Social support, Quality of life and Psychological wellbeing in cancer patients

By

Ayesha Maqsood

Department of Humanities & Social Sciences

Faculty of Arts and Social Science

GIFT University

Gujranwala-Pakistan

2018-2022

1
Topic: Social support, quality of life and psychological wellbeing in cancer patients

By

Ayesha Maqsood

181870035

A dissertation submitted to the

Department of Humanities & Social Sciences

Faculty of Arts and Social Science

GIFT University, Gujranwala-Pakistan

In partial fulfillment of the requirements for the

DEGREE OF BS HONS

IN

PSYCHOLOGY

2018-2022

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Social support, quality of life and psychological wellbeing in cancer patients

By

Ayesha Maqsood

Approved by

_______________

Research Supervisor

________________

Internal Examiner

________________

External Examiner

________________

Head of Department

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 CERTIFICATE OF RESEARCH COMPLETION

It is certified that this thesis Social support, Quality of life and Psychological wellbeing in cancer

patients submitted by Ayesha Maqsood Registration No. 181870035 for Bs degree at Faculty of

Arts and Social Sciences, GIFT University, is an original research work and contains satisfactory

material to be eligible for evaluation by the examiner(s) for the award of the above stated degree.

Name

Tayyab Habib

Lecturer

GIFT University

Signature _________________

Date: __________________

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 CERTIFICATE OF EXAMINERS

It is certified that the research work contained in this thesis titled “Social support, quality of life

and psychological wellbeing in cancer patients” is up to the mark for the award of BS Hons in

Psychology.

Internal Examiner External Examiner

Signature: Signature:

Supervisor: Name:

Date: Date:

Head of Department

Department of Humanities and Social Sciences

GIFT University, Gujranwala

Signature: ________________

Name: __________________

Date: _________________

5
 DEDICATION

Thanks Almighty Allah, who created me and sent me down on earth, and gave me courage to

fulfill my duties, I dedicate this thesis to my beloved parents and my beloved brother who have

been source of inspiration and gave me a strength when I thought of giving up and continually

provide me a moral, emotional, spiritual and financial support.

To my brother, friends and classmates who shared their words of advice and

encouragement to finish this study. And lastly I dedicated this book to the Almighty God, thank

you for the guidance, strength and power of mind, protection, skill and for giving me a healthy

life. All of these I offer to you.

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 ACKNOWLEDGEMENTS

At the very outset I must admit that completion of this thesis would not have been possible without

the help of Allah Almighty who is always kind, merciful, and benign to his crown creature. I,

therefore, owe all my thanks to him and pray that may he be always so kind showering his

blessings on me in future as well.

This thesis becomes a reality with the kind support and help of many individuals. I would like to

extend my sincere thanks to all of them.

Foremost, I want to offer this endeavor to our GOD ALLAH Almighty for the wisdom he

bestowed upon me, the strength, peace of my mind and good health in order to finish this research.

I would like to express my gratitude towards my family for the encouragement which helped me

in completion of this paper. My beloved and supportive father, Maqsood Ahmed, my mother Azra

Bibi, and my beloved brother Shoaib Ahmed who is always by my side when times I need them

Sthe most, for supporting me financially, also for stabilizing me emotionally and always praying

for me.

I am highly indebted to GIFT University and Faculty of Art and Sciences for their guidance and

constant supervision as well as for providing necessary information regarding this research & also

for their support in completing this endeavor.

I would like to express my special gratitude and thanks to my statistician, Miss Saba Sajjad and

Sana Rehman for sharing her knowledge and technical know-how. Distinguished members of the

panel, my supervisor Mr. Tayyab Habib for the approval of my work and my friends Hamna

Manzoor and Ansa Afsheen for her constant guidance and empathy.

And all the respondents for their honest and cooperative response to all the questions solicited in

this study.

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 TABLE OF CONTENT

Dedication……………………………………………………………………………. 6

Acknowledgement…………………………………………………………………….7

Table of Content ……………………………………………………………………... 8

List of Tables ………………………………………………………………………...10

List of Figures ……………………………………………………………………….11

List of Appendices……………………………………………………………………12

Abstract………………………………………………………………………….........13

CHAPTER NO 1. INTRODUCTION ……………………………………………… 14

1.1 Operational Definition …………………………………………………………...19

1.1.1 Psychological wellbeing………………………………………………………19

1.1.2 Social support…………………………………………………………………19

1.1.3 Quality of life…………………………………………………………………19

1.2 Rationale …………………………………………………………………………20

1.3 Aims and Objectives ……………………………………………………………. 20

CHAPTER NO 2 LITERATURE REVIEW …………………………………………21

2.1 Cancer and its ratio in Pakistan...…… ……………………………………………21

2.2 Social support and psychological wellbeing……….………………………...........24

2.3 Quality of life ………………………………………….…………………………..28

2.4 Theoretical Framework ………………….………………………………………...32

2.5 Conceptual framework ……………………………………………………...……..36

CHAPTER NO 3 METHODOLOGY ………………………………………………....37

3.1 Research Method …………………………………………………………………..37

3.2 Research Design ………………………………………………………………….37.

3.3 Participant ………………………………………………………………………….37

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3.3.1 Inclusion Criteria ………………………………………………………………..37.

3.3.2 Exclusion Criteria ………………………………………………………………..37

3.4 Sample Size ……………………………………………………………………….37

3.5 Sampling Technique ………………………………………………………………37

3.6 Hypothesis ………………………………………………………………………...37

3.7 Measures …………………………………………………………………………...38

3.7.1 Riffs psychological wellbeing scale……. ………………………………………..39

3.7.2 WHO Quality of life scale …. …………………….. …………………………… 39

3.7.3 Personal resource questionnaire ………………………………………………….39

3.8 Ethical Consideration ………………………………………………………………40

3.9 Procedure……………………………………………………………………………41

3.10 Analysis …………………………………………………………………………...41

CHAPTER NO 4: RESULTS ……………………………………………………………...42

4.1 Descriptive Statistics ………………………………………………………………….. 42

4.2 Inferential Statistics ………………………………………………………………….…44

CHAPTER NO 5: DISCUSSION ………………………………………………………..... 48

Limitations of the Study …………………………………………………………………….51

Recommendations …………………………………………………………………………..51

Conclusion…………………………………………………………………………………..52

REFERENCES ………………………………………………………………………...….53

Appendix A Questionnaire ……………………………………………………………......58

Part A: Demographics ………………………………………………………………..….. 58

Part B: Personal resource questionnaire………….……………………………………….59

Part C: Riffs psychological wellbeing scale ……………………………………….…….61

Part D: WHO Quality of life scale…. ……………………………………………...…….66

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LIST OF TABLES

Table Page

Table 4.1.1 Demographic profile of respondents ……………………………………….. 42

Table 4.2.1 psychometric properties to check reliability of scales……………………….43

Table 4.2.2 Correlation Analysis to Check Relationship Between social support, quality of life and

psychological wellbeing…………………………………………………………………..44

Table 4.2.3 Regression analysis………………………………………………………….45

Table 4.2.4 Anova to Check Age Difference in Study Variables ………………………..45

Table 4.2.5 T-test to check the effect of family difference in study variables……….…..46

Table 4.2.6 T-test to check the effect of residential area on study variables……………. 47

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LIST OF FIGURES

Conceptual framework………………………………………………………………….36

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LIST OF APPENDIXES

Appendix A Questionnaire ……………………………………………………………...58

Part A: Demographics ………………………………………………………………….. 58

Part B: Personal resource questionnaire………….…………………………………...….59

Part C: Riffs psychological wellbeing scale ……………………………………….…….61

Part D: WHO Quality of life scale…. ………………………………………………..….66

Part E: Permission of scale used in Research ……………………………………………68

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 ABSTRACT

Background: Cancer is medical disease in Pakistan. Now after the cardiovascular disease,

cancer is the leading cause of death all over the world. Cancer causing 4.2 million deaths in males

and breast cancer is the most common cancer in women that causes 3.3 million women die each

year (WHO 2012). In Pakistan the number of reported cancer cases is also on rise and it is

estimated that only in Lahore district about 3000 cancer patients are presented to cancer hospitals

(Akhtar, 2007). The second most common cause of mortality worldwide is cancer.

Objective: The main objective of this study to explore the relationship between social support,

quality of life and psychological wellbeing in cancer patients. The goal is to predict the effect of

family system and residential area on social support, quality of life and psychological wellbeing.

Methodology:

Study design: The study design was quantitative correlational design.

Study method: A quantitative Survey Method is used in this research.

Sampling technique: a purposive sampling technique was used in this study.

Data collection and Analysis: Riffs psychological wellbeing scale was used to measure

psychological wellbeing, WHO Quality of life scale was used to measure quality of life and

personal resource questionnaire was used to measure social support. The sample size was 120

patients in which 60=male and 60=female. Correlation analysis was used to explore the

relationship between variables and regression analysis was use to predict the relationship. Anova

was used to measure age difference and t test was used to predict the effect of family system and

residential area on psychological wellbeing in cancer patients.

Results: The result of study shows that social support has significant positive correlation with

psychological wellbeing (p<.05) and on the other hand quality of life has insignificant positive
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correlation with psychological wellbeing (p>.05). In regression analysis social support and quality

of life has insignificant predictor of psychological wellbeing. Anova was applied on gender

difference it shows that age has significant effect on psychological wellbeing. Patients at the age

of 20-39 have greater effect as compared to other age groups. Independent sample t test was

applied on family system and residential area to check the effect of social support, quality of life

and psychological wellbeing. It shows that it has also insignificant effect on family system and

residential area.

Conclusion: This study revealed that cancer patients had a high rate of psychological wellbeing

in youngsters. Quality of life should be improved in cancer patients that effect on psychological

wellbeing. Strong social support significantly correlated with psychological wellbeing. Therefore,

routine psychiatric evaluation and follow-up should be advised. The age group of 20-39 have high

rate in social support, quality of life and psychological wellbeing.

Spouse, family, and friend counseling could be done alongside patient counseling to promote

social support. Better pain management and rehabilitation techniques should be tried for improved

quality of life.

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 CHAPTER 1: INTRODUCTION

The medical disease known as cancer occurs when body cells begin to grow

uncontrollably. A cancer is records for the ancient sickness. There are numerous types of cancer

described. The most prevalent varieties include Carcinoma (lung, colon, breast, and Sarcoma

(bone cancer), ovarian cancer and cartilage), Lymphoma (lymphatic cancer, leukemia and nodes

blood cancer) (Sara, 2013). After cardiovascular disease, cancer is the leading cause of death all

over the world. Cancer causing 4.2 million deaths in males and breast cancer is the most common

cancer in women that causes 3.3 million women die each year (WHO 2012). It is believed that

only in the Lahore area, where reported cancer incidence are on the rise, over 3000 cancer patients

are admitted to hospitals (Akhtar, 2007). Cancer is the second most common cause of death

worldwide. In 2012, 8.2 million people worldwide lost their lives to cancer. 2 The number of

cancer cases in Asia is predicted to rise from 6.1 to 10.7 million in 2030, while the number of

cancer deaths will rise from 4.1 to 7.5 million. 3 Similarly, the incidence of cancer is rising in

Pakistan, where there were 1.4 million cancer cases reported in 2012 out of a population of 173

million, with a predicted increase to 150,000 cases year. ).

In Asiatic countries like Pakistan there is an ongoing increase in the progression of cancer

and it has become one of the prominent causes of death (Agarwal et al., 2007). Cancer symptoms

or treatment-related side effects like fatigue, nausea, and appetite loss are highly common and

have a considerable negative impact on quality of life Steginga et al. (2009) and Gray et al Pan

and Tsai (2012); et sal., 2011).

Social support include support from family, friends and health providers ( Breitbart 2013).

The social support include support from family, friends. In order to reduce negative psychological

reactions like pessimism and sadness, social support is a key factor. Social support acts as a buffer

15
while reducing the detrimental impact of adverse life events on one's physical and emotional well-

being (Waghmare, 2015).

According to Caplan and Killelea (1976), having social support is important while coping

with a crisis. Additionally, a ton of research (Sarason et al., 1987; Samarel et al., 1997) describes

it as a crucial source of emotional support that helps cancer patients adjust psychologically.

According to Atchley (2000), our social support system is formed by people we can rely on to

offer consistent emotional support, affirmation, knowledge, and assistance, especially during

difficult situation. Additionally, benefiting from other group members' cancer experiences peoples

fosters the growth of practical coping mechanisms and enhances emotional health adaptation

(Spiegel, 1981).

Cancer patients with higher level of perceived social support have a better psychosocial

adjustment to the illness. The high social support, good quality of life enhance their wellbeing and

capacity of fight against illness (Harun and Salina 2015). The psychological wellbeing is affected

by social support and quality of life among cancer patients (Ghafoor and Mahmoud 2012).

In order to reduce negative psychological reactions like pessimism and sadness, social

support is a key factor. In this way, social support acts as a stress-relieving buffer and lessens the

detrimental consequences of stressful life events on one's physical and emotional health (Sujata

2015). Sharing cancer experiences with other group members provides benefits since doing so

enhances the development of efficient coping mechanisms and emotional adjustment (Spiegel,

2016).

QOL has been used as a primary endpoint measure evaluating the effectiveness of cancer

management and care. In order to assess the social support of cancer patients personal resource

questionnaire was used. It has 15 items and 7 point Likert scale that assess the social support in

individual and its effect on wellbeing.

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 A person's view of their place in life in relation to their objectives, expectations, and

standards, as well as the culture and value system in which they live, is referred to as their quality

of life. It is a broad notion that is complicatedly influenced by a person's physical and mental well-

being, level of independence, social connections, and interactions with key environmental

elements (Khattak, Javaid and Nadeem 2012). Health related quality of life is a significant

measure in this research to predict the psychological wellbeing of cancer patients. Assessing the

quality of life increase the treatment and coping ability of patients. Recently the numbers of studies

conducted on health related quality of life and wellbeing of patients.

According to studies from Canada and Germany, blood cancer patients experience a

significant symptom burden that negatively affects general health. Additionally, it has been noted

that a number of symptoms, including nausea, vomiting, anxiety, sadness, dyspnea, exhaustion,

pain, and sleeplessness, might have an impact on a patient's prognosis, quality of life (Malik,

Rizwan and Hussain 2015). The psychological wellbeing is affected by social support and quality

of life among cancer patients (Ghafoor and Mahmoud 2012). There was a need to evaluate the

quality of life of persons with various chronic illnesses as a result of the rise in life expectancy

over the past 50 years in the Western world. Additionally, it was important to comprehend how

crucial social support is for patients' good psychological wellness and health (Denise 2012). QOL

is a subjective measure of physical, psychological, and social well-being that captures how patients

feel about how breast cancer diagnosis and treatment have affected their everyday lives. According

to numerous researches, individuals with different forms of cancer had longer survival times when

their QOL is higher (Yuan, 2016). In order to assess the quality of life WHO quality of life scale

was used that measure the quality of life in cancer patients.

Cancer affects the psychological wellbeing of patients by influencing the factor of social

support and quality of life. Psychological well-being includes life satisfaction, happiness and self-

acceptance (Bowling 1991). Individual development, self-acceptance, autonomy, a feeling of

17
purpose in life, happy connections with others, and environmental dominance are all components

of psychological well-being (the potential to effectively manage personal life and the surrounding

world). The term "well-being" can also refer to a state of health that comes from a full

understanding of the integrity of each individual aspect and includes spiritual aspects of life.

According to a study, people with cancer feel worse health and wellbeing after getting cancer and

receiving cancer treatment as compared to people with chronic conditions or people without a

prior cancer diagnosis and major chronic conditions (Fard, 2019).

Family social support and psychological health are both crucial factors in the sickness and

its recovery since they have a favorable or negative impact on the person's mental state (Caress,

et al., 2009; Vermaas, 2010). This destructive illness, which presents a patient with several

physical, psychological, and social hurdles to overcome, has a significant impact on Pakistan.

They play a significant role in making the condition chronic and worse, psychological variables

should be considered just as carefully as biological ones when treating physically ill people. In

this context, it has been noted that even among medical experts, awareness of the need for and

significance of psychological variables in recovery and prognosis is quite uncommon in Pakistan

(Jami, Masood and Kalsoom 2017) .

The present study was conducted to explore the psychological wellbeing in cancer patients

by examining the demographic variables, residential area and family system. Demographic

variables include gender either male or female. Gender also play key role in determining the result

of this study. Family system include joint or nuclear family system and residential area include

the urban and rural area. People with urban areas have good quality of life and all resources are

present that help him to cope with disease and on the other side people with rural area have not

resources that help them. The present study is specifically aimed to explore the relationship of

familial social support and psychological wellbeing and how familial social support available for

the patients of cancer varies in terms of nuclear and joint family system.
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 Operational Definitions of Key Terms:

Operational Definition:

The variables used in this research are social support, quality of life and psychological

wellbeing of cancer patients. 100 patients are included from Medcare hospital Gujranwala and

Shaukat Khanam hospital, Anmol hospital Lahore

Psychological wellbeing:

 Psychological wellbeing: Carol Ryff in 1989, proposed six characteristics for

psychological well-being: autonomy, environmental mastery, personal growth, positive

relationships with others, life purpose, and self-acceptance.

Social support:

 Social support: social support defined as interpersonal relationship of person that might

affect the psychological and social functioning (Caplan, 1974). Social support can also be

identified as information that are accepted from others who loved, valued, esteemed, and

cared for (Cohen & Wills, 1985; Shumaker & Brownell, 1984). Support can come from

many sources, such as family, friends, pets, organizations, coworkers and health providers.

Quality of life:

 Quality of life: In 1947, the World Health Organization (WHO) defined QoL as a “state of

complete physical, mental, and social well-being, and not merely the absence of disease

and infirmity”. In 1995, the WHO definition evolved as follows: “Individuals’ perceptions

of their position in life in the context of the culture and value systems in which they live

and in relation to their goals, expectations, standards, and concerns. These variables are

measured by using scales. Theses scales are Riff’ psychological wellbeing scale, quality

of life scale and personal resource questionnaire.

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Rationale:

The social support (include family, friends and doctors of patients) and quality of life

effect on psychological wellbeing of patients. The main aim of current research is to explore the

relationship between psychological wellbeing, quality of life and social support in cancer patients.

Cancer is increasing in Pakistan so I have interest in this topic to explore the effect of social support

and quality of life in cancer patients. The purpose is to study these variables and check how these

variables affect each other. This study also includes to identify the demographic difference

between social support and quality of life in cancer patients. Moreover, very limited indigenous

studies have been found on these variables so this research study will be an addition to the

literature in this context.

Objectives:

 Following are the main objectives of this research:

 Predict the quality of life and psychological wellbeing in cancer patients.

 Predict the effect of social support and psychological wellbeing in cancer patients.

Explore the relationship between social support, quality of life and psychological

wellbeing among cancer patients.

 Family systems include nuclear and joint family system. Predict their social support and

quality of life and psychological wellbeing.

 Residential areas involve rural and urban areas. Predict their social support, quality of life

and psychological wellbeing.

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 Chapter 2: LITERATURE RVIEW

Cancer is common disease in Pakistan and it includes its various types like lung cancer,

breast cancer, mouth cancer and lymphatic cancer etc. When cancer diagnose in peoples, it effect

on their mental health and psychological wellbeing. Many researches conducted on cancer patients

that indicate their psychological wellbeing by different factors like social, economic and religious

factor etc. Research conduct on lung cancer patients in oncology, it is quantitative study in

relationship between social support and psychological wellbeing in lung cancer patients. It is

correlational study and sample is cancer patients. The result shows that there is positive

relationship between social support and psychological wellbeing (Scholz U 2013).

The research conducted in Jordan on breast cancer women. It is quantitative correlational

study. The main objective of the study is to explore the relationship between social support and

psychological wellbeing of breast cancer women. The Hospital Anxiety and Depression Scale, the

Breast Module, and EORTC QLQ-C30 were used for assessment (HADS). Patients' quality of life

scores may be predicted by clinical, demographic, and psychosocial factors, thus these were

gathered. The numbers of patients interviewed were 236 and result found that social functioning

has highest score and emotional functioning has lowest scores. The patients have overall good

quality of life and their psychological wellbeing is impaired (Abu-Helalah, Al-Hanaqt, 2014).

The research conducted in china to check relationship between resilience, social support as well

as anxiety/depression of lung cancer patients. This study looked at the relationship between social

support and patients with lung cancer's anxiety and sadness. Patients with lung cancer were the

subject of a cross-sectional study at China's Xiangya Hospital of Central South University. The

study comprised 289 individuals in all, ranging in age from 25 to 81. These instruments were used

for measuring their study variables. These include Connor Davidson resilience scale, the Social

21
Assistance Rating Scale, the Self-Rating Depression Scale, and the Self-Rating Anxiety Scale.

According to correlational analyses, anxiety and depression were inversely correlated with

psychological resiliency and every aspect of social support, including subjective support, objective

support, and the use of supports. On the other hand, subjective support, support use, and objective

support were all positively correlated with psychological resilience. Mediational analyses revealed

that resilience could both fully mediate the association between support use and anxiety as well as

partially moderate the relationship between anxiety and subjective support. In contrast, resilience

may fully buffer the relationship between subjective support and depression as well as partially

mediate the relationship between support use and depression. Resilience, however, did not act as

a bridge. (Xiao, Peng and Kuang, 2018).

The study conducted on cancer patients in 2020 in Turkey. The purpose of this cross-

sectional study was to determine the relationship between perceived social support, perception of

disease and quality of life, in cancer patients in Turkey. Data collected from two hospitals, face to

face interview was used. Sample was cancer patients and population was Turkish people. The

scales that was used in this research are perceived social support, illness perception questionnaire

and nightingale assessment scale. The patients in the study had a mean age of 61.37 14.89 years.

Patients who were married had more social support than those who were not married. The disease

perception scale significantly correlated negatively with the total quality of life scale score, as well

as with the subscales measuring physical and social wellbeing (Dogan and Siylin, 2020). The

diagnosis and treatment of breast cancer can stimulate a series of negative emotional changes in

patients, that affecting their quality of life. Patients with greater resilience have been found to have

better quality of life. Social support networks are crucial protective elements that are required for

the development of resilience. So, the purpose of this study was to look at how social support

affected Chinese breast cancer patients&; resilience and quality of life. The sample was 98 breast

cancer patients from a teaching hospital in Chongqing, China, were interviewed using a

22
demographic- disease survey, the Chinese version of the Connor-Davidson Resilience Scale 25,

the Medical Outcomes Study Social Support Survey, and the Functional Assessment of Cancer

Therapy Breast Cancer. Descriptive statistics, independent sample t tests, one-way ANOVAs, and

regression analyses were used to analyze the data. The average scores for resilience, social support,

and quality of life were moderate at 54.68, 61.73, +and 80.74, respectively. Participants who had

more dependable social support were more resilient and had higher quality of life. Partially

mediating the connection between resilience and quality of life was social support. The percentage

of the mediation effect was 28.0% (Zhang , Zhao , Cao , Ren 2017). Cancer patients face a number

of existential problems, including the constant fear of death and various types of distress.. The

current research aims to examine the relationship between perceived social support, death anxiety,

and several demographic variables. 80 breast cancer patients were chosen as a sample from

Pakistan's various oncology departments. Death anxiety scale and personal resource questionnaire

was used to measure the variables in study. Correlation, regression and Anova analysis was used

to measure social support, fear of death and demographics. According to results, social support

has a negative relationship with death anxiety. According to demographic variables it was

discovered that education and marital status were linked to death anxiety in breast cancer patients.

The findings imply that social support helps people feel less anxious about dying and speeds up

their recovery (Khalid 2019).

The study conducted on cancer patients in Pakistan. The objective of the study was to

determine the prevalence of psychosocial morbidity (perceived social support and psychological

discomfort) while assessing patients with malignant growth patients' personal satisfaction and

quality of life. The research design of the present study was cross sectional conducted between the

variables in January and June 2020. The study sample was a total of 100 participants (cancer

patients) using the purposive sampling method to collect data. Depression anxiety and stress scale,

Multidimensional Scale of Perceived Social Support (MPSS) and WHO quality of life scale was

23
used to measure the variables. To analyze the study data frequencies and simple linear regression

analysis was used in SPSS. The result shows Psychological distress and quality of life have an

inverse relationship and also reported high frequencies of both perceived social support and

psychological distress (Riaz , Gillani , Nisar and Bukhari 2020).

One of the coping techniques is spirituality, which is also increasingly becoming the focus

of academic and therapeutic research. With the aid of oneself, nature, and sacred objects, one

might search for meaning and purpose in life through a set of emotions known as spirituality. The

aim of study was to evaluate the relationship between spirituality and social support with its impact

on cancer patients' stress. The study design was correlational design. The data provided by this

cross-sectional study was 15 July through 31 August 2019. Data from 200 cancer patients were

collected using a structured questionnaire and a purposive sampling technique up. The age range

was 18 years and above. For measuring the patients' spirituality, the Peterman et al, 12-items scale

(Functional Assessment of Chronic Illness Therapy-Spiritual wellbeing scale (FACIT-Sp) was 13

adopted. Berlin Social support Scale (BSSS) was 14 used to measure social support. All

questionnaires are 5 point Likert scale that measures the variables. SPSS V-20 was used to analyze

the data. For the link between both the variables, Pearson's correlation was applied. The result

shows that the majorities (75%) of cancer patients were men, the majorities (58%) were single,

and 35% of patients were in the 49–58 age range. According to an analysis of patients' spirituality,

37% of them identified as highly spiritual, and 36% said they used the Holy Quran's recitation to

treat their illness. Stress received a mean score of 2.32, social support 2.19, and spirituality 2.42.

Spirituality and social support had inverse but significant relationship with the patients' stress,

according to a correlation study (Ali, Muhammad, Khan, Ahmad - Rawal, 2020).

The study was conducted to assess the relationships between several demographic factors

and despair and hopelessness in Turkish cancer patients who were nearing the end of their lives.

This research was a descriptive survey with repeated measurements carried out in a university
24
hospital in the eastern Turkish city of Erzurum. The population was Turkish people and sample

was cancer patients. The sample size was 216 hospitalized patients. Data were collected using

questionnaires (demographic questionnaire, Beck Hopelessness Scale (BHS), and Beck

Depression Scale (BDS), and their effects on depression and hopelessness were examined in

relation to demographic and disease-related variables. The result of study shows that Cancer

patients who were female, illiterate, married, and residing in rural areas scored much higher on

the hopelessness scale. Longer disease duration, radiation treatment, and metastatic disease all

significantly increased the scores for hopelessness and depression ( Sahin, Tan and Polat, 2013).

Cancer patients deal with a variety of issues, including psychological ones like stess, anxiety, and

depression; physical ones like hair loss, pain, exhaustion, nausea, and vomiting; social ones like

social isolation and loss of role and function; and, ultimately, problems with their quality of life.

The study was conducted on factors affecting the patient’s quality of life. The sample was cancer

patients under chemotherapy and sample size was 526 of the College District Outpatients in the

Ankara Numune Training and Research Hospital. The data was collected by Personal Information

Form and Nightingale Symptom Assessment Scale (N-SAS) and analyzed via basic descriptive

statistics and linear regression analysis in SPSS. The result shows that the Patients were mostly

female (54.8%), married (83.5%), housewives (44.6%), elementary school graduates (57.1%),

receiving fluorouracil-based therapy (47.2%), and nearly all had rituals related to their religion or

culture to deal with the illness. Compared to men, women were less physically and socially well.

The psychological and overall well-being of singles were worse. The physical and social well-

being of housewives was the poorest. There was no correlation between education level and

quality of life (P > 0.05). Patients with breast cancer and sarcoma had the lowest levels of social

support compared to other cancer patients. Patients' N-SAS scores were unaffected by prayers,

vows, consulting local herbalists, or seeing ocaks (folk doctors). Hence gender play important role

and first factor that effect quality of life (S Üstündag, AD Zencirc, 2015).

25
 In cancer patients, social support is associated with reduced psychological distress. This

study explores the effects of social support on the psychological distress of Chinese lung cancer

patients and emphasizes the mediating roles of perceived stress and coping strategies. The study

was correlational study design and population was Chinese people and sample was cancer patients.

The sample size was 441 patients from seven hospitals in Chongqing, China, between September

2018 and August 2019. Coping style and perceived stress were considered to be mediator in

adjusting outcomes. The instruments used in research was demographic sheet, distress

thermometer for measuring distress, multidimensional scale of perceived social support for

measuring social support, Medical Coping Modes Questionnaire (MCMQ) for measuring coping

strategies and perceived stress scale for stress. The data analyze through SPSS and result shows

that detection rate of 17.7% for psychological distress among Chinese lung cancer patients. Social

support was significantly negative association with psychological distress, which was partially

mediated by confrontation coping and perceived stress ( Tian, Jin, Chen, Tang, 2021).

The study conducted in Pakistan on cancer patients. This study focuses to the neglected

connection between patients' perceptions of the treatment received and its effects on their

wellbeing, as well as the gender role. A quantitative research method involving purposive

sampling was applied. The sample size was 60 patients. The Psychological General Wellbeing

Index and the Manual Care Dependency Scale were used to collect data. Cancer patients were

treated according to ethical standards, and informed consent was acquired from them. Regression,

correlation, and the t-Test were all used in the analysis. The outcomes showed that the scales were

trustworthy. Cancer patients' perceived care and wellbeing are discovered to be marginally

connected. The perceived quality of care by patients accounted for 30% of the variation in

psychological wellness. There are gender disparities in how well-being is viewed. Findings

suggest that a 1% change in psychological wellbeing predicts a 30% change in perceived care

quality among cancer patients ( Shahbaz, Shibli, Amjad and John, 2021).

26
 The research conducted on cancer patients. This prospective study's goal was to compare

the results for individuals with diverse gynecological cancers in terms of their psychological and

physical functioning. Two questionnaires measuring psychological health and daily functioning

were filled out by a sample of 119 cancer patients who had just received their diagnosis. Three

different time intervals were used to collect outcome measurements: before surgery, 3 months

after surgery, and 1 year following surgery According to results, the sample as a whole had a

considerable increase in psychological well-being between the first and third time points. Patients

with endometrial cancer had slightly higher scores before surgery than patients with ovarian and

cervical cancer. With the exception of endometrial cancer patients, all patients' level of functioning

in everyday life decreased three months following surgery, but it improved at the one-year checkup

( Greimel, Freidl, 2000).

There is emerging evidence that people who have had their head and neck cancer or been

injured may later have psychological discomfort. The main aim of this study to determine how

this affected their quality of life (QoL) and determine whether they would be open to receiving

referrals for counseling. A survey method was used to collect data. The study was correlational

study design and sample size was 96. A self-reported questionnaire was filled out by a total of 96

patients with facial injuries and 124 patients with head and neck cancer in order to gauge

psychological distress (as measured by the Hospital Anxiety and Depression Scale (HADS) and

the Acute Stress Disorder (ASD) Scale), quality of life (WHOQoL-BREF), treatment satisfaction,

and willingness to accept psychological support. Results find out that the 43% of patients in the

trauma group and 12% in the cancer group reported having significant levels of anxiety, while

39% of patients displayed high levels of depressive symptoms ( Shiraz, Rahtz, Bhui, I Hutchison

, 2014).

After receiving therapy for a year, we conducted a cross-sectional study to examine the

quality of life (QOL) of breast cancer patients and to find elements that might help to advance
27
breast cancer treatment. Between May 2008 and May 2010, 154 patients with breast cancer were

gathered from The First Affiliated Hospital of Harerbin Medical University and divided into three

groups. The Functional Assessment of Cancer Therapy-Breast (FACT-B) version 4 was used to

evaluate the quality of life, and a semi-structured interview was conducted to learn more about the

informational and therapeutic needs of breast cancer patients. Results find out that among the three

groups, Group II had the highest levels of social well-being, functional wellbeing, and Total

FACT-G. Among the three groups, Group III had the highest levels of physical well-being,

emotional well-being, breast-specific subscales, total FACT-B, and TOI. Lower EWB scores were

significantly correlated with younger women and higher tumor stage (40 years), higher PWB

scores were significantly correlated with lower tumor stage, increased SWB scores were

significantly correlated with education and occupation, and higher PWB scores were significantly

correlated with lower tumor stage. Among these patients, 56% were concerned about their

symptoms. A sexual relationship restriction was mentioned by 42% of the patients and 57% of

them said they desired reconstructive surgery to enhance their self-image ( HongLi, Xiao-Chun,

Jiang-Bin, 2014).

The study conducted on cancer patients by exploring the effect of partner’s response to

psychological wellbeing. The purpose of this study was to investigate quantitatively how patients

with cancer and their partners' reactions to disgust relate to the psychological health of the patients.

From cancer-related organizations, we enlisted 50 individuals with various cancer diagnoses and

their partners (e.g., charities). The levels of disgust propensity, disgust sensitivity, self-disgust,

and anxiety and depressive symptoms were assessed using questionnaires that the patients

completed. Their partners' susceptibility to and predisposition toward disgust were also evaluated.

Results conclude that self-disgust, disgust propensity, and sadness in cancer patients were all

strongly positively linked with partners' disgust sensitivity. According to studies, patients' self-

disgust mediates the impact of partners' disgust sensitivity on their psychological health. The first

28
quantifiable proof that cancer patients' psychological well-being is dependent on partner

sensitivity to disgust and self-disgust play a mediating role (HA Azlan, PG Overton, J Simpson,

2017. The current study was to describe state anxiety after radical prostate cancer (PCa) treatment

and the impact of trait anxiety on participants' psychological well-being. For the current

investigation, a cross-sectional survey of 70 men with localized PCa was carried out between

February and July 2012. On 21, 25, and 24 of the patients, respectively, radical retropubic

prostatectomy (RRP), permanent prostate brachytherapy (PPB), and external beam radiation

(EBRT) were employed. State anxiety, trait anxiety, and general health were assessed using the

State-Trait Anxiety Inventory and the 8 Items Short Form Health Survey (SF-8). In accordance

with the findings, patients who got RRP had a 47.6% rate of very high and high state anxiety

compared to 40.0% and 37.5% for patients who received PPB and EBRT. The rate of extremely

high and high trait anxiety was significantly lower in the RRP group (23.7%). Trait and state

anxiety were found to be strongly correlated. ( Taoka, Matsunaga, Kubo, Suzuki, 2014).

This research examined at the prevalence and relationships between psychiatric problems

in breast cancer patients, including hospital anxiety, stress, and depression as well as positive and

negative affect. The moderating effect of emotional regulation on the association between hospital

anxiety and symptoms of stress, anxiety, and depression was also examined in this study A cross-

sectional study design served as the foundation for the purposeful sampling technique. From

August 2019 to January 2020, 155 diagnosed breast cancer patients were gathered from a variety

of facilities in Pakistan, including the Noori Hospital, Islamabad, Pakistan Institute of Medical

Sciences, Islamabad, Kulsoom International Hospital, and Combined Military Hospital,

Rawalpindi. The participant is between the ages of 20 and 50 (M=35.00, SD=2.01). To determine

the prevalence of hospital anxiety, stress, depression, and anxiety using four standardized tools.

To analyze the study's data, correlational and moderation analyses were carried out. The findings

of this study showed that psychological distress, anxiety, and depression in breast cancer patients

29
were strongly correlated with hospital anxiety. Results of the current study also showed that

hospital sadness and greater levels of negative mood in cancer patients were inversely correlated

with emotional regulation. Additionally, the results showed that in breast cancer patients,

emotional control moderated the relationship between general hospital anxiety and emotional

regulation. Because hospital anxiety encourages a higher prevalence of emotional regulation in

breast cancer patients, moderate research indicated that hospital anxiety was connected with lower

levels of stress (A Rashid, M Aqeel, B Malik, 2021).

The effectiveness of cognitive behavior stress management (CBSM), a treatment that is

appropriate for women who have received a breast cancer diagnosis, has not been studied in an

Omani cultural context. It is an effective intervention. In order to do this, we used a sample of 6

Omani women who had been diagnosed with early-stage breast cancer to assess the efficacy of an

8-week CBSM group program. Examining clinically meaningful changes in distress, social

support, and the psychological capacity to cope with breast cancer from the pretest to the posttest

and follow-up was the goal of this case study (i.e., 1 month later). Substantial positive effect sizes

were found overall in the group, showing clinical improvement over time in distress symptoms

and social support, but strong unfavorable effect sizes were also seen. The results indicate that

social support can help Omani women who battle with breast cancer and its treatment to lessen

their distress and enhance their coping mechanisms (Shams, and Al-Azri, 2019).

This research examined at how gynecologic cancer patients' quality of life, symptoms, and

social lives were affected by their therapy. Face-to-face interviews were used to gather information

to assess the patients' individual and illness features. The severity of the side effects was assessed

using the Edmonton Symptom Assessment Scale. The quality of life was assessed using the

Functional Assessment of Cancer Therapy-General 4 questionnaire. The patients' overall quality

of life scores after treatment were worse than their overall scores before treatment. Patients who

underwent chemotherapy and chemo radiotherapy had a lower quality of life and were less active
30
in social activities than those who underwent radiation (S Tekbaş, NH Şahin, NC Sayın, 2022 ).

In the current study, four domains—mental health and mood, psychological well-being, social

well-being, and spirituality—were studied to determine whether cancer survivors had impairment,

resilience, or growth responses in comparison to a sociodemographically matched group.

Investigations were also done into how aging affected psychological adjustment. The participants

were 796 matched respondents without a history of cancer and 398 cancer survivors who took part

in the MIDUS survey (Midlife in the United State. The outcomes include selfreport measures of

psychological well-being, social well-being, spirituality, and mental health and mood. Results

indicated that cancer survivors demonstrated impairment relative to the comparison group in

mental health, mood, and some aspects of psychological well-being (Erfani, Abedin, Blount

,2017).

The growing incidence of cancer among older makes it crucial to promote health and

wellbeing among people as they age. This study highlights the advantages of volunteering and

having a positive outlook for the future for older cancer patients. From the Health and Retirement

Study's 2008 wave, 2,670 people who had cancer were selected as a nationally representative

sample. To investigate the relationships between optimism, voluntarism, life happiness, and

psychological health, we built a structural equation model. Volunteerism, which in turn impacted

life satisfaction and psychological well-being, was significantly predicted by optimism. It was

discovered that there were significant path coefficients toward life satisfaction and psychological

well-being depending on the extent of participation in volunteer activities. According to the

findings of this study, older persons with cancer who have kept a good attitude on life and partake

in individually fulfilling activities tend to have psychological well-being and a sense of fulfillment

in their lives ( Heo, Chun, Lee and Kim,2016).

31
 Theoretical Framework

Health-related behaviors and subjective, social, and psychological characteristics are all part

of the dynamic idea of well-being. The Riff Scales of Psychological Well-Being is an instrument

with a theoretical foundation that focuses on assessing many aspects of psychological well-being..

These elements include the following:

 Self-acceptance

 The establishment ties to others

 Sense of autonomy in thoughts and actions

 The capacity to control complicated settings according to needs and values

 Sense of purpose in life

 Continued growth and development

Fundamental difficulties have hindered the evaluation of psychological well-being

constructs created from theory. Because they lacked reliable measurements over the most of the

20th century, hypothetical perspectives of well-being had little to no empirical impact. The

standards for what constituted well-being were also numerous, varied, and value-laden. Although

they were limited in their definition of constructs, no theoretical conceptions were widely used

because there were no reliable theoretically-derived assessments of psychological well-being. The

need for a tool to quantify psychological well-being constructs derived theoretically was identified

by researcher Carol Ryff. The theoretical literature on mental health, self-actualization, optimal

functioning, maturity, and developmental life span has been summarized [2, 3, 4, 8, 9]. Ryff

discovered that these various domains came together around a group of fundamental ideas or

dimensions, including self-acceptance, good relationships with others, autonomy, environmental

mastery, purpose in life, and personal development. In order to define the poles of each dimension,

assessed as a scale, Ryff started the process of developing an instrument to test the theoretically

32
supported core aspects of psychological well-being. High scorers on the self-acceptance scale, for

instance, "possess a positive attitude toward the self; acknowledge and accept multiple aspects of

the self, including good and bad qualities; and feels positive about past life," while low scorers on

the same scale "feels dissatisfied with what has occurred with past life; is disappointed with what

has occurred with certain personal qualities; wishes to be different than what he or she is”. First,

Carol Ryff believed that the definition of wellbeing should not be limited to biological or medical

terms rather, it should be viewed as a philosophical inquiry into what it means to live a good life.

Second, there was a lack of empirical rigor in the then-current psychological theories of well-

being. In order to develop a theory that combines philosophical issues with empirical empiricism,

Ryff looked for foundational ideas in a wide range of well-being theories and studies, from

Aristotle to John Stuart Mill, from Abraham Maslow to Carl Jung. The intersections she

discovered between the recurrence and convergence of these distinct theories served as the

foundation for her new model of well-being. The Carol Ryff psychological framework Being

complex and extending beyond happiness or positive feelings is one way that well-being differs

from earlier models in a significant way. A good life involves all of the various dimensions of

wellbeing and is comprehensive and balanced rather than being narrowly focused. The

Nichomachean Ethics of Aristotle, which contends that the goal of life is to live virtuously, is the

foundation for Ryff's theory. Following are Carol Riff’s six categories for well-being:

Self-acceptance

High self-acceptance: You have a favorable attitude toward yourself, you recognize and

accept all of your qualities, both good and poor, and you have nice feelings about your

past.

Low self-acceptance: You feel unsatisfied with yourself, are disappointed in the events of

your past life, are troubled by some aspects of your personality, and wish you could

change.
33
Personal growth

Strong Personal Growth: You feel that your development is ongoing, that you are

expanding and growing, that you are open to new experiences, that you are realizing your

potential, that you have seen improvements in yourself and your behavior over time, and

that you are changing in ways that reflect your increased self-awareness and effectiveness.

Weak Personal Growth: You feel like you're standing still in life; you don't feel like you're

becoming better or expanding over time; you're bored and uninterested in life; and you

find it difficult to adopt new attitudes or habits.

Purpose in life

Strong Life Purpose: You feel as though your present and past lives have meaning, you

hold beliefs that give your life purpose, and you have goals and objectives for life. You

also have goals in life and a feeling of direction in your life.

Weak Life Purpose: You lack a feeling of purpose in life, have few objectives or

aspirations, aren't very well-directed, can't understand the meaning of your former life,

and don't hold any outlooks or beliefs that give life importance.

Relationship with others

Strong Positive Relationships: You have relationships with others that are warm,

fulfilling, and trustworthy; you care about their welfare; you have strong empathy; you

can be affectionate and intimate; and you are aware of the give-and-take nature of

relationships.

Weak Relationships: You have few close, trusting relationships with people; it is difficult

for you to be warm, open, and concerned about others; you struggle with interpersonal

34
 relationships; you are isolated and frustrated; and you are unwilling to make concessions

in order to maintain significant relationships with people.

Environmental mastery

High environmental mastery: You have a strong sense of control over a wide variety of

outdoor activities, make the most of the opportunities that are presented to you, and create

or choose situations that are consistent with your own personal aims and values.

Low environmental mastery: It symbolizes difficulty managing daily duties, a sense of

helplessness towards changing or improving your environment, a lack of awareness of

available options, and a loss of control over your surroundings.

Autonomy

High Autonomy: You can resist social pressure to think and act in certain ways, govern

your behavior inwardly, and evaluate yourself using your own criteria. You are

autonomous and self-determining.

Low Autonomy: You worry about other people's expectations and assessments of you,

you depend on their opinions to guide crucial decisions you make, and you give in to

social pressures to think and act in particular ways.

35
 Conceptual framework

Social
support

Psychological
wellbeing

Quality of
life

36
 Chapter 3: METHODOLOGY

Research Method:

A quantitative relational Survey Method is used in this research.

Research Design:

The research design used in this study is Correlational Research Design.

Sample:

The sample of the study will be male (n = 50) and female (n = 50) male cancer patients of shaukat

khanam hospital Lahore, anmol hospital Lahore and med care hospital from Gujranwala. Before

data collection informed consent be will be given to participants. The age range of the participants

will be 20 to 80 years, and sample will be collected purposely that is cancer patients.

Inclusion Criteria:

The participants of this research are cancer patients. 120 patients of cancer are included (McHugh

1995). Purpose sampling technique is used in which only cancer patients will be participate.

Exclusion Criteria:

The patient with any other disease will not be part of this study. So the participant are only cancer

patients.

Sampling Technique:

A purposive sampling technique was employed to select the study participants.

Hypothesis:

The hypotheses of research are:

37
  There will be significant positive relationship between social support and psychological

wellbeing.

 There will be significant positive relationship between psychological wellbeing and quality

of life.

 There will be significant age difference in social support, quality of life and psychological

wellbeing in cancer patients.

 There will be significant family system differences in quality of life, social support and

psychological wellbeing in cancer patients.

 There will be significant residential differences in social support, quality of life and

psychological wellbeing in cancer patients

Measures:

Data is collected through survey method. It consisted of a questionnaire having four parts:

1. A part included the demographics in which participants were asked about their name, gender,

age, family system and residential area.

2. B part included a validated tool. These questions measured psychological wellbeing.

3. C part measured quality of life.

4. D part measured social support.

Reliability analysis was ensured by checking the value of Cronbach alpha through SPSS.

Research Instruments:

The data collection tools in research will be demographic questionnaire, Riff’s psychological

wellbeing scale, personal resource questionnaire and quality of life scale.

38
 1. Riff's Psychological Well-being Scale

It has 6 dimensions including the purpose in life, self-acceptance, autonomy, personal growth,

positive relations with others, and environmental mastery. Each of these dimensions consists of 3

items. The answers to the items in this part were developed and scored in 7-point Likert scale.

1 = strongly agree; 2 = somewhat agree; 3 = a little agree; 4 = neither

agree or disagree; 5 = a little disagree; 6 = somewhat disagree; 7 = strongly disagree.

The test-retest reliability coefficient of RPWBS was 0.82. The subscales of Self-acceptance,

Positive Relation with Others, Autonomy, Environmental Mastery, Purpose in Life, and Personal

Growth were found to be 0.71, 0.77, 0.78, 0.77, 0.70, and 0.78 respectively, which were

statistically significant (p<0.001). The correlation coefficient of RPWBS with Satisfaction with

Life, Happiness, and Self-esteem were also found to be: 0.47, 0.58, and 0.46 respectively which

were also significant (P<0.001).

2. Personal Resource Questionnaire

PRQ-2000 is the latest version of PRQ (Weinert, 2000). It is a self-administered instrument

composed of 15 items scored on a 7-point Likert scale that is designed to measure perceived

social support. The instrument was based on a synthesis of concepts with strong emphasis on the

work of Robert Weiss (1969). The item responses range from 1 (strongly disagree to 7 (strongly

agree), and scores for all 15 items are summed to obtain the total social support score. Total

possible scores range from 15 to 105, with higher scores reflecting higher levels of perceived

social support. Reliability and validity are high for PRQ-2000, as is internal consistency, with

alpha coefficients ranging from .87 to .93.

39
 3. Quality of life scale

The WHO QOLS was originally a 16-item instrument that measured five conceptual domains

of quality of life: material and physical well-being, relationships with other people, social,

community and civic activities, personal development and fulfillment, and recreation. It has

seven point Likert scale. The seven responses were "delighted" (7), "pleased" (6), "mostly

satisfied" (5), mixed" (4), "mostly dissatisfied" (3), "unhappy" (2), "terrible" (1).

Flanagan did not report internal consistency reliability (Cronbach's alpha) estimates in his

instrument development work. Estimates from the first study of 240 American patients with

chronic illness (diabetes, osteoarthritis, rheumatoid arthritis and post-ostomy surgery)

indicated that the 26-item QOLS satisfaction scale was internally consistent (α = .82 to .92)

and had high test-retest reliability over 3-weeks in stable chronic illness groups (r = 0.78 to r

= 0 .84).

Instruments Authors No. of items Likert points Responses Reliability

Personal resource Patricia 15 7 1=SD 0.87-0.93

questionnaire brandt, 7=SA

Clarann

Weinert in

1970

WHO quality of life John 26 5 1=Satisfied 0.82-0.92

scale Flanagan in 5=Dissatisfied

1970

Riffs psychological Carl D.Ryff in 18 7 7= SA 0.82

wellbeing scale 1989 1=SD

40
Ethical Consideration:

The study procedure complied with all ethical standards for research involving human subjects,

ensuring informed consent, voluntary participation, confidentiality, and data protection. Over the

course of the study, there were no ethical violations.

Procedure:

There are three variables that was present to in this research (social support, quality of life and

psychological wellbeing). The data was collected from shaukat khanam Lahore, anmol hospital

and medcare Gujranwala . The participants are 120 cancer patients (McHugh, 1995). The survey

method was used in which questionnaire was filled by cancer patients. The data was collected then

analyzed in SPSS to identify the result. The questionnaire was used to measure the variables. The

questionnaires was Riff’s psychological wellbeing scale, WHO quality of scale and personal

resource questionnaire.

Proposed Analysis

After data collection all the instruments was scored and analyzed with the help of statistical

package for social sciences (SPSS) version 19. SPSS was used to analyze the data. Descriptive

was used to measure the mean and standard deviation. T test was applied to check the family

system and residential area. Correlation was applied to check the difference between variables.

Multiple regression was used to predict the relationship either it is weak or strong. Anova was

used for measuring the difference in age groups. This analysis was used in this research to explore

the relationship between social support, quality of life and psychological wellbeing among cancer

patients.

41
 Chapter 4: RESULTS

Descriptive statistics:

Table 1

Demographic profile of respondents

Variables Categories Frequency Percentage

Gender

Male 60 50

Female 60 50

Total 120

100

Age(20-80)

20-39 36 29.8

40-59 51 42.1

60-80 33 27.3

Residential area

Rural 57 47.1

Urban 63 52.1

Total 120 100

Family system

Joint 59 49.2

Nuclear 61 50.8

Total 120 100

42
 Table 1 shows that there were total 100 respondents. Out of 100, 50% (N=60)

respondents are male, and 50% (N=60) respondents are female. (N=36) respondents were of age

group 20-39, 29.8% (N=51) respondents were of age group 40-59, 42.1% (N=33) respondents

were of age group 60-80. 27.3% (N=59) respondents have joint family system, 49.2% and (N=61)

respondents have nuclear family system 50.8%. (N=57) respondents have rural areas 47.1% and

(N=63) respondents have urban areas 52.1%. Participants belong to nuclear family system are

higher than joint family system and urban people are higher than rural people in residential area.

Table 2

Psychometric properties

Minimum, Maximum, Mean, Standard Deviation and Alpha Reliability of Scales (N=120)

Items N Mean SD Range α

RPWS 119 64.5 14.0 31-100 .80

QOLS 109 77.9 12.8 54-127 .64

PRQS 118 64.3 15.3 29-98 .75

Note: RPWS=Riff psychological wellbeing scale, QOLS=Quality of life scale, PRQS= personal

resource questionnaire.

Table 2 shows psychometric properties for the scales used in present study. The cronbach

α value for Ryffs psychological wellbeing scale was .80 which indicates that scale was reliable.

The cronbach α value for WHO quality of life scale was .64 which shows acceptable internal

consistency. The cronbach α value of personal resource questionnaire was .75 which shows that

scale was reliable.

43
 Inferential statistics:

Correlation analysis was used to check relationship between social support, quality of life and

psychological wellbeing of cancer patients. Regression analysis was used to predict the

relationship between variables. Anova was used to measure demographics with social support,

quality of life and psychological wellbeing of cancer patients.

Table 3

Correlation analysis of study variables

variables N M SD 1 2 3

RPWS 119 64.5 14.07 -

PRQS 118 64.3 15.3 .01 -

W-QOLS 109 77.9 12.8 .103 .416** -

Note: RPWS= Riffs psychological wellbeing scale, PRQS= Personal resource questionnaire,

QOLS= Quality of life scale

Table 3 shows that psychological wellbeing has significant positive correlation with social

support (r=0.01, p<.05) and psychological wellbeing has not significant positive correlation with

quality of life (r=.10, p>.05). Social support has significant positive correlation with quality of life

(r=.41**, p>.05).

44
Table 4

Regression analysis of study variables

PW

B SE T P 95%CI

Constant 55.0 8.78 6.26 .000 [37.64,72.4]

PRQS .002 .097 .019 .985 [-.190,.194]

WHO .112 .117 .958 .340 [-.120,.345]

Table 4 indicate that psychological wellbeing is insignificant positive predictor of social

support (β=.002, p>.05), whereas quality of life has non-significant predictor of psychological

wellbeing (β=.103, p>.05).

Table 5

Mean comparison of age on WHO quality of life scale, personal resource questionnaire and Riffs

psychological wellbeing scale

20-39 40-59 60-80

M SD M SD M SD F P

TPW 66.08 15.3 62.6 12.8 65.8 14.5 .786 .045

T-PRQS 65.9 12.4 64.7 16.4 62.3 16.6 .47 .02

T-WHO 79.7 10.2 77.4 13.6 76.5 14.3 .51 .001

Table 5 indicates that age range of 20-39 have (M=66.08, SD=15.3), 40-59 have

(M=62.6, SD=12.8) and 60-80 have (M=65.8, SD=14.5) of psychological wellbeing. Social

support has age range of 20-39 have (M=65.9, SD=12.4), 40-59 have (M=64.7, SD=16.4) and 60-
45
80 have (M=62.3, SD=16.6). It also indicates that quality of life has age range of 20-39 (M=79.7,

SD=10.2), 40-59 have (M=77.4, SD=13.6) and 60-80 have (M=76.5, SD=14.3). It shows that age

has significant effect on psychological wellbeing, quality of life and social support. The mean

comparison of age range shows that 20-39 age range has great effect on psychological wellbeing,

social support and quality of life than other age groups.

Table 6

Mean comparison of family system on WHO quality of life scale, personal resource questionnaire

and Riffs psychological wellbeing scale

Joint Nuclear

M SD M SD t P

TRPW 66.0 14.3 62.1 13.4 1.41 .16

TWHO 77.4 12.02 78.3 13.6 -.33 .74

TPRQS 62.3 15.8 66.3 14.8 -1.3 .17

Table 6 indicates that there is not significant family difference in terms of Social support t

(105) = -1.3, p>.05, quality of life t (105) =-.33, p>.05and psychological wellbeing t(105) =1.41,

p>.05 among cancer patients.

46
Table 7

Mean comparison of residential area on WHO quality of life scale, personal resource

questionnaire and Riffs psychological wellbeing scale

Rural Urban

M SD M SD t P

TPW 66.1 14.3 63.1 13.7 1.41 .16

TWHO 77.0 10.9 78.6 14.3 -.614 .54

TPRQ 63.6 15.2 65.0 15.5 -.311 .75

Table 7 indicates that there is not significant residential area in terms of Social support t

(105) = -.311, p>.05, quality of life t (105) =-.614, p>.05and psychological wellbeing t (105)

=1.41, p>.05 among cancer patients.

47
 Chapter 5: Discussion

The study was quantitative study to determine the quality of life, social support and psychological

wellbeing in cancer patients. The purpose of this study was to explore relation between social

support, quality of life and psychological wellbeing and also predict the effect of age, family

system and residential area on social support, quality of life and psychological wellbeing.

It was hypothesized that there will be positive relation between social support and

psychological wellbeing of cancer patients. The current findings showed that social support and

psychological wellbeing has significant positive relation among cancer patients. Social support

include support from family, friends and health care providers. When social support is high then

it improve psychological wellbeing and this hypothesis proves in this study. This study was

conducted in Pakistan and any individual suffer from any disease or crisis situation they need

support from every person that give them hope of live and hence it relate with psychological

wellbeing. According to Caplan and Killelea (1976), having social support is important while

coping with a crisis. Numerous researchers have discovered that social support is crucial for

promoting psychological acclimatization to a cancer diagnosis (Kavitha & Jayan, 2014).The study

conducted on cancer patients in 2021. The purpose of this study was to investigate the effects of

health perceptions, leisure-time physical activity (LTPA), and social support on psychological

wellbeing on cancer living in the UK. It was cross sectional study and results found that social

support has significant relation with wellbeing of cancer patients (Naguyen 2021).

Secondly it was hypothesized that there will be significant positive relation between

quality of life and psychological wellbeing in cancer patients. Findings of Pearson correlation

shows that quality of life has insignificant relation with psychological wellbeing. Many studies

conducted on cancer patients on quality of life. In 1987 a study conducted on cancer patients to

48
explore the quality of life. The results found that the quality of life impaired due to treatment

applied on cancer patients than normal individual and hence it is insignificant relation with

wellbeing (Knipperbeg 1985). A low quality of life score was significantly predicted by family

history of cancer. Our findings diverge from those that have been published in other studies

(Northouse et al., 2002; Von Ah et al., 2012). Counselors and psychosocial support services should

pay particular attention to the family history as a factor that may have a negative effect on quality

of life scores.

Then it was hypothesized that there will be significant age difference in social support,

quality of life and psychological wellbeing in cancer patients. Mean difference on age through

anova shows that age difference has significant effect on social support, quality of life and

psychological wellbeing. The mean comparison of age range shows that 20-39 age range has great

effect on psychological wellbeing, social support, and quality of life than other age groups. In

2013 research conduct in china on cancer patients that result indicates that support from society

had a stronger positive association with quality of life among younger survivors than among older

survivors (Lu, 2013).

Then it was hypothesized that there will be significant family system effect on social

support, quality of life and psychological wellbeing in cancer patients. T test shows that there is

not significant family difference in terms of social support, quality of life and psychological

wellbeing among cancer patients. In Pakistani culture family system are not matter either nuclear

or joint because of the nation's collectivistic culture, in which people rely on one another and

provide unconditional support for one another's needs. The study conducted in Pakistan in 2020

on social support and psychological wellbeing of cancer patients. The findings indicate that social

support has insignificant effect on psychological wellbeing (Khalid and Akhtar2020).

49
 Lastly it was hypothesized that there will be significant residential area effect on social

support, quality of life and psychological wellbeing in cancer patients. The current findings shows

that there is not significant residential area in terms of Social support, quality of life and

psychological wellbeing among cancer patients. Now in Pakistan there is not huge difference in

rural and urban lifestyle due to technological advancement. Equal opportunities and almost equal

facilities are present for people. This result is similar to study conducted in Scotland that also

shows that residential area not effect on physical wellbeing and emotional wellbeing (Chong et

al., 2005).

50
Limitations of the study:

The biggest limitation was data collection. Data collection of cancer patients is very

difficult task because it is very sensitive and time consuming task as cancer patients suffering from

radiotherapy and chemotherapy treatments etc. They are suffering from exhausted and burned

activities that disturb them physically as well as mentally and hence response from patients was

very biggest task for me. The current study used a sample size and gender effects were not

examined. Hospitals and organizations both expressed opposition to studying cancer patients. A

key finding during data collecting was that the majority of cancer patients have a highly negative

self-perception. There is a need to improve the quality of life of cancer patients by improving their

lifestyle and proper care centers in hospitals that is helpful for patients.

Recommendations:

Some suggestions have been offered that is highlighted in this study findings that might prove

useful in additional research.

 Future research will reveal the relationship among cancer types like breast, colorectal and

lugs etc.

 In addition, the research sample could be expanded to include a large population.

 The disease records indicate that child is also affected by this chronic illness and future

research will reveal the psychological wellbeing in child.

51
  The data will collected to all Pakistan cancer centers for generalizability of this research

and for effective results in future.

Conclusion:

This study revealed that cancer patients had a high rate of psychological wellbeing in

youngsters. Quality of life should be improved in cancer patients that effect on psychological

wellbeing. Strong social support significantly correlated with psychological wellbeing. Therefore,

routine psychiatric evaluation and follow-up should be advised. The age group of 20-39 have high

rate in social support, quality of life and psychological wellbeing.

Spouse, family, and friend counseling could be done alongside patient counseling to promote

social support. Better pain management and rehabilitation techniques should be tried for improved

quality of life.

52
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iv
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in oncology nursing (Vol. 28, No. 4, pp. 236-245). WB Saunders.

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settings, 24(3), 355-364.

v
 ‫‪APPENDIX‬‬

‫)‪(Questionnaires‬‬

‫‪Part A‬‬

‫‪Demographics‬‬

‫نام ‪:‬‬

‫عمر‪:‬‬

‫جنس‪:‬‬

‫‪ ‬مرد‬

‫‪ ‬عورت‬

‫رہائشی عالقے‪:‬‬

‫‪ ‬دیہی‬

‫‪ ‬شہری‬

‫خاندانی نظام‪:‬‬

‫‪ ‬جوہری‬

‫‪ ‬مشترکہ‬

‫‪vi‬‬
 ‫‪Part B‬‬

‫ذاتی وسائل کا سوالنامہ (‪)PRQ2000‬‬

‫وینرٹ‬

‫براہ کرم ہر ایک کو پڑھیں‬

‫آپ کے لیے موزوں ترین جواب کو بیان اور حلقہ بنائیں۔ کوئی صحیح یا غلط نہیں ہے۔‬

‫‪ :1‬سختی سے متفق نہیں۔‬

‫‪ :2‬متفق نہ ہوں۔‬

‫‪ :3‬کسی حد تک اختالف‪-‬‬

‫‪ :4‬غیر جانبدار‪-‬‬

‫‪ :5‬کچھ حد تک متفق‪-‬‬

‫‪ :6‬متفق‪-‬‬

‫‪ :7‬پوری طرح سے متفق‪-‬‬

‫پوری‬ ‫کچھ متفق‬ ‫کسی غیر‬ ‫سوالنامہ سختی متفق نہ‬

‫طرح‬ ‫حد‬ ‫ہوں حد تک جانبدار‬ ‫سے‬

‫سے‬ ‫تک‬ ‫اختالف‬ ‫متفق‬

‫متفق‬ ‫متفق‬ ‫نہیں۔‬

‫‪ .1‬کوئی ایسا ہے جسے میں اپنے قریب محسوس‬

‫کرتا ہوں جو مجھے محفوظ بناتا ہے‪.‬‬

‫‪vii‬‬
‫‪ .2‬میں ایک ایسے گروپ سے تعلق رکھتا ہوں‬

‫جس میں میں اہم محسوس کرتا ہوں‪.‬‬

‫‪ .3‬لوگوں نے مجھے بتایا کہ میں اپنے کام اچھی‬

‫طرح سے کرتا ہوں (نوکری‪ ,‬گھر بنانا)‪.‬‬

‫‪ .4‬میرا اس شخص سے کافی رابطہ ہے جو‬

‫مجھے بناتا ہے کہ میں خاص محسوس کروں‪.‬‬

‫‪ .5‬میں دوسروں کے ساتھ وقت گزارتا ہوں جن‬

‫کی میرے جیسی دلچسپیاں ہیں‪.‬‬

‫‪ .6‬دوسروں نے مجھے بتایا کہ وہ میرے ساتھ کام‬

‫کرنے سے لطف اندوز ہوتے ہیں۔‬

‫(نوکری‪ ،‬کمیٹیاں‪ ،‬منصوبے)‪.‬‬

‫‪ .7‬اگر مجھے مدد کی ضرورت ہے تو ایسے‬

‫لوگ ہیں جو ایک طویل مدت کے لیے دستیاب‬

‫ہیں ۔‬

‫‪ .8‬میرے دوستوں کے گروپ میں ہم ایک‬

‫دوسرے پر احسان کرتے ہیں۔‬

‫‪ .9‬دوسروں کی دلچسپیاں اور مہارتیں تیار کرنے‬

‫کے لئے میرے پاس دوسروں کو ترقی کی‬

‫ترغیب دینے کا موقع ہے‪.‬‬

‫‪viii‬‬
‫‪ .11‬میرے ایسے رشتہ دار اور دوست ہیں جو‬

‫میری مدد کریں گے چاہے میں ان کی مدد نہ‬

‫کر سکوں‪.‬‬

‫‪ .11‬جب میں پریشان ہوں‪ ،‬تو کوئی ہے جس کے‬

‫ساتھ میں رہ سکتا ہوں جو مجھے اپنے ساتھ‬

‫رہنے دیتا ہے‪.‬‬

‫‪ .12‬میں جانتا ہوں کہ دوسرے لوگ بطور شخص‬

‫میری تعریف کرتے ہیں‪.‬‬

‫‪ .13‬کوئی ہے جو مجھ سے پیار کرتا ہے اور میری‬

‫پرواہ کرتا ہے‪.‬‬

‫‪ .14‬میرے پاس سماجی واقعات اور تفریح‬

‫سرگرمیوں کا اشتراک کرنے کے لیے لوگ‬

‫ہیں۔‬

‫‪ .15‬مجھے کسی دوسرے شخص کی ضرورت کا‬

‫احساس ہے۔‬

‫‪ix‬‬
 ‫‪Part C‬‬

‫نفسیاتی بہبود کے پیمان‬

‫براہ کرم اپنے معاہدے کی ڈگری کی نشاندہی کریں (‪ 7-1‬تک کے سکور کا استعمال کرتے ہوئے)‪.‬‬

‫‪ .4‬نہ ہی متفق نہ ہی اختالف‬ ‫‪ .3‬تھوڑا سا اتفاق‬ ‫‪.2‬کسی حد تک متفق‬ ‫‪ .1‬بہت زیادہ اتفاق‬

‫‪ .7‬تھوڑا سا اختالف‬ ‫‪ .6‬کسی حد تک اختالف ہے‬ ‫‪.5‬بہت زیادہ اختالف‬

‫کسی حد بہت زیادہ‬ ‫ہی تھوڑا‬ ‫نہ‬ ‫تھوڑا‬ ‫کسی‬ ‫بہت‬

‫اختالف‬ ‫تک‬ ‫نہ سا‬ ‫متفق‬ ‫سا‬ ‫حد‬ ‫زیادہ‬

‫اختالف‬ ‫اختال‬ ‫ہی‬ ‫اتفاق‬ ‫تک‬ ‫اتفاق‬

‫ہے‬ ‫ف‬ ‫اختالف‬ ‫متفق‬

‫‪ )1‬میں اپنی رائے ظاہر کرنے سے‬

‫وہ‬ ‫نہیں ڈرتا‪ ،‬یہاں تک کہ‬

‫زیادہ تر لوگوں کی رائے کی‬

‫مخالف کرتی ہوں‪.‬‬

‫‪ )2‬میرے فیصلے عام طور پر ہر‬

‫کسی سے متاثر نہیں ہوتے ہیں۔‬

‫‪ )3‬میں پریشان رہتا ہوں کہ‬

‫دوسرے لوگ میرے بارے میں‬

‫کیا سوچتے ہیں۔‬

‫‪ )4‬میں مضبوط رائے رکھنے‬

‫والے لوگوں سے متاثر ہوتا‬

‫ہوں‪.‬‬

‫‪x‬‬
‫‪ )5‬مجھے اپنی رائے پر بھروسہ‬

‫ہے‪ ،‬چاہے وہ عام اتفاق رائے‬

‫کے خالف ہوں۔ میرے لیے‬

‫متنازعہ معامالت‬

‫پر اپنی رائے دینا مشکل ہے۔‬

‫‪ )6‬زیادہ تر لوگ مجھے محبت‬

‫کرنے واال سمجھتے ہیں۔‬

‫‪ )7‬میرے لئے قریبی تعلقات کو‬

‫برقرار رکھنا مشکل اور مایوس‬

‫کن رہا ہے۔‬

‫‪ )8‬مجھے اپنی شخصیت کے زیادہ‬

‫تر پہلو پسند ہیں۔‬

‫‪ )9‬میں اکثر تنہا محسوس کرتا ہوں‬

‫کیونکہ میرے چند قریبی دوست‬

‫ہیں جن کے ساتھ میں اپنی‬

‫پریشانیاں بانٹ سکوں‪.‬‬

‫‪ )11‬میں خاندان کے افرادیا دوست‬

‫کے ساتھ ذاتی اور باہمی گفتگو‬

‫سے لطف اندوز ہوتا ہوں۔‬

‫‪xi‬‬
‫وقت‬ ‫‪ )11‬لوگ مجھے اپنا‬

‫دوسروں کے ساتھ بانٹنے وال‬

‫شخصیت سمجھتے ہیں‪.‬‬

‫‪ )12‬میں نے دوسروں کے ساتھ‬

‫بہت سے گرمجوشی اور‬

‫بھروسہ مند تعلقات کا تجربہ‬

‫نہیں کیا ہے۔‬

‫‪ )13‬میں جانتا ہوں کہ میں اپنے‬

‫دوستوں پر بھروسہ کر سکتا‬

‫ہوں‪ ،‬اور وہ جانتے ہیں کہ وہ‬

‫مجھ پر بھروسہ کر سکتے ہیں۔‬

‫‪ )14‬جب میں اپنی زندگی کی‬

‫کہانی کو دیکھتا ہوں تو میں‬

‫خوش ہوتا ہوں کہ حاالت کیسے‬

‫نکلے ہیں۔‬

‫‪ )15‬عام طور پر میں اپنے بارے‬

‫مثبت‬ ‫اور‬ ‫پراعتماد‬ ‫میں‬

‫محسوس کرتا ہوں۔‬

‫‪ )16‬مجھے ایسا لگتا ہے کہ میں‬

‫جن لوگوں کو جانتا ہوں ان میں‬

‫سے بہت سے لوگوں نے میری‬

‫‪xii‬‬
‫زندگی سے زیادہ فائدہ اٹھایا‬

‫ہے۔‬

‫‪ )17‬زندگی میں کئی طریقوں سے‬

‫میں اپنی کامیابیوں سے مایوس‬

‫محسوس‬

‫کرتا ہوں۔‬

‫‪ )18‬میرا اپنے بارے میں رویہ‬

‫زیادہ تر مثبت نہیں ہے جیسا‬

‫لوگ اپنے بارے میں محسوس‬

‫کرتے ہیں‪.‬‬

‫‪xiii‬‬
Part D

xiv
xv
 Part-E

Permission for scale used in research

1. Riffs psychological wellbeing scale

xvi
2. Personal resource questionnaire

3. WHO Quality of life scale

xvii