In April 2018 Penny Brohn UK welcomed University of Bath MSc student, Becky Samuel, to join our in-house research and evaluation team to complete her dissertation on the experiences of some of our clients with advanced cancer.
What is post-traumatic growth?
The theory of post-traumatic growth is often coupled with traumatic events, such as a natural disaster, but very rarely is it used for people with advanced cancer. Why? The common assumption is that if the illness is so severe there can’t be any positives which can lead to growth after the traumatic occurrence. Therefore there’s very little research into this theory in relation to advanced cancer and that is why Becky’s investigation into the positive outcomes of Penny Brohn UK’s Bristol Whole Life Approach is so valuable.
The Post Traumatic Growth theory (Tedeschi and Calhoun, 20141) is broken into five streams which can be used to measure if a person has achieved growth from their experience. The five streams are:
- Personal strength.
- New possibilities.
- Appreciation for life.
- Relating to others.
- Spiritual changes.
For her research Becky interviewed 12 people who have attended courses at Penny Brohn UK, and who have advanced cancer. The interviews lasted between 40 minutes to one hour and thereafter were transcribed and analysed using a thematic approach (looking out for common themes across the answers of the 12 participants).
From the analysis, Becky was able to break down the experiences of these 12 people into two further themes:
Existing in the space between living and dying
In this case ‘the space’ is living with cancer and its impact on their lives while also coming to terms with a life shortened by cancer.
Control – People diagnosed with cancer often remark on the loss of control over their own life as doctors and schedules of hospital appointments take over. By exploring diet, exercise, emotions, relationships and stress management – key areas of Penny Brohn’s Bristol Whole Life Approach – those attending our courses could regain control over some aspects of their life through self-management techniques.
Coping with an awareness of death – Becky’s research highlighted that coping with this increased awareness of death for a lot of the participants was worsened by the societal norm to avoid talking about death, but conversely within this study a common thread found that an acceptance of death is a positive step and is not seen as giving in.
Meaning making – If the individuals reached an acceptance of the uncertainties within their life and their death, there was a common experience of a desire to live beyond the cancer world. To them living is more than their preoccupation with cancer, death and recovery, they wanted to live a meaningful life with the people close to them.
The ability to accept living in that ‘space’ was characterised by a growth in appreciation of life, relating to others and healthy behaviour change. Three of the five streams used to measure post traumatic growth.
Commonly described within the interviews was the experience of cancer, causing both a closer authenticity to the self and a forced fakery.
Authenticity to the self – Within the data captured, the participants made sense of their illness as a physical manifestation of psychological and emotional issues that they had been avoiding. Through this perception cancer forced people to use problem focused coping mechanisms to deal with unresolved issues, which led to greater self-awareness and emotional expression. This experience was overall characterised by a growth in personal strength through the increased ability to deal with emotional issues and as a freedom to be true to themselves, breaking through the social norm that you always have to be okay.
Putting up a pretence to those closest – In contradiction to the previous sub-theme a diagnosis of cancer caused them to put up a façade of being okay to those closest to them. Supporters may also experience trauma as a result of cancer and coping strategies are just as important to them. Participants also described the value of friendships with people who have or have had cancer, to whom they could fully disclose everything they were feeling. Penny Brohn UK was described as a valuable place where you can be yourself and get support from people in the same position.
Being able to express and get support for psychological and emotional challenges led to growth in: personal strength and relating to others.
Becky’s research gives clear evidence that people with advanced cancer can experience post-traumatic growth. Through healthy lifestyle changes, gaining control over their illness, facing death and the ability to be authentic to themselves and those close to them all led to this growth. The services we offer here were an important aspect of these experiences, presenting the importance of supporting individuals holistically to experience an opportunity and growth despite a cancer diagnosis.