“Sometimes You Just Have to Walk Alone”—Meanings of Emotional Support Among Danish-Born and Migrant Cancer Patients

Department of Health Services Research, Institute of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Journal of Psychosocial Oncology (Impact Factor: 1.04). 11/2010; 28(6):699-717. DOI: 10.1080/07347332.2010.516808
Source: PubMed


The study explores differences and similarities in needs for and experiences with emotional support among Danish-born and migrant cancer patients. Qualitative narrative interviews with 18 adult cancer patients were conducted. Analysis was inspired by phenomenological methods. Migrant patients experienced more dispersed social networks compared to Danish-born patients. However, common difficulties in asking for and receiving emotional support were related to cancer being perceived as a fatal disease among the social network, and this lead to fear among patients that articulating needs for support would result in loss of normality and nonpatient identity.

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Available from: Maria Kristiansen, May 18, 2014
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This material was analyzed thematically. Results: Substudy IA found the crude Odds Ratio (OR) for non-use of mammography screening to be 1.38 (95% CI, 1.30-1.46) for women born in other-Western countries and 1.80 (95% CI, 1.71-1.90) for women born in non-Western countries compared with Danish-born women. Adjusted OR for non-use among women living within households of 2–4 persons was 0.63 (95% CI, 0.61-0.65) among Danish-born women; 0.60 (95% CI, 0.53-0.69) among women born in other-Western countries; and 0.74 (95% CI, 0.64-0.85) among non-Western women compared with women living alone. Substudy IB found that migrant patients had social networks that were more dispersed than those of non-migrant patients. However, common difficulties in asking for and receiving emotional support were related to cancer being perceived as a fatal disease within informal relations. This led to fear among patients that articulating needs for support would result in loss of normality and non-patient identity. For social support in formal relations, Substudy IIA showed how both non-migrant and migrant patients perceived support given by healthcare professionals as available, empathic and valuable. Prerequisites for provision of support were 1) setting aside sufficient time for the patient to feel safe and able to verbalize emotional concerns, 2) continuity in relationships, and 3) ability to understand the patient’s emotional reactions without creating additional distress. Substudy IIB found that major cancer patient associations in the Nordic countries differed in relation to stage of policy and practices regarding migrant patients. Migrant patients were perceived to face barriers in accessing support within general healthcare services due to language barriers and socioeconomic vulnerability, and needs for services provided by associations were felt to be high. Adaptation of services focused on overcoming linguistic barriers, using pro-active outreach strategies and involving staff with migrant background. Substudy III found cross-cultural surveys on cancer wards using name-based identification of respondents to be inflicted with various difficulties regarding identification of respondents and involvement of nurses due to both external (policy changes, strike among nurses) and internal factors on the wards (heavy workload, lack of time, focus on medical aspects of cancer rather than psychosocial aspects). Conclusion: Although conceptualized and measured differently in the substudies, social support was found to be important for participation in cancer screening and when undergoing cancer care among migrants and non-migrants. Using multiple methods and including a diverse population group elucidated both differences and similarities in access to and perception of social support from informal and formal relations. 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This could be achieved by involving healthcare professionals in research, but awareness of the influence of possible external and internal factors and efforts to deal with these factors are fundamental to successfully implementing cross-cultural cancer research in a clinical setting.
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