problem
solving and distress in prostate cancer patients and their spousal caregivers. Supportive Care in Cancer, 13,
367-374.
Kozachik, S. L., Given, C. W., Given, B. A., Pierce, S. J., Azzouz, F., Rawl, S. M., et al. (2001). Improving
18 November 2014

Page 7 of 9

ProQuest

depressive symptoms among caregivers of patients with cancer: Results of a randomized clinical trial. Oncology
Nursing Forum, 28(7), 1149-57.
Kristjanson, L. J., &Ashcroft, T. (1994). The family's cancer journey: A literature review. Cancer Nursing, 17(1),
1-17.
Lindholm, L., Mkel, C., Rantanen-Siljamki, S., &Nieminen, A. L. (2007). The role of significant others in the
care of women with breast cancer. International Journal of Nursing Practice, 13, 173-181.
Melin-Johansson, C., Axelsson, B., Danielson, E. (2007). Caregivers' perceptions about terminally ill family
members' quality of life. European Journal of Cancer Care, 16, 338-345.
Mellon, S., &Northouse, L. L. (2001). Family survivorship and quality of life following a cancer diagnosis.
Research in Nursing &Health, 24(6), 446-459.
Ministry of Health. (2003). Republic of Turkey cancer statistics. Retrieved August 10, 2008, from
http://www.saglik. gov.tr
National Association of Orthopaedic Nurses. (2005). Palliative care: Improving the quality of care for patients
with chronic, incurable musculoskeletal conditions consensus document. Orthopaedic Nursing, 24, 8-1 1 .
Noyes, J. R., Holt, C. S., &Massie, M. J. (1998). Anxiety disorders. In J. Holland (Ed.), Psycho-oncology (pp.
548-564). New York: Oxford University Press.
Passik, S. D., &Kirsh, K. L. (2005). A pilot examination of the impact of cancer patients' fatigue on their spousal
caregivers. Palliative Supportive Care, 3, 273-279.
Resendes, L. A., &McCorkle, R. (2006). Spousal responses to prostate cancer: An integrative review. Cancer
Investigation, 24, 192-198.
Shell, J. A., &Kirsch, S. (2001). Psychosocial issues, outcomes, and quality of life. In: SE Otto (Ed.), Oncology
nursing (4th d., pp. 948-972). Philadelphia: Mosby.
Tam Ashing, K., Padilla, G., Tejero, J., &Kagawa-Singer, M. (2003). Understanding the breast cancer
experience of Asian American women. Psychooncology, 12, 38-58.
Tezcan, M. (2000). Turk ailesi antropolojisi. Ankara : imge Kitabevi Yaymlan
Tuinstra, J., Hagedoorn, M., Van Sonderen, E., Ranchor, A. V., Van den Bos, G. A., Nijboer, C., et al. (2004).
Psychological distress in couples dealing with colorectal cancer: Gender and role differences and intracouple
correspondence. British Journal of Psychology, 9, 465-478.
Weitzner, M. A., McMiUan, S. C., &Jacobsen, P. B. (1999). Family caregiver quality of life: Differences between
curative and palliative cancer treatment settings. Journal of Pain and Symptom Management, 17(6), 418-428.
AuthorAffiliation
Merai Demiralp, PhD, RN, Psychiatric Nursing Department, School of Nursing, Gulhane Military Medical
Academy, Ankara, Turkey.
Sevgi Hatipoglu, PhD, RN, Professor, Surgical Nursing Department, School of Nursing, Gulhane Military
Medical Academy, Ankara, Turkey.
Emine Iyigun, PhD, RN, Assistant Professor, Surgical Nursing Department, School of Nursing, Gulhane Military
Medical Academy, Ankara, Turkey.
Bahtiyar Demiralp, MD, Associate Professor, Orthopaedics and Traumatology Department, Gulhane Military
Medical Academy, Ankara, Turkey.
Engin llker Cicek, MD, Specialist, Orthopaedics and Traumatology Department, Erzurum Military Hospital,
Erzurum, Turkey.
Mustafa Basbozkurt, MD, Professor, Orthopaedics and Traumatology Department, Gulhane Military Medical
Academy, Ankara, Turkey.
Subject: Caregivers; Musculoskeletal diseases; Tumors; Orthopedics; Families & family life;

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MeSH: Activities of Daily Living, Adolescent, Adult, Bone Neoplasms -- psychology, Female, Humans, Male,
Middle Aged, Muscle Neoplasms -- psychology, Religion, Turkey, Bone Neoplasms -- nursing (major),
Caregivers -- psychology (major), Family -- psychology (major), Muscle Neoplasms -- nursing (major)
Publication title: Orthopaedic Nursing
Volume: 29
Issue: 2
Pages: 86-91
Number of pages: 6
Publication year: 2010
Publication date: Mar/Apr 2010
Year: 2010
Publisher: Lippincott Williams & Wilkins
Place of publication: Pitman
Country of publication: United States
Publication subject: Medical Sciences--Nurses And Nursing, Medical Sciences--Orthopedics And Traumatology
ISSN: 07446020
Source type: Scholarly Journals
Language of publication: English
Document type: Journal Article
Document feature: References
Accession number: 20335767
ProQuest document ID: 195963462
Document URL: http://search.proquest.com/docview/195963462?accountid=31533
Copyright: Copyright Lippincott Williams & Wilkins Mar/Apr 2010
Last updated: 2014-10-10
Database: ProQuest Nursing & Allied Health Source

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