Purpose. The diagnosis, progression, or recurrence of advanced cancer can be traumatic events for family caregivers (FCs), who report substantial psychological and physical distress. Evidence indicates the presence of post-traumatic disorders in a significant proportion of FCs, yet there is a scarcity of research supporting early interventions to prevent it. The purpose of this study is to characterize the distress in FCs shortly after the diagnosis of acute leukemia (AL), which is a prototypical condition for the acute onset of a life-threatening disease with intensive treatment and severe physical symptoms. Methods. Nine FCs consented to participate in a qualitative interview about their experience with AL. A grounded theory approach was used to analyze the transcribed interviews. Results. Findings identified 3 phases in FCs’ distress: anticipatory, acute, and post-acute. The anticipatory phase, which precedes the diagnosis, was characterized by concerns related to uncertainty. FCs’ in the acute phase described overwhelming distress related to the diagnosis and the threat to life. Further analyses show an immediate response to this heightened distress in all FCs, who report a decrease in emotional arousal with intentional efforts to avoid thoughts and feelings to an unfavourable future. Only in the post-acute phase, FCs’ begin to discuss themes related to difficult emotions. Conclusions. The decrease in distress observed soon after the diagnosis of AL is indicative of a dissociative response to overwhelming emotions. Underlying painful feelings seemed inaccessible during the acute phase and began to emerge later in the course of the treatment. Future research on targeted psychotherapeutic interventions should take into consideration the possible adaptive functions of this initial response.

Obiettivo. La diagnosi, la progressione o la recidiva di tumore avanzato possono essere degli eventi traumatici nella vita di caregiver primari (CP), che riportano notevole distress fisico e psicologico. Nonostante molti studi indichino la presenza di disturbi post-traumatici in una proporzione significativa di CP, esiste una carenza di ricerca scientifica che supporti lo sviluppo di interventi preventivi. L’obiettivo di questo studio è di caratterizzare il distress in CP subito dopo la diagnosi di leucemia acuta (LA), quest’ultima identificata come la condizione prototipica per malattie potenzialmente mortali ad insorgenza acuta, con trattamento intensivo e sintomi fisici severi. Metodo. Nove CP hanno dato il consenso a partecipare ad una intervista qualitativa riguardante la loro esperienza con la LA. Un approccio Grounded theory è stato utilizzato per l’analisi dei trascritti. Risultati. I risultati identificano 3 fasi nel distress dei CP: anticipatoria, acuta e post-acuta. La fase anticipatoria, che precede la diagnosi, è caratterizzata da preoccupazioni legate all’incertezza. CP nella fase acuta parlano di un’angoscia molto elevata e legata alla diagnosi ed alla possibilità di perdere una persona cara. Analisi successive mostrano un’immediata risposta a questa emozione in tutti i CP, che riportano una diminuzione dell’arousal emotivo in compresenza a sforzi intenzionali per evirate pensieri ed emozioni legati ad un futuro infausto. Solo nella fase post-acuta, i CP cominciano a discutere temi legati ad emozioni difficili. Conclusioni. La diminuzione di distress osservata subito dopo la diagnosi di LA è indicativa di una risposta dissociativa da emozioni difficili. Sentimenti più dolorosi sembrano inaccessibili durante la fase acuta e cominciano a ri-emergere più avanti nel corso del trattamento. Studi futuri su interventi psicoterapici mirati dovrebbero tenere in considerazione possibili funzioni adattive di questa risposta iniziale.

Distress in Family Caregiver of Individuals Recently Diagnosed With Acute Leukemia: a Grounded Theory Study

MALFITANO, CARMINE
2021

Abstract

Purpose. The diagnosis, progression, or recurrence of advanced cancer can be traumatic events for family caregivers (FCs), who report substantial psychological and physical distress. Evidence indicates the presence of post-traumatic disorders in a significant proportion of FCs, yet there is a scarcity of research supporting early interventions to prevent it. The purpose of this study is to characterize the distress in FCs shortly after the diagnosis of acute leukemia (AL), which is a prototypical condition for the acute onset of a life-threatening disease with intensive treatment and severe physical symptoms. Methods. Nine FCs consented to participate in a qualitative interview about their experience with AL. A grounded theory approach was used to analyze the transcribed interviews. Results. Findings identified 3 phases in FCs’ distress: anticipatory, acute, and post-acute. The anticipatory phase, which precedes the diagnosis, was characterized by concerns related to uncertainty. FCs’ in the acute phase described overwhelming distress related to the diagnosis and the threat to life. Further analyses show an immediate response to this heightened distress in all FCs, who report a decrease in emotional arousal with intentional efforts to avoid thoughts and feelings to an unfavourable future. Only in the post-acute phase, FCs’ begin to discuss themes related to difficult emotions. Conclusions. The decrease in distress observed soon after the diagnosis of AL is indicative of a dissociative response to overwhelming emotions. Underlying painful feelings seemed inaccessible during the acute phase and began to emerge later in the course of the treatment. Future research on targeted psychotherapeutic interventions should take into consideration the possible adaptive functions of this initial response.
CARUSO, Rosangela
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11392/2487838
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