Coping Strategies and Spousal Support in Women with Reproductive Cancer

I
SPOUSAL SUPPORT AMONG WOMEN WITH REPRODUCTIVE
CANCER AND ITS CORRELATION WITH THEIR COPING
STRATEGIES
SHILSA JAMES
Amala College of Nursing, Thrissur
DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF
THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF SCIENCE IN NURSING
KERALA UNIVERSITY OF HEALTH SCIENCES
2020

II
SPOUSAL SUPPORT AMONG WOMEN WITH REPRODUCTIVE
CANCER AND ITS CORRELATION WITH THEIR COPING
STRATEGIES
By
SHILSA JAMES
Dissertation submitted to the
Kerala University of Health Sciences
Thrissur
In partial fulfillment of the requirements for the degree of
MASTER SCIENCE
In
MEDICAL SURGICAL NURSING
Under the guidance of
Mr. Don Jose K, MSc (N)
Asst. Professor
Department of Medical Surgical Nursing
Amala College of Nursing
Thrissur
2020

III
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation entitled “Spousal support among women
with reproductive cancer and its correlation with their coping strategies” is a bonafide
and genuine research work carried out by me under the guidance of Mr. Don Jose K,
Asst. Professor, Department of Medical Surgical Nursing, Amala College of Nursing,
Thrissur.
Date: 03-08-2020
Place: Thrissur Shilsa James

IV
CERTIFICATION BY THE GUIDE
This is to certify that the dissertation entitled “Spousal support among women
and genuine research work done by Shilsa James in partial fulfillment of the
requirements for the degree of Master of Science in Medical Surgical Nursing.
Date: 03-08-2020 Mr. Don Jose K, MSc (N)
Place: Thrissur Asst. Professor
Department of Medical Surgical Nursing
Thrissur

V
ENDORSEMENT BY THE PRINCIPAL
This is to certify that the dissertation entitled “Spousal support among women
research work done by Shilsa James in partial fulfillment of the requirements for the
degree of Master of Science in Medical Surgical Nursing.
Date: 03-08-2020 Prof. Dr. Rajee Reghunath MSc (N), PhD
Place: Thrissur Principal
Thrissur

VI
COPY RIGHT
DECLARATION BY THE CANDIDATE
I hereby declare that the Kerala University of Health Sciences, Thrissur shall
have the right to preserve, use and disseminate this dissertation / thesis in print or
electronic format for academic / research purpose.
Date: 03-08-2020 Shilsa James
Place: Thrissur

VII
ACKNOWLEDGEMENT
“The beginning of all wisdom is acknowledgement of facts”
-Juho Kusti Paasikivi-
The investigator is grateful to God Almighty, without his benevolent
blessings this study would not have been possible.
With much pleasure the investigator conveys her gratitude to all those who
have indulged themselves in supporting for her welfare and progress.
The investigator wishes to express her sincere gratitude to Rev. Fr. Francis
Kurissery CMI, Director, Amala Institute of Medical Sciences for giving the
opportunity to utilize all facilities in the reputed institution for the successful
completion of this dissertation.
The investigator wishes to express her sincere gratitude to Prof. Dr. Rajee
Reghunath, MSc (N), PhD, Principal, Amala College of Nursing for his wise
support, genius suggestions for completing the study.
The investigator is extremely thankful to Sr. Litha Lizbeth, MSc (N),
Professor, Vice Principal and HOD of Obstetrics and Gynecological Nursing
department, Amala College of Nursing, for her general support and valuable
suggestions for completion of the study.
The investigator extends her utmost and in depth gratitude to Lakshmi G,
MSc (N), Professor, HOD of Medical Surgical Nursing department, Amala College of
Nursing, for her generous and valuable guidance which she rendered throughout the
study.

VIII
The investigator owes her sincere appreciation and heartfelt gratitude to
Mr. Don Jose K, MSc (N), Assistant Professor, Medical Surgical Nursing
department, Amala College of Nursing for spending his valuable time, expert
suggestions, constant encouragement, patience and prayerful support from the
beginning till the end of this research.
The investigator extends her special gratitude to Sr. Dona MSc (N), Assistant
Professor, Medical Surgical Nursing department, Final year class coordinator, Amala
College of Nursing for her constant support and guidance.
The investigator is extremely thankful to Sr. Jyothish C S, MSc (N),
Associate Professor, Medical Surgical Nursing department, First year class
coordinator, Amala College of Nursing for her constant support, encouragement,
guidance and prayers.
The researcher places on record, her sincere gratitude to Dr. Anil Jose,
Professor, HOD Medical Oncology, Amala Institute of Medical Sciences, for his
support and suggestions.
The researcher places on record, her sincere gratitude to Dr. Sunu Cyriac,
Assistant Professor, Department of Medical Oncology, BMT, Amala Institute of
Medical Sciences, for his support, expert suggestions and guidance.
The investigator expresses special thanks to Mrs. Jini M P, MSc Biostatistics,
Assistant Professor, Amala Institute of Medical Sciences, for her immense help and
valuable suggestions throughout the study, till completion.
The investigator extends her gratitude to all Faculty members of Amala
College of Nursing, for timely criticism, support and suggestions.

IX
The investigator is also thankful to all study participants for their
cooperation for the successful completion of the study.
The investigator wishes to express her sincere thanks to all experts who have
helped her in making the tool in valid and reliable form.
The investigator expresses her sincere thanks to Mr. Binoy who helped in
performing the English tool translation.
The investigator extends her gratitude to Mrs. Babitha N P and Sr. Deepthi
who helped in performing editing for proper English language and overall style of the
theses.
The investigator wishes to express her sincere thanks to Mr. Davis K O and
Mrs. Maryland P F, Librarians, Amala College of Nursing, for their guidance to
make reference on time.
The investigator also wishes to convey her gratitude to Nurse in charge and
staff nurses of Oncology department of Amala Institute of Medical Sciences,
Thrissur for their cooperation and support.
The investigator expresses her special thanks to Friends and classmates for
their constant encouragement, support and valuable time for achieving success of the
study.
The investigator also takes this opportunity to express her indebtedness to
loving mother Mrs. Shaji James, dearest brother Mr. Shancil James and entire
family members for their inseparable support, prayers and untiring efforts which
encouraged her throughout the study.

X
Appreciation is extended to all colleagues and friends who encouraged and
helped in various aspects for conducting the study, for their constant encouragement
and support in each moment up to the success of the study.
May the God bless and reward each one of you. With heartfelt and everlasting
gratitude,
Date: 03-08-2020 Shilsa James
Place: Thrissur

XI
ABSTRACT
The present study was aimed to assess the correlation between coping
strategies and spousal support among women with reproductive cancer in Amala
Institute of Medical Sciences, Thrissur. The objectives of this study were to assess the
spousal support among women with reproductive cancer, to assess the coping
strategies, to find the correlation between spousal support and their coping strategies,
to find the association between coping strategies with selected demographic and
clinical variables and to find the association between spousal support with selected
demographic and clinical variables. The research Approach was Quantitative and
research design adopted was Cross sectional survey method. 128 women were
selected by consecutive sampling technique. Data was collected using structured
questionnaire to assess the demographic and clinical variables, modified BRIEF Cope
scale to assess the coping strategies and modifies Sources of Social Support Scale to
assess the spousal support. The study was based on Sr. Callista Roy’s Adaptation
Model. The result showed that there is a positive correlation between coping
strategies and spousal support (r = 0.131). There is an association between coping
strategies and age in years (P < 0.001), coping strategies and education of patient (P <
0.001), coping strategies and area of residence (P < 0.05), coping strategies and
duration of marital life (P < 0.001), spousal support and age (P < 0.001), spousal
support and number of children (P < 0.001), spousal support and education of spouse
(P < 0.05), spousal support with duration of marital life (P < 0.05), spousal support
and support system available (P < 0.001).
Keywords: coping strategies, spousal support, Callista Roy’s adaptation model,
women with reproductive cancer.

XII
TABLE OF CONTENT
Chapters Title Page No
1
2
3
4
5
6
INTRODUCTION
REVIEW OF LITERATURE
METHODOLOGY
ANALYSIS AND INTERPRETATION
RESULTS
DISCUSSION, SUMMARY AND CONLUSION
REFERENCES
APPENDICES
1
15
30
41
92
99
107
116

XIII
TABLE OF TABLES
Table
No
Titles Page
No
1
2
3
4
5
6
7
8
9
10
Frequency and percentage distribution of women with reproductive
cancer according to age
cancer according to the education of patient
cancer according to the occupation of patient, economic status and
type of family
cancer according to number of children
cancer according to education of spouse
cancer according to occupation of spouse and habits of spouse
cancer according to area of residence and duration of marital life
cancer according to duration of illness
cancer according to sources of previous knowledge about cancer and
support systems available
cancer according to site of cancer and pattern of occurrence
44
45
46
47
48
49
50
51
52
53

XIV
Table
No Titles
Page
No
11
12
13
14
15
16
17
18
19
20
21
22
23
24
cancer according to stage of cancer and treatment taken
cancer according to type of surgery
cancer according to comorbidities
Distribution of subjects according to coping strategies
Distribution of subjects according to spousal support
Mean, standard deviation , range of coping strategies and spousal
support scores of subject
Correlation between coping strategies and spousal support
Association between coping strategies and age in years
Association of coping strategies with education of patient and
occupation of patient
Association of coping strategies with economic status and type of
family
Association between coping strategies and number of children
Association between coping strategies and education of spouse
Association of coping strategies with occupation of spouse and
habits of spouse
Association of coping strategies with area of residence and duration
of marital life
54
55
56
57
58
59
60
61
62
63
64
65
66
67

XV
Table
No
Titles
Page
No
25
26
27
28
29
30
31
32
33
34
35
36
37
38
Association between coping strategies and duration of illness
Association between coping strategies and sources of previous
knowledge
Association of coping strategies with support system available and
site of cancer
Association of coping strategies with pattern of occurrence and
stage of cancer
Association of coping strategies with treatment taken and type of
surgery
Association between coping strategies and comorbidities
Association between spousal support and age
Association of spousal support with education of patient and
Association of spousal support with economic status and type of
family
Association between spousal support and number of children
Association of spousal support with education and occupation of
spouse
Association of spousal support with habits of spouse and area of
residence
Association between spousal support and duration of marital life in
years
Association between spousal support and duration of illness
68
69
70
71
72
73
74
75
76
77
78
79
80
81

XVI
Table
No
Titles
Page
No
39
40
41
42
43
Association between spousal support with sources of previous
knowledge and support system available
Association between spousal support and site of cancer
Association of spousal support with pattern of occurrence and stage
of cancer
Association of spousal support with treatment taken and type of
surgery
Association between spousal support and comorbidities
82
83
84
85
86

XVII
LIST OF FIGURES
Figure
No
Name of figure Page No
1
2
Conceptual framework based on Sr. Callista Roy Adaptation
model
Schematic representation of study design
14
34

XVIII
LIST OF APPENDICES
SECTION I
Appendix
No
Title Page
No
A
B
C
D
E
F
G
H
I
J
K
Approval letter from Institutional Ethical Committee
Permission letter to conduct the study
Letter seeking expert opinion on content validity of research tool
List of expert
Certificate of tool validity
Malayalam tool validity certificate
Information to the participants
Informed consent
Permission letter to use tool
Research tool in English
List of abbreviations
117
118
119
120
122
123
124
125
127
129
137
SECTION II – MALAYALAM
Appendix
No
Title Page
No
L
M
N
Information to the participants
Informed consent
Tool II - modified BRIEF Cope Scale
Tool III – modified Sources of Social Support Scale
138
139
141
144

1
CHAPTER 1
INTRODUCTION
Background of the problem
Need and significance of the study
Statement of the problem
Objectives
Operational definitions
Hypothesis
Conceptual framework

2
INTRODUCTION
“She stood in the storm, and when the wind did not blow her away,
She adjusted her sails.
- “Elizabeth Edward”-
Background of the study
The one who has a distinctive personality and possess a kind and caring heart
is a woman. As well known, she is a mystery that one can never comprehend.
Everything in her life is subject to change any time. However, she is capable of
adapting to any kind of changing environment. When a baby girl starts an embryonic
life in her mother’s womb, throughout her prenatal phase, up to the time of birth,
variety of roles function along with the physiological changes that happen to her.
Despite all, she is a versatile, courageous and a beautiful creation of God.
Reproductive cancers are the cancer that happens anywhere in the conceptive
framework of a woman’s body. It includes cancers in the breast, cervix, uterus, vulva,
endometrium and ovaries. Several risk factors are identified for female reproductive
cancer. Some are non-modifiable factors such as age, family history and genetic
makeup while others are modifiable factors like menstrual and reproductive factors,
hormone replacement therapy and Body Mass Index (BMI) that can be changed
through healthy habits.1
In 2018 GLOBOCAN database shows that breast cancer is the most
commonly diagnosed cancer and the leading cause of cancer death in women (15.0%).
Also Cervical cancer ranks 4th
for both incidence (6.6%) and mortality (7.5%).2
Globally the sixth and seventh most common form of female cancers are ovarian and
uterine cancer respectively.3

3
According to American Institute for Cancer Research the estimated cancer
case among females around the world is 8.5 million. Among these cancers
gynecological cancers shows high incidence in which breast cancer itself shows
25.4% of newly diagnosed cases. America has the highest incidence rate for uterine
cancer and third highest incidence of ovarian cancer in the world.4
The Global Burden of Disease Study was conducted between 1990 – 2016
that has significantly showed the burden of cancers and their variations across the
states of India. The age-standardized incidence rate of breast cancer was 40.7% with
an estimated 1,18,000 cases from 1990 to 2016. Cervical cancer was the second
leading cause of cancer deaths for females in 12 Indian states including Kerala. Study
also showed an estimated 77,000 cases with age-standardized incidence rate of 39.7%.
Followed by these cancers ovarian cancers had the sixth highest incidence rate among
females with estimated cases of 4 per 1,00,000 with 26,000 incident cases and 76,000
prevalent cases in 2016.5
In addition to the burden of morbidity and mortality these cancers carry an
economic burden also. This includes direct costs such as the costs of treatment and
indirect costs such as the costs to family or society from loss of income or
productivity due to illness or premature death. There are also other quantifiable costs
of cancer such as time spent by caregivers, spouse, family members, transportation
and assistance in the home. The costs of cancer pose unique challenges in both high
and low-resource environments.6
According to Lazarus and Folkman coping is a “constantly changing cognitive
and behavioral efforts to manage external or internal demands that are appraised as
taxing or exceeding resources of the person.” The internal and external demands that

4
are appraised as taxing or exceeding the resources of the person is nothing but an
expression used for describing one’s internal state of stress.7
It has been identified that several coping strategies are being manipulated by
the patients during the course of disease. They are adhering to prayer, avoiding
negative thoughts and people, developing positive will to live, receiving support from
family, spouse, friends and social support systems. Cancer diagnosis affects the
psychological well-being of both patients and their partners and effective coping has
been suggested to be a conjoint process of mutual support.8
Diagnosis of gynecological cancer is having a social and psychological effect
by the means of sexuality and motherhood. Definitely such women will be
experiencing a range of concerns and fears of disfigurement, marital life and role
changes, uncertainty regarding recurrence and fear of death. Not only the victims but
also the partners are also getting affected with this cancer diagnosis. Their way of
coping and adjustment to the situation also plays a major role in this.9
A large body of research over the past decades has confirmed that women’s
perceived social support is a critical factor in their adjustment to cancer. Furthermost,
post traumatic growth from the cancer experience is positively related to support from
the spouse along with emotional support is rated as the most helpful form of
support.10
Need and significance of the study
WHO defines Health as a state of complete physical, mental and social
wellbeing and not merely the absence of disease or infirmity. Specifically health is a
dynamic condition resulting from a body’s constant adjustment and adaptation in

5
response to stresses and changes in environment for maintaining an inner equilibrium
called homeostasis.11
Family history of cancer is considered as one of the important risk factors in
predicting personal cancer risk. Population-based estimates of the prevalence of
family history of cancer among women in USA shows that the prevalence of first-
degree family history of breast, ovarian, endometrial, and cervical cancers was 6.4%
(5.7–7.1%), 1.1% (0.8–1.4%), 3.5% (3.0–4.0%) and 2.1% (1.7–2.5%) respectively.
The prevalence of family history of breast cancers increased significantly with
respondent’s age. Similar results for family history of breast cancer were obtained
from an analysis of responses from the Women’s Interview Study on Health (WISH).
This says that family history among women can be an indicator to rule out their life
time risk for reproductive cancers.12
A cross sectional study was conducted in 2015 among 221 women on ways of
coping with stress and perceived social support in gynecological cancer patients at
university hospital Istanbul, Turkey. Study concluded that women with high
educational status have showed a high perceived social support and use of effective
coping ways. Also shown a positive correlation between effective coping ways with
stress and perceived social support from family, friends and significant others (P<
.05), (r=0.52).13
Now a days families and marriage are becoming more volatile. Separation,
divorce, disruption and lone parent are prominent among the society. Indian culture
encourages intact marital life; specifically intact marriage is proven to be the strongest
indicator for health and well-being. For obvious reasons women cannot contribute to
development if they are not in good health. When they are in health challenging

6
situation the importance of social and family supports have proven to be significant in
coping with challenges and time of recovery from the states of dependency.14
A descriptive study was conducted among 472 low-income ethnic minority
women with breast or gynecological cancer to assess the prevalence of depression at
urban public medical center. Results shows that there is high prevalence of depressive
disorder among these patients and is correlated with pain, anxiety and health-related
quality of life (HRQL). The study suggests that there is a need for routine screening,
evaluation and treatment for depression because these women are unlikely to receive
treatment or supportive counseling during the course of illness.15
A qualitative study was conducted in 2018 among 8 women survivors of
cervical cancer to examine the coping strategies at Nigeria. The study was conducted
in two context characterized by presence and absence of spouse. Study concluded that
marital context plays significant role in coping among women with cervical cancer.
The authors recommend increased husband – wife support, counseling and screening
awareness especially during life threatening illness. So that it could encourage quick
recovery and improved well-being there by contributing to development.14
Literatures regarding psychiatric disorders and gynecological oncology shows
that patients with gynaecological cancer are at risk for psychiatric disorder such as
major depression and anxiety disorders. Also depression, anxiety and adjustment
problems appear to worsen over the course of the treatment persisting well after the
initial diagnosis and therapy.16
A descriptive study was conducted in 2016 among 190 women on relationship
between the level of social support perceived by women with gynecologic cancer and
mental adjustment to cancer at Diyarbakir province of Turkey. Study revealed that

7
perceived social support had a positive correlation with the subscale fighting spirit (r
= 0.34–0.56; P< 0.001 for all) and a negative correlation with the subscales of
helplessness/hopelessness (r = − 0.25 to − 0.48; P< 0.001 for all) and fatalism (r = −
0.20 to − 0.30; P< 0.01 for all) in the mental adjustment to cancer scale. This study
showed the important role of family and social support in coping with gynecological
cancer among women.17
The above literature highlights several ways of coping strategies and support
systems that are available and utilized by women with reproductive system cancer.
Also the researcher communicated with patients who are diagnosed with reproductive
cancer during her clinical experience .She came to know more about their support
system and coping strategies and observed that there is an effect of spousal support on
coping with their cancer. As the researcher found a limited number of studies on the
relationship between spousal support and coping among women with cancer of
reproductive system, she felt the need to understand and identify the importance of
spousal support for effective coping with reproductive cancer among women.
Statement of the problem
A study to assess the spousal support among women with reproductive cancer
and its correlation with their coping strategies at Amala Institute of Medical Sciences,
Thrissur.

8
Objectives
1. Assess the spousal support among women with reproductive cancer.
2. Assess the coping strategies among women with reproductive cancer.
3. Determine the correlation between spousal support among women with
reproductive cancer and their coping strategies.
4. Find the association between coping strategies with selected demographic and
clinical variables.
5. Find the association between spousal support with selected demographic and
clinical variables.
Operational definitions
Spousal support: It refers to the psychological, physical, financial and other forms of
support provided by the spouse to a woman with cancer of reproductive system which
is obtained from modified Sources of Social Support Scale scoring.
Women:It refers to the women aged above 18 years and diagnosed with reproductive
system cancers undergoing treatment in AIMS and whose primary care giver is
husband.
Reproductive cancer:It refers to any cancer which can occur in the conceptive frame
work of a women’s body such as uterus, ovary, fallopian tube, cervix, vulva and
breast.
Correlation: Correlation is a process of establishing relationship or connection
between spousal support and coping strategies of women with cancer of reproductive
system.

9
Coping strategy: Coping Strategies refers to a series of actions or thought process
used in meeting a stressful or unpleasant situation by a women diagnosed with
reproductive cancer which is obtained from modified BRIEF Cope Scale scoring.
Hypotheses
H1: There is a significant correlation between spousal support among women with
reproductive cancer and their coping strategies.
H2: There is a significant association between coping strategies with selected
demographic and clinical variables among women with reproductive cancer.
H3: There is a significant association between spousal support with selected
demographic and clinical variables among women with reproductive cancer.
Conceptual framework
Conceptual framework of this study is derived from Roy’s Adaptation Model
formulated by Sister Calista Roy in 1964. The focus of this study is the adaptation of
the individual to various stimuli both from the environment and from within.
Sister Calista Roy’s Adaptation Model
Conceptual framework consists of a set of defined concepts and relational
statements. Framework provides rationale for relationship between variables of the
study and gives direction of planning, data collection and interpretation of the result.
This model views individual as a bio psychological adaptive system that are in
constant interaction with the environment and copes with the environmental changes
through the process of adaptation. A system is “a set of parts connect to function as a

10
whole for some purpose and that does so by virtue of the interdependence of its
parts.” Along with wholeness the adaptive system is characterized by input, control,
output and feedback process. Each person is seen as integrated whole with biological
and social components and in constant interaction with the surrounding
environment.16
As per this model in order to maintain homeostasis or integrity, people must
respond to the changes from external and internal stimuli. Each individual’s
adaptation is modulated by the coping mechanism and it is acting as a control process.
All circumstances conditions or changes which challenge the person as an adaptive
system is considered as the environment. Both internal and external factors are
identified as the stimuli and they are categorized into three groups.16
Input (Environmental changes / stimulus)
Stimulus is something that provoke a response point of interaction for the
human system and the environment.
 Focal stimuli
Any Internal and external stimulus that immediately confounding the person is called
focal stimuli. In this study diagnosis of cancer, duration of illness, treatment and
coping strategies were the immediate stimuli that affect the person’s normal balanced
life.
 Contextual stimuli
All other associated stimuli present in the situation that contribute to the effect of
focal stimuli. In this study hospitalization, social support, family support, spousal
support and financial constraints constitutes the contextual stimuli.

11
 Residual stimuli
Any environmental factors within or without the human system with effects in the
current situation that are unclear. Here socio demographic variables such as age,
education of patient and spouse, occupation of patient and spouse, type of family,
religion, cultural beliefs, number of children and comorbidities are those residual
stimuli.
Adaptation level
Adaptation level is the condition of the life process. That indicated by the
good scores in modified BRIEF Cope scale and modified Sources of Social Support
Scale.
Coping mechanism
 Regulator subsystem : Automatic response to stimuli (neural, chemical and
endocrine)
 Cognator subsystem : Controls internal process related to higher brain
functions such as perception, information, processing, learning from the past
experience, judgment and emotion.
Coping process are innate or acquired ways of interacting with changing
environment. Acquired coping mechanisms are developed through series of strategies
such as learning. In the present study these coping process including both regulator
and cognator mechanisms are being manifested in subsystems of persons called as
adaptive modes or effectors.
Effectors
It consists of
1. Physiologic – physical mode
2. Self-concept mode

12
3. Role function model
4. Interdependence mode
Physiologic – physical mode: It is associated with the physical and chemical process
involved in the function and activities of living organism which are not included in
the present study.
Self - concept mode: It is defined as the composite of beliefs and feelings about
oneself at a given time and is formed from the internal perceptions and perception of
others. In the present study they are self-esteem, self-distraction, positive reframing,
spirituality, body image, depression, lack of interest, religion, denial, social isolation
and emotional bonding with spouse.
Role function mode: It mainly focuses on the role of person occupies in society. In
the present study it constitutes the family role, rearing children, sexual dysfunction,
daily activities, active coping, occupational role changes and instrumental support
from spouse.
Interdependence mode: It involves person’s relationship with significant others and
support system. In the present study it constitutes the withdrawal, dependency,
venting, acceptance, dissatisfaction with relationship, disruption of interactions and
informational support from spouse.
Output
Adaptive response
Adaptive response leads to health, good coping mechanism with adequate
support system to present situation. In this study, which is represented by high spousal

13
support (modified Sources of Social Support Scale score) and high coping strategies
(modified BRIEF Cope Scale score).
Maladaptive response
Maladaptive response includes deterioration in health patients will be
assuming poor coping strategies. In this study low spousal support (low score in
modified Sources of Social Support Scale) low coping strategies (low score in
modified BRIEF Cope Scale) will be the maladaptive response.
Roy views regulator and cognator as a method of coping. Focal, contextual
and residual stimuli act upon women with reproductive cancer. They undergo
adaptive responses through cognator and regulator sub systems internally and
externally. By which they make output through interpretation and integration of
physiological, self-concept, interdependence and role function modes. This impact is
manifested as either adaptive or maladaptive responses. That is by exhibiting good
coping strategies along with good spousal support. High scores in modified BRIEF
Cope Scale and modified Sources of Social Support Scale as adaptive response and
low score in modified BRIEF Cope Scale and modified Sources of Social Support
Scale as maladaptive responses.

15
CHAPTER II
1. Literature related to prevalence of reproductive cancer among women
2. Literature related to coping strategies among women with reproductive
cancer
3. Literature related to spousal support among women with reproductive
cancer
4. Literature related to psychological issues among women with reproductive
cancer

16
Review of literature is a broad, comprehensive, in-depth, systematic and
critical review of scholarly publications, unpublished scholarly print materials, audio
visual materials and personal communications. It helps the researcher to find any gap
or inconsistencies in a body of research and identification of refined clinical
interventions to test through empirical research. Researchers almost never conduct a
study in an intellectual vacuum their studies usually undertaken within the context of
an existing knowledge base. A review of literature provides us with the current
theoretical and scientific knowledge about a particular problem and resulting in
synthesis of what is known and not known that may keep current in our practice by
regularly searching the literature for information on topics of particular interest.19
For the present study the investigator reviewed and analysed the related
literature to broaden the understanding and to gain insight into selected problem under
study. The literature review of this study is organized and present under following
aspects.
Literature related to prevalence of reproductive cancer among women
An epidemiological observational study was conducted by Hamid Salehiniya
and Safoura Taheri in 2019 on epidemiology and risk factors of ovarian cancers in the
world by analysing 125 articles that had been published during the year 1925 – 2018.
Articles were accessed through Medline, Web of science core collection and Scopus
database. Study revealed that ovarian cancer is the seventh most cancer among
women. In 2018 4.4% of entire cancer related mortality among women was related to
ovarian cancer. The incidence was found to be high among high Human Development

17
Index (HDI) countries. The study showed the significance of ovarian cancer and its
heavy burden on women’s health.20
An epidemiological study was conducted by J D Sharma, Dr. Barman et.al in
2017 on gynaecological cancers in Kamrup urban District registry at Assam India.
Information got collected from voluntary participation of different sources like major
hospitals, diagnostic canters, state referral board and birth and death registration
canters within registry areas. Study showed that total of 661 cases of ovarian, cervical
and uterine cancers was registered out of total 3767 female cancer cases. The annual
average crude rate for women in cancer is 117.4 per 1,00,000 population.21
A cross sectional study was conducted by Akbar Omran, Reza Aliza, Navei
et.al in 2018 on epidemiology of female reproductive cancers in Mazandaran Province
(Northern Iran). Study analysed 4460 patient records in Mazandara population based
cancer registry. Result showed that the mean age of patients was 53.45 years and
incidence rate of female reproductive cancers was 8.51 per 1,00,000 persons per year.
The study also highlighted that the incidence of female reproductive cancers were
more in urban than rural.22
A community based cross sectional survey was conducted by John S, Jose R,
Haran J C and Augustine P in 2017 among women hailing from Thiruvananthapuram
Kerala. A breast cancer screening programme was conducted through media for 2000
women aged above 20 years. The socio demographic variables and various known
risk factors for breast cancers were collected with the help of semi structured
proforma. Results showed that the mean age of women was 45 and among these
82.5% had never undergone any screening programme. The breast cancer risk

18
calculator assessment showed that 65% of women who were screened had no risk,
22.2% had moderate risk and 12.9 % had low risk.23
A tertiary hospital based retrospective descriptive study was conducted by
Sonia Puri, Veenal Chadha and Pandey AK in 2018 on epidemiology of ovarian
tumours in Northern India. Purpose of the study was to identify and determine the
pattern of ovarian tumors among patients at Chandigarh. Results showed that
maximum number of cases were from the state of Haryana contributing to nearly 41%
of total cases. Among them, 24.4% of cases were in the age group of 50 to 59 years
followed by 40 to 49 years. The study also concluded that epithelial adenocarcinoma
was the commonest histology subtype seen in these women.24
An epidemiological study was conducted by Shreshtha Malvia et.al in 2017 on
Breast cancer among Indian women. Data collected from various latest national
cancer registries and were compared for incidence and mortality rates. Study revealed
that the age adjusted incidence rate of carcinoma of the breast was found as high as 41
per 1,00,000 women in Delhi, followed by Chennai (37.9), Bangalore (34.4) and
Thiruvananthapuram district (33.7).25
Literature related to coping strategies among women with reproductive cancer
Women with breast cancer experience problems related to multiple aspects of
their lives. However, applying effective strategies can result in enhancing their quality
of life and their psychosocial adaptation to the disease.
A descriptive study was conducted by Marta Kulpa et.al in 2016 on Anxiety,
depression, cognitive coping strategies and health locus of control in patients with
ovary and uterus cancer during anticancer therapy. The study was conducted at

19
reproductive organs cancer clinic in Institute of Oncology in Warsaw, among 78
subjects. Hospital Anxiety and Depression Scale (HADS) was used to assess the
anxiety and depression level. Cognitive strategies for coping with stress were rated by
using the Cognitive Emotions Regulations Questionnaire (CERQ). Results showed
that 43.6 % patients had low anxiety, 28.2% patients had medium anxiety and 28.2%
showed high anxiety. Meanwhile 66.7% patients had low depression, 16.7% patients
had medium depression and 16.7% showed high depression. The average measured
intensity of cognitive coping strategies was self-blame 5.01, acceptance 7.59,
rumination 6.14, positive refocusing 6.55, refocus of planning 6.74, positive
reappraisal 6.60, putting into perspective 5.74, catastrophising 5.21 and blaming
others 3.56. Study concluded that there is a positive correlation between anxiety and
self-blame (r=0.213), rumination strategies (r=0.132). Study also showed a positive
correlation between depression and blaming others (r=0.103).26
A correlational survey was conducted by Athar Javedh, Mathur R G and
Molly Babu in 2017 at Amala Cancer Hospital, Thrissur to assess the level of stress,
coping strategies and quality of life of female cancer patients related to chemotherapy
induced alopecia. Structured rating scale and interview technique were used for
assessing the level of stress, coping strategies and quality of life (QOL) among 100
female patients with chemotherapy induced alopecia. Result showed that the overall
mean score of level of stress, coping strategies and quality of life (QOL) were
45.5±9.76, 41.32±5.89 and 42.49±7.38 respectively. Majority of patients (78%) had
moderate level of stress (94%) were using effective coping strategies and (83%) had
good quality of life. Study concluded that majority of patients had moderate level of
stress and were using effective coping strategies and had good quality of life.27

20
A descriptive study was conducted by Subhashini N in 2014 at Andhra
Pradesh, on coping strategies among breast cancer patients on chemotherapy. Study
was conducted among 100 breast cancer patientsby using Modified folk man and
Lazarus ways of coping scale for assessing the coping strategies. Results showed that
52% had moderate level of coping, 28% had adequate level of coping and 20% had
low level of coping. There was an association between the escape avoidance and
residence with the chi square value of 9.619, positive reappraisal and second stage of
breast cancer with the chi square value of 17.67 significant at P value 0.05.The study
concluded that most of the breast cancer patients were having moderate level of
coping and most using coping strategies were seeking social support and problem
solving followed by distancing.9
A qualitative phenomenological study was conducted by Hajian S et.al in 2017
to investigate women’s experiences in living with breast cancer, the related
complications and how they cope with these issues in Iran. The data collection was
conducted by semi-structured in-depth interviews among 22 patients by purposive
sampling technique. The transcribed interviews were analysed using Van Manen’s
thematic approach. Three dominant themes that emerged from the interviews were
emotional turmoil, avoidance and logical efforts. Results highlighted the importance
of addressing psycho-oncology intervention programs to address the unmet psycho-
social and palliative care needs of patients suffering from breast cancer.28
An exploratory study was conducted by Smit S and Agarwal N in 2015 on
coping with cancer among 75 women with gynecologic cancer to examine the
supports available at Saskatoon Cancer Center Canada. The questionnaires were
distributed to 75 women with cervical (21.7%), uterine (23.2%), ovarian (52.5%) and
vulvar cancer (2.6%). Questions explored common areas like diagnosis, therapy

21
phase, feelings, attitudes and support. Study showed that the major support during
diagnosis was from the family (96.8%). Talking with closed ones helped 71.4%
samples. All women found their gynaecologic oncologist and nurse were easy to
approach and supportive. Study concluded that better available supports may enhance
the experience of women following diagnosis and during therapy for cancer and it
will help women to cope with cancer more effectively.29
A longitudinal study was conducted by Bessely VL et.al in 2018 on coping
strategies, trajectories and their associations with patient-reported outcomes among
women with ovarian cancer. The study was conducted among 634 women. Trajectory
modelling was used to assess patterns of coping over time. Study showed that three
coping strategy clusters that were used among women got identified. They were use
of “taking action/positive framing” followed by four distinct trajectories over time
low-stable (44%), medium-stable (32%), medium-decreasing (11%) and high-stable
(12%). Use of “social emotional support” with four trajectories such as low-increasing
(7%), low-decreasing (44%), medium-decreasing (40%) and high-stable (8%). Use of
“denial” (74%) and acceptance of reality (26%) was the third coping strategy cluster
among. Women who accepted reality reported significantly less anxiety, depression
and better quality of life.30
A cross sectional study was conducted by Lidh and Zugh in 2015 on
association between stress, coping strategies and perceived social support among
young patients with gynecologic cancers in China. The study was conducted among
236 young women with gynecologic cancers who were admitted to the West China
Second University Hospital. Data were collected using questionnaires such as
multidimensional scales of perceived social support (MSPSS) and coping strategies
with stress including effective coping ways (ECW) and ineffective coping ways

22
(ICW). Study showed that those with a job, fare incomes and higher levels of
education were more likely to get higher social support scores and lower ineffective
ways of coping scores compared with those who unemployed and education of
primary school level (P < 0.05). Effective ways of coping scores increased with
increasing levels of total social support scores (r = 0.247, P < 0.05) and support from
family (r = 0.324, P < 0.05), friends (r = 0.172, P < 0.05) and significant others (r =
0.183, P < 0.05). Study concluded that social support from the family is the main
source of young women with gynecologic cancers in coping with stress.31
A descriptive study was conducted by Cosentino C et.al in 2018 on
psychophysiological adjustment to ovarian cancer among Italian women. The study
was conducted among 38 women in the age group of 29-80 years who were in follow
up for ovarian cancer. Each participant filled a psycho-oncological record,
Multidimensional Scale of Perceived Social Support, Derridford Appearance Scale-
59, Mental Adjustment to Cancer and EORTC Quality of Life Questionnaire Version
3.0. Results showed that these women have shown a high rate of perceived general
social support (M = 5.93) but they seem to have some general concern about their
appearance (M = 85.97, SD = 24.4). They have also shown a good total Quality of
Life (M = 66.32) with specific difficulties in emotional functioning (M = 69.19). The
study suggests that the extremely negative conditions force these women to face
cancer openly and pushing them “moving on” more than “trying to get back”.32
A cross sectional study was conducted by Sharone manne, Shannon Myers,
Melissa Ozga and David Kissane in 2015 on resilience, positive coping and quality of
life among women newly diagnosed with gynaecological cancer in New Jersey. Study
was conducted among 218 women. They had a mean age of 55 years and 80% of were
whites. Participants completed measures of resilience, positive emotional expression,

23
positive reappraisal, cultivating a sense of peace and meaning and quality of life.
Univariate and multiple mediation analyses were conducted. Study revealed that
greater resilience was related to higher quality of life (P < 0.001). The findings
suggested that resilient women may report higher quality of life during gynecological
cancer diagnosis because they are more likely to express positive emotions, reframe
the experience positively and cultivate a sense of peace and meaning in their lives.33
A longitudinal study was conducted by Ewa Kupcewicz et.al in 2016 on
coping with stress by women diagnosed with gynaecologic cancer at Olsztyn district,
Poland. The study was conducted among 102 women. A self-structured questionnaire,
the Scale of Perceived Stress (PSS-10) and the Multidimensional Inventory for
Measuring Coping with Stress (Mini COPE) were used to collect data. Results
showed that majority (65.7%) of investigated women experienced high stress, 23.5%
of them had average stress and one in ten women (10.8%) showed low scores of
stress. This study highlighted the importance of need for psychological counselling
and care in gynaecologic cancer patients.34
A cross-sectional study was conducted by Eliana Zandonade and Maria Helena
in 2017 on anxiety and coping among 307 women with breast cancer in
chemotherapy. Study revealed that there was a significant association of the anxiety
and problem-focused coping strategies (p<0.0001) with a focus on emotion. Study
concluded that women with breast cancer who have low level anxiety tend to use
problem solving strategies whereas patients with medium to high level anxiety tend to
use emotion-focused coping strategies.35
A descriptive study was conducted by Natalya A et.al in 2016, at Russia on
strategies and resources for coping with fear of disease progression in women with

24
reproductive system cancer. The study was conducted among 177 women. There were
59 women with breast cancer and 118 with gynecological cancers as participants.
Study results showed that coping strategies had a significant differences among the
groups of women with varying levels of fear of disease progression. It also revealed
that women with a pronounced fear of disease progression significantly related to
coping strategies such as “venting of emotions” (11.76±2.20), “mental
disengagement” (9.79± 2.60) and “behavioral disengagement” (10.71±3.11).36
Literature related to spousal support among women with reproductive cancer
Partner support may play a key role in a young woman’s adjustment to a
serious stressor such as breast cancer. In addition younger age increases vulnerability
to anxiety.
A prospective cohort study was conducted by Gelber S et.al in 2015 on partner
support and anxiety in young women with breast cancer. Study was conducted among
675 young women with breast cancer stages I-III having median age 36. Perceived
partner support was assessed by using items extracted from the marital subscale of the
Cancer Rehabilitation Evaluation System and generalized social support was assessed
with the Medical Outcomes Study-Social Support Survey. Anxiety was measured
using the anxiety subscale of the Hospital Anxiety and Depression Scale. The study
showed that 14% of the women were not partnered and among those who were
partnered 20% were categorized as unsupported. Women in an unsupported-partnered
relationship had higher odds of anxiety symptoms compared with women in a
supported-partnered relationship.37
A cross-sectional study was conducted by Winton S, Greenwood S and
Depetrillo Din 2014 on difference in types and intensities of illness and treatment-

25
related psychosocial concerns among single and partnered women with gynecologic
cancer in Canada. The study was conducted at Foothills Medical Centre among 49
women with ovarian (n=31), endometrial (n=12) and cervical (n=6) cancer. Study
showed that single (n=13) and partnered women (n=36) similarly reported prognosis
as their highest concern, but single women (26% of the sample) reported that
communication with the treatment team, treatment side effects and prognosis were of
greater salience to them than to partnered women. The later group had greater
sexuality and partner relationship concerns.38
A prospective longitudinal study was conducted by Sarah wimberly kinsinger
et.al in 2014 on perceived partner support and psychosexual adjustment to breast
cancer. The study examined the relationship between baseline levels of several types
of perceived partner support (instrumental, informational, emotional and negative)
and psychosexual adjustment over the course of 12 months. The study conducted
among 130 post – surgery patients. The study concluded that baseline perceptions of
greater emotional and instrumental support from a partner were associated with
greater relationship satisfactions at all-time points.39
A study was conducted by Chang S C. H, Woo J S. and BrottoL. A. in 2014
on perceived spousal support and beliefs toward cervical smear screening among 424
Chinese women in Taiwan. Study showed that mean age of sample was 34 years in
which 28% did not have high school education and 58% perceived their general
health to be fair or poor. Women who perceived lower spousal support were more
likely to be those without high school education (39% vs. 21%). Multiple regression
analysis revealed that women who perceived lower spousal support were associated
with lower perceived benefits (B = 0.210, p<0.001) and higher barriers (B =0.228,
p<0.001).40

26
A quantitative correlation study was conducted by Jacqueline K. Schonholtz in
2000 and examined the role of approach coping and marital support in predicting
psychosocial adjustment in 21 married women receiving chemotherapy for breast
cancer in America. Psychosocial adjustment was assessed with the Psychosocial
Adjustment to Illness Scale. Approach coping was assessed with the Coping
Responses Inventory (CRI). Marital support was assessed with the Family
Relationships Index (FRI). The results indicate that those women who experienced
greater marital support and those who employed a higher approach coping strategies
had better psychosocial adjustment to their breast cancer. Results from Pearson
correlations showed that approach coping and marital support are significantly
correlated with each other (r = 0.82, P<0.05).10
An experimental study was conducted by Jennifer L. Scott and W. Kim
Halford in 2004 on effects of a couple-coping intervention on adjustment to early
stage breast or gynecological cancer among couples at Griffith University, America.
The study was conducted among 57 women with primary breast cancer and 37 with
gynaecological cancer. The study examined the effect of interventions like couple-
based coping training (CanCOPE), individual coping training for the woman and a
medical education control. Couple’s support communication, self-reported
psychological distress and coping effort were re assessed intervention. Study results
showed that CanCOPE produced significant improvements in couple’s supportive
communication (p<0.05), reduced psychological distress (p<0.01) and coping effort
(p<0.001). Study highlighted the importance of training in couples rather than
individual coping in facilitating adaptation to cancer since there were a large
significant difference (d=1.23) between CanCOPE and patient coping training.8

27
Literature related to psychological issues among women with reproductive
cancer
A critical review was done by Meta A, Malik E, Philipson E et.al in 2017 on
concomitant psychiatric symptoms and impaired quality of life in women with
cervical cancer. Study examined the current relevant literature on concomitant
psychiatric symptoms with a focus on anxiety or depression in a population with
gynecologic cancer to identify the predictors, associated factors and prevention
strategies of psychiatric disorders. Review summarized that patients with gynecologic
malignancies especially cervical cancer had a very high prevalence of psychiatric
symptoms including depression (33%-52%). Specifically low socioeconomic status,
sexual inactivity, absence of a partner and physical symptoms were correlated with an
increased risk for concomitant psychiatric symptoms.41
A phenomenological study was conducted by Yaman S and Araz S in 2016 on
psychological problems experienced by women with gynecological cancer and how
they cope with it in Turkey. The study conducted among 17 married women. A semi
structured in-depth question directive was used to collect the data. The study
identified psychological problems such as frustration, despair, depression, inability to
control anger, disruption in body image and problems with their sex lives. The women
in the study stated that among activities they prayed frequently and also emphasized
that social support from family and others was important in coping. The majority said
that they were able to cope through denial.42
A non-experimental longitudinal study was conducted by Telepak LC et.al in
2014 on psychosocial factors and mortality in women with early stage endometrial
cancer. The study was conducted among 87 participants with endometrial cancer and

28
who subsequently underwent surgery. Presence of regional disease, medical
comorbidity severity and greater use of an active coping style prior to surgery was
significantly associated with a lower probability of all-cause mortality hazard ratio
(HR) = 0.78, (p = 0.04). Life stress, depressive symptoms, use of self-distraction
coping, receipt of emotional support and endometrial cancer quality of life prior to
surgery were not significantly associated with all cause.43
A study was conducted by Tang GX in 2015 on determinants of suicidal
ideation among gynaecological cancer patients at Central South University Changsha
Hunan, China. 603 women diagnosed with gynaecological cancer were participated in
the study. Study showed that 105 (18.1%) patients reported suicidal ideation with the
highest rate in patients with ovarian cancer (30.16%). Suicidal ideation was associated
with depression symptoms, care providers, chemotherapy history and acceptance-
resignation. Path analysis showed that the acceptance-resignation affected suicidal
ideation directly as well as mediated by social support and depression symptoms
while confrontation and avoidance affected suicidal ideation entirely through social
support and depression symptoms. The study concluded that suicidal ideation is high
among patients with gynecological cancer especially among ovarian cancer patients.44
A descriptive study was conducted by Cleora S, Roberts and Katheleen
Rossette on psychosocial impact of gynecologic cancer among 32 women survivors
after radical hysterectomy, vulvectomy and total pelvic exenteration in 2014. The
patient’s average score on the Functional Living Index-Cancer was 124 that is most of
them were reported a good quality of life. But they showed moderately elevated
levels of psychological distress that were comparable to levels of breast cancer
patients who had participated in an earlier study. Also they identified a negative

29
correlation between age and psychological distress (r = -0.64). It revealed that
younger patients appeared to be more at risk for psychological problem after radical
gynaecologic surgery.45
Summary
The investigator carried out a careful and in depth review of the previous
studies with a view to get a strong basis for the study. While undergoing these studies
it helped the investigator to gain better knowledge regarding prevalence of
reproductive cancer among women, coping strategies, spousal support among women
with reproductive cancer and prevalent psychiatric illness among them.There were a
number of studies which focused on several support systems available for women
with reproductive cancer and their coping strategies. In the light of these reviews, the
investigator planned to conduct a study to assess the spousal support, coping
strategies and their correlation among women with reproductive cancer.

30
CHAPTER III
METHODOLOGY
Research approach
Research design
Setting of the study
Population
Sample and sampling technique
Inclusion criteria
Exclusion criteria
Schematic representation of the study
Tool
Development of tool
Description of tool
Content validity
Reliability of the tool
Pilot study
Data collection process
Plan for data analysis

31
METHODOLOGY
Introduction
Research methodology is a system of broad principles or rules from which
specific methods or procedures may be derived to interpret or solve different
problems within the scope of particular discipline.It is a systematic way to solve a
problem.46
This chapter deals with description of research approach, research design,
setting, sampling technique, schematic representation of the study, development and
description of tools, pilot study, data collection procedures and plan for data analysis.
Research approach
Research approach tells the researcher what to collect and how to analyse it.46
It involves description of the plan to investigate the phenomenon under study in a
structured (quantitative), unstructured (qualitative) or combination of these two
methods (mixed method).47
In view of nature of the problem selected for the study and the objectives to be
accomplished, quantitative research approach was adopted for the study.
Research design
The research design of a study spells out the basic strategies the researcher
adopt to develop evidence that is accurate and interpretable.46
In order to achieve the
aims and objectives of a study researcher must select an appropriate and suitable
research design. Research design selected for this study was Cross sectional survey
design. The base measures were spousal support and coping strategies among women
with reproductive cancer.

32
Setting of the study
The study was conducted in department of Oncology in Amala Institute of
Medical Sciences, Thrissur.
Population
The population is the entire aggregation of cases in which a researcher is
interested. In this present study it involves all women with reproductive cancer
admitted in Amala Institute of Medical Sciences.
Sample and sampling technique
A sample is the representative unit of a target population. The sample for this
study consists of 128 women with reproductive cancer admitted in Amala Institute of
Medical Sciences. Sampling is the process of selecting a representative segment of the
population under study. The samples were selected by consecutive sampling
technique based on inclusion and exclusion criteria until the desired sample size were
achieved.
Inclusion criteria
Women who are
 diagnosed with reproductive cancers such as cancer of breast, uterus,
fallopian tube, ovary, cervix and vagina of stage 2 and above
 undergoing chemotherapy, radiation therapy and surgical therapy or
combination therapy for reproductive cancer
 having duration of illness of 6 months or more
 aware about their disease
 staying with their husband
 willing to participate in the study

33
Exclusion criteria
Women who are
● unable to read and write
● unconscious and bed ridden
● mentally ill

34
Research
problem
 A study to assess the spousal support among
women with reproductive cancer and its
correlation with their coping strategies at Amala
Institute of Medical Sciences, Thrissur.

Population
and setting
Research
design  Cross sectional survey design
 Women with reproductive cancer admitted
in Amala Institute of Medical Sciences,
Thrissur
Tools
Sample
and
sampling
 128 women with reproductive cancer, by
consecutive sampling technique
 Self-structured demographic and clinical
variables
 Modified Brief Cope scale
 Modified Sources of Social Support sale
Data
analysis
 Descriptive and inferential statistics using
Fisher’s exact test and Carl Pearson’s
correlation test
FIGURE: 2 SCHEMATIC REPRESENTATION OF THE STUDY DESIGN

35
Tools
A research tool is a device used to measure the concept of interest in a
research project. Tool used in present study were:
Tool I:
Part A : Structured questionnaire to assess the demographic variables
Part B : Structured questionnaire to assess the clinical variables
Tool II : Modified BRIEF Cope Scale to assess the coping strategies
Tool III : Modified Sources of Social Support Scale to assess the spousal
support
Development of tool
An intense and extensive search of literature was undertaken by the
investigator regarding coping strategies and spousal support among women with
reproductive cancer and available tools to measure those variables. Available tools to
measure coping strategies and spousal support were collected by the researcher and
checked for their applicability in the present study.
With the help of literature review and discussion with experts in the field of
Medical Surgical Nursing, investigator developed initial draft of the research tool. It
was developed as 3 set of tool. Demographic and clinical variables, modified BRIEF
Cope Scale and modified Sources of Social Support Scale were for assessing coping
strategies and spousal support among women with reproductive cancer. After getting
ethical committee approval tools were validated by 8 experts and finalized.

36
Description of tool
Data collection tools are procedures and instruments used by the investigator
to observe or measure the key variable in the research problem. On the basis of
objectives the following tools were developed for data collection.
Tool I: Part A - Structured questionnaire to assess demographic variables
A structured questionnaire to assess the demographic variables such as age,
education of patient, occupation of patient, economic status, type of family, number of
children, education of spouse, occupation of spouse, habits of spouse, area of
residence and duration of marital life in years. Data was collected using interview
method.
Tool I: Part B - Structured questionnaire to assess clinical variables
A structured questionnaire to assess the clinical variables such as duration of
illness, sources of previous knowledge about cancer, support systems available, site of
cancer, pattern of occurrence, stage of cancer, treatment taken, and comorbidities.
Data was collected using interview method.
Tool II: Modified BRIEF Cope Scale
Modified BRIEF Cope Scale consists of 24 statement items under 12
subscales to assess the level of coping strategies. The participants were instructed to
put tick mark in the respective box as they like. The statements were scored as 1, 2, 3
and 4. With top score as 4.
 Maximum score : 96
 Minimum score : 24
Poor coping : 24 - 48
Average coping : 48 - 72
Good coping : 72 – 96

37
The scoring of modified BRIEF Cope Scale is as follows,
Tool III: Modified Sources of Social Support Scale
Modified Sources of Social Support Scale consists of 10 statements to assess
the spousal support. The participants were instructed to put tick mark in the respective
box as they wish. The statement number 1 - 6, 9 and 10 scored as 5,4,3,2,1. The
statement number 7 and 8 are reverse scored with the first column scored as 1 and last
column scored as 5.
 Maximum score : 50
 Minimum score : 10
Poor spousal support : 10 -23
Average spousal support : 24 -37
Good spousal support : 38 -50
The scoring of modified Sources of Social Support Scale is as follows,
Options
I’ve been
doing this a lot
I’ve been doing
this a medium
amount
I’ve been
doing this a
little bit
I haven't been
doing this at
all
Scores 4 3 2 1
Options
A lot
Pretty large
amount
Moderate
amount
A little Not at all
Scores 5 4 3 2 1

38
Content validity
The structured questionnaire along with modified BRIEF Cope Scale and
modified Social Support Scale was submitted to 8 experts, in which 4 persons in the
field of Medical Surgical Nursing, two Medical Oncologists, one Clinical
Psychologist and a Medical Social Worker to establish content validity. Modifications
were made as per the expert’s opinion. The corrections were incorporated in the final
tool.
Reliability of the tool
Reliability is the degree of consistency and accuracy with which an instrument
measures the attribute for which it is designed to measure.47
A tool can be considered
reliable if it measures an attribute with similar results in repeated use. Reliability of
the tool II modified BRIEF Cope Scale to assess the coping strategies and tool III
modified Sources of Social Support Scale to assess the spousal support was
established by test re–test method. The reliability score obtained by using Cronbach’s
alpha ‘r’. Reliability score obtained for modified BRIEF Cope Scale was r = 0.82 and
for modified Sources of Social Support Scale was r = 0.94. So the tools were found to
be reliable.
Pilot study
Pilot study is the small scale preliminary try out of the actual study. After
obtaining the ethical committee clearance and formal permission from administrative
authorities pilot study was conducted from 04/12/2019 - 05/12/2019, at Amala
Institute of Medical Sciences, Thrissur. Samples were identified on the basis of
inclusion and exclusion criteria by consecutive sampling technique. Informed consent
was obtained from the samples and their spouses after giving brief introduction about
the study and its purpose. After that demographic and clinical variable were collected

39
by the investigator by interview method and from medical records. Then modified
BRIEF Cope Scale and modified Sources of Social Support Scale were administered
to the samples. Data collected were amenable to statistical analysis and thus the study
was found to be feasible.
Data collection process
Data collection is the gathering of information from the samples.46
A formal
permission obtained from the Institutional Ethical committee, the Director, Amala
Institute of Medical Sciences, Thrissur and Principal Amala College of Nursing,
Thrissur to conduct the study. Data collection was carried out from 01/01/2020 to
31/01/2020. A total of 128 samples were selected according to inclusion criteria using
consecutive sampling technique. After a brief introduction the investigator has
explained the purpose of the study and obtained informed consent from the samples
and their spouses. The data collection was done in the oncology wards of Amala
Institute of Medical Sciences, Thrissur and it took around 30 minutes for each sample.
Demographic and clinical variables were collected from the samples using structured
questionnaire by interview method. Modified BRIEF Cope Scale and modified
Sources of Social Support Scale were administered to assess the coping strategies and
spousal support respectively. The subjects cooperated well during the study. The
investigator expressed her sincere gratitude for their co-operation.
Plan for data analysis
Analysis is the process of systematic organization and synthesis of data and
testing hypothesis using the data.46
Based on the objectives and hypothesis of the
study the following steps were taken to analyze the data.
 Organized and recorded data in master sheet

40
 Calculated frequency and percentage distribution of subjects based on baseline
variables and clinical variables.
 Calculated the coping strategies by using modified BRIEF Cope Scale.
 Calculated the spousal support by using modified Sources of Social Support Scale.
 Pearson’s correlation test was used to assess the correlation between coping
strategies and spousal support among women with reproductive cancers.
 Fisher’s exact test was used to assess the association between coping strategies,
spousal support among women with reproductive cancers with their demographic
and clinical variables.
Summary
This chapter has dealt with the research methodology adopted for the proposed
study which has provided the information regarding the systematic procedures by
which the investigator starts from the initial identification of problem to the
conclusion.

41
CHAPTER IV
Section A : Distribution of women with reproductive cancer according to
demographic variables
Section B : Distribution of women with reproductive cancer according to
clinical variables
Section C : Distribution of women with reproductive cancer according to
coping strategies
Section D : Distribution of women with reproductive cancer according to
spousal support
Section E : Analysis of coping strategies and spousal support
Section F : Analysis of correlation between coping strategies and spousal support
Section G : (1) Analysis of association between coping strategies and
(2) Analysis of association between coping strategies and
clinical variables
Section H : (1) Analysis of association between spousal support and
(2) Analysis of association between spousal support and clinical
variables

42
Analysis is defined as the process of organizing and synthesizing data as to
answer research questions and to test hypothesis.46
Present study was to assess the
correlation between coping strategies and spousal support among women with
reproductive cancer in Amala Institute of Medical Sciences Thrissur District. The
collected data were tabulated, analyzed and interpreted using descriptive and
inferential statistics.
Objectives
1. Assess the spousal support among women with reproductive cancer.
2. Assess the coping strategies in women with reproductive cancer.
3. Find the correlation between spousal support among women with reproductive
cancer and their coping strategies.
4. Find the association between coping strategies with selected demographic and
clinical variables.
5. Find the association between spousal support with selected demographic and
clinical variables.

43
Presentation of data
Section A : Distribution of women with reproductive cancer according to
Section B : Distribution of women with reproductive cancer according to
clinical variables
Section C : Distribution of women with reproductive cancer according to
coping strategies
Section D : Distribution of women with reproductive cancer according to
spousal support
Section E : Analysis of coping strategies and spousal support
Section F : Analysis of correlation between coping strategies and spousal
support
Section G : (1) Analysis of association between coping strategies and
(2) Analysis of association between coping strategies and
clinical variables
Section H : (1) Analysis of association between spousal support and
(2) Analysis of association between spousal support and
clinical variables

44
Section A: Distribution of women with reproductive cancer according to
This section deals with frequency and distribution of women with reproductive
cancer according to demographic variables such as age, education and occupation of
patient, economic status, type of family, number of children, education and occupation
of spouse, habits of spouse, area of residence and duration of marital life in years.
Table 1: Frequency and percentage distribution of women with reproductive
cancer according to age
(n=128)
Variables Frequency Percentage
Age in years
31 – 40
41 – 50
51 – 60
61 – 70
7
44
55
22
5.5
34.4
43.0
17.1
Table 1 reveals that the majority (43.0%) of subjects were in the age group of 51 – 60
years, 34.4% were in the age group of 41 – 50 years, 17.1% were in age group of
61 – 70 years and 5.5% were belongs to age group of 31 – 40 years.

45
cancer according to education of patient
(n=128)
Education of patient
Primary school
High school
Pre degree
Degree
23
70
23
12
18.0
54.7
18.0
9.3
Table 2 reveals that the majority (54.7%) of subjects have high school education,
18.0% of subjects have both primary and pre degree education and 9.3% of subjects
have degree education.

46
cancer according to occupation of patient, economic status and type of family.
(n=128)
Occupation of patient
Home maker
Private employee
Daily wages employee
Government employee
Economic status
BPL
APL
Type of family
Nuclear family
Joint family
100
12
11
5
67
61
100
28
78.1
9.4
8.6
3.9
52.3
47.7
78.1
21.9
Table 3 shows that the majority (78.1%) of the subjects were home maker, 9.4% of
them were private employees, 8.6% were daily wage employees and 3.9% were
government employees. Economic status of the family shows that the majority (52.3%)
were in BPL category and 47.7% were in APL category. Type of family shows that the
majority (78.1%) were belongs to nuclear family and 21.9% were belongs to joint
family.

47
cancer according to number of children
(n=128)
Number of children
≤ 3
> 3
107
21
83.6
16.4
Table 4 shows that the majority (83.6%) subjects had 3 or less than 3 number of
children and 16.4% had more than 3 numbers of children.

48
cancer according toeducation of spouse
(n=128)
Education of spouse
Primary school
High school
Pre degree
Degree
38
56
22
12
29.7
43.8
17.1
9.4
Table 5 shows that the majority (43.8%)of spouse has high school education, 29.7%
have primary education, 17.1% have pre degree education and 9.4% have degree
education.

49
cancer according to occupation of spouse and habits of spouse
(n=128)
Occupation of spouse
Private employee
Unemployed
Government employee
Habits of spouse
None
Alcoholism only
Both alcoholism & smoking
Smoking only
58
33
24
13
70
35
19
4
45.3
25.8
18.8
10.1
54.7
27.3
14.9
3.1
Table 6 shows that the majority (45.3%) of the spouses were private employees, 25.8%
were daily wage employee, 18.8% of them were unemployed and 10.1 % were
government employees. Habits of spouse shows that the majority (54.7%) of them have
no habits, 27.3% have habit of alcoholism only, 14.9% have habit of both alcoholism
and smoking and 3.1% have habit of smoking only.

50
cancer according to area of residence and duration of marital life
(n=128)
Area of residence
Rural
Urban
Duration of marital life
in years
11-20
21-30
31-40
>40
98
30
15
55
41
17
76.6
23.4
11.71
42.96
32.04
13.29
Table 7 shows that the majority (76.6%) of subjects were from rural area, 23.4% were
from urban area. Duration of marital life in years shows that the majority (42.96%)
were between 21 – 30 years, 32.04% were between 31 – 40 years, 13.29% were >40
years and 11.71% were between 11 – 20 years of duration.

51
Section B: Distribution of women with reproductive cancer according to clinical
variables
This section deals with the frequency and percentage distribution of women
with reproductive cancer according to duration of illness, sources of previous
knowledge about cancer, support system available, site of cancer, pattern of occurrence,
stage of cancer, treatment taken, type of surgery and comorbidities.
cancer according to duration of illness
(n=128)
Duration of illness in years
< 1
1-2
> 2
82
19
27
64.06
14.85
21.09
Table 8 shows that the majority (64.06%) of subjects have less than 1 year, 21.09% of
them were between 1 – 2 years of duration and 14.85% of them have more than 2 years
of duration of illness.

52
cancer according to sources of previous knowledge about cancer and support
systems available.
(n=128)
Sources of previous
knowledge
Tertiary health center
Social media
Family members
Nil
Support system available
Husband
Family members
Others
54
46
24
4
93
34
1
42.13
35.93
18.82
3.12
72.7
26.5
0.80
Table 9 shows that the majority (42.13%) of subjects have sources of previous
knowledge from Tertiary health center, 35.93% from social medias, 18.82% from
family members and 3.12% of subjects have no previous knowledge about cancer.
Support system available shows that the majority (72.7%) has husbands as support
system, 26.5% of subjects have family members and 0.8% has other (Friends) support
systems.

53
cancer according to site of cancer and pattern of occurrence
(n=128)
Site of cancer
Cancer of breast
Cancer of ovary
Cancer of uterus
Cancer of cervix
Pattern of occurrence
Primary
Metastasis
Recurrence
81
22
16
9
86
22
20
63.3
17.2
12.5
7
67.2
17.2
15.6
Table 10 shows that the majority (63.3%) of subjects have cancer of breast, 17.2% have
cancer of ovary, 12.5% have cancer of uterus and 7% have cancer of cervix. Pattern of
occurrence shows that the majority (67.2%) have primary cancer, 17.2% have
metastasis cancer and 15.6% have cancer recurrence.

54
cancer according to stage of cancer and treatment taken
(n=128)
Stage of cancer
Stage 2
Stage 4
Stage 3
Treatment taken
Surgery & chemotherapy
Surgery, chemotherapy & radiation therapy
Chemotherapy & radiation therapy
Surgery & radiation therapy
59
36
33
76
31
12
9
46.1
28.1
25.8
59.4
24.2
9.4
7.0
Table 11 shows that the majority (46.1%) of subjects have stage 2 cancer, 28.1% have
stage 3 cancer and 25.8% have stage 4 cancer. Treatment taken by the subjects shows
that the majority (59.4%) of subjects have underwent combination of surgery and
chemotherapy, 24.2% have combination of surgery, chemotherapy, radiation therapy,
9.4% have combination of Chemotherapy and radiation and 7.0% have combination of
Surgery and radiation therapy.

55
cancer according to type of surgery and comorbidities
(n=128)
Type of surgery
MRM*
TAH + BSOж
Nil
TAH#
+ MRM
Cytoreduction
79
28
12
5
4
61.7
21.9
9.4
3.9
3.1
* MRM - Modified Radical Mastectomy #
TAH - Total Abdominal Hysterectomy
жBSO - Bilateral Salpingo Oophorectomy
Table 12 shows that the majority (61.7%) of subjects underwent MRM, 21.9%
underwent TAH+ BSO, 9.4% have not underwent surgery, 3.9% underwent
TAH+MRM and 3.1% underwent cytoreduction.

56
cancer according to comorbidities
(n=128)
Comorbidities
Nil
Diabetes mellitus
Hypothyroidism
Hypertension & Diabetes mellitus
Hypertension & Dyslipidemia
Hypertension
Hypothyroidism & Diabetes
mellitus
Hyperthyroidism
48
23
22
12
7
6
6
4
37.4
18
17.2
9.4
5.5
4.7
4.7
3.1
Table 13 shows that the majority (37.4%) of subjects have no comorbidities, 18% have
diabetes mellitus, 17.2% have hypothyroidism, 9.4% have hypertension and diabetes
mellitus, 5.5% have hypertension and dyslipidemia, 4.7% have hypertension and
hypothyroidism with diabetes mellitus and 3.1% have hyperthyroidism.

57
Section C: Distribution of women with reproductive cancer according to coping
strategies
with reproductive cancer according to coping strategies.
Table 14: Distribution of subjects according to coping strategies
(n=128)
Coping strategies Frequency Percentage
Poor
Average
Good
8
28
92
6.3
21.9
71.8
Table 14 reveals that themajority (71.8%) of women with reproductive cancer have
good coping strategies, 21.9% of them have average coping strategies and 6.3% of
them have poor coping strategies.

58
Section D: Distribution of women with reproductive cancer according to spousal
support
with reproductive cancer according to spousal support.
Table 15: Distribution of subjects according to spousal support
(n=128)
Spousal support Frequency Percentage
Poor
Average
Good
1
21
106
0.8
16.4
82.8
Table 15 shows that themajority (82.8%) of women with reproductive cancer have
good spousal support, 16.4% have average spousal support and 0.8% have poor spousal
support.

59
Section E: Analysis of coping strategies and spousal support
This section deals with the analysis of mean, standard deviation and range of
the scores of coping strategies and spousal support among women with reproductive
cancer.
Table 16: Mean, standard deviation, range of coping strategies and spousal
support scores of subjects
(n=128)
Variables Mean Standard deviation Range
Coping strategies
Spousal support
74.54
40.98
10.471
5.232
55
27
Table 16 reveals that the mean value of coping strategies scores of the subject is 74.54,
standard deviation is 10.471 and range is 55. Mean value of spousal support score of
subject is 40.9, standard deviation is 5.232 and range is 27.

60
Section F: Analysis of correlation between coping strategies and spousal support
This section deals with correlation between coping strategies and spousal
support among women with reproductive cancer.
Table 17: Correlation between coping strategies and spousal support
(n=128)
Variables Mean
Standard
deviation
Pearson’s
correlation
coefficient (r)
p value
Coping strategies
Spousal support
74.54
40.98
10.471
5.232
0.131 0.141
Table 17 reveals that correlation coefficient r value of coping strategies with spousal
support of women with reproductive cancer is 0.131 and p value is 0.141. Hence there
is a positive correlation between coping strategies with spousal support among women
with reproductive cancer.

61
Section G: (1) Analysis of association between coping strategies and demographic
variables
This section deals with the association between coping strategies and selected
demographic variables such as age, education and occupation of patient, economic
status, type of family, number of children, education and occupation of spouse, habits
of spouse, area of residence and duration of marital life in years.
Table 18: Association between coping strategies and age
(n=128)
Age in
years
Coping strategies Fisher’s
exact test
value
df p value
Poor Average Good
31 – 40
41 – 50
51 – 60
61 – 70
5
3
0
0
0
6
15
7
2
35
40
15
33.84 6 0.0001**
**
significant at 0.01 level
Table 18 shows the association of age with coping strategy by using Fisher’s exact
test.The Fisher’s value obtained for the association of age with coping strategy is 33.84
and P value obtained is 0.0001 (<0.05). Hence association between age and coping
strategy is statistically significant.

62
Table 19: Association of coping strategies with education of patient and
(n=128)
Variables
exact test
value
df p value
Poor Average Good
Primary school
High school
Pre degree
Degree
Home maker
Private employee
Government employee
0
8
0
0
7
1
0
0
5
18
0
5
20
4
2
2
18
44
23
27
73
6
10
3
25.39
4.975
6
6
0.0001**
0.547
**
Table 19 shows association of variables like education of patient and occupation of
patient with coping strategy by using Fisher’s exact test.The Fisher’s value obtained for
the of education of patient with coping strategy is 25.39 and p value is 0.0001 (<0.05).
Hence association between education of patient and coping strategy is statistically
significant.
The Fisher’s value obtained for the association of occupation of patient with
coping strategy is 4.975 and p value is 0.547 (>0.05). Hence association between
occupation of patient and coping strategy is not statistically significant.

63
Table 20: Association of coping strategies with economic status and type of family
(n=128)
Variables
exact test
value
df p value
Poor Average Good
Economic status
APL
BPL
Type of family
Nuclear family
Joint family
5
3
7
1
14
14
22
6
42
50
71
21
0.921
0.519
2
2
0.631
0.771
Table 20 shows association of variables like economic status, type of family and
number of children with coping strategy by using Fisher’s exact test.The Fisher’s value
obtained for the association of economic status with coping strategy is 0.921 and p
value is 0.631 (>0.05). Hence association between economic status and coping strategy
is not statistically significant.
The Fisher’s value obtained for the type of family with coping strategy is
0.519 and p value is 0.771 (>0.05). Hence association between type of family and
coping strategy is not statistically significant.

64
Table 21: Association between coping strategies and number of children
(n=128)
Variables
exact test
value
df p value
Poor Average Good
Number of
children
≤ 3
> 3
4
4
18
10
58
34
0.583 2 0.747
Table 21 shows association of the number of children and coping strategy by using
Fisher’s exact test. The Fisher’s value obtained for the number of children with coping
strategy is 0.583 and p value is 0.747 (>0.05). Hence association between number of
children and coping strategy is not statistically significant.

65
Table 22: Association between coping strategies and education of spouse
`
(n=128)
Variables
exact test
value
df p value
Poor Average Good
Education of
spouse
Primary school
High school
Pre degree
Degree
1
4
2
1
13
6
4
5
24
46
16
6
11.540 6 0.073
Table 22 shows association of theeducation of spouse and coping strategy by using
Fisher’s exact test. The Fisher’s value obtained for the association of the education of
spouse with coping strategy is 11.540and p value is 0.073 (>0.05). Hence association
between education of spouse and coping strategy is not statistically significant.

66
Table 23: Association of coping strategies with occupation of spouse and habits of
spouse
(n=128)
Variables
exact test
value
df p value
Poor Average Good
Occupation of spouse
Private employee
Government employee
Unemployed
Habits of spouse
Alcoholism only
Smoking only
Both alcoholism &
smoking
None
2
5
1
0
3
0
3
2
12
8
4
4
10
0
6
12
19
45
8
20
22
4
10
56
13.436
10.727
6
6
0.200
0.097
Table 23 shows association of variables like occupation of spouse and habit of spouse
with coping strategy by using Fisher’s exact test.The Fisher’s value obtained for the
association of occupation of spouse with coping strategy 13.436 and p value is 0.200
(>0.05). Hence association between occupation of spouse with coping strategy is not
statistically significant.
The Fisher’s value obtained for the association of habit of spouse with
coping strategy is 10.727 and p value is 0.097 (>0.05). Hence association between habit
of spouse with coping strategy is not statistically significant.

67
Table 24: Association of coping strategies with area of residence and duration of
marital life
(n=128)
Variables
exact test
value
df p value
Poor Average Good
Area of residence
Rural
Urban
Duration of marital
life in years
11-20
21-30
31-40
>40
5
3
6
2
0
0
26
2
2
6
13
7
67
25
7
47
28
10
6.763
31.636
2
6
0.034*
0.0001**
**
*
Table 24 shows association of variables like area of residence and duration of marital
life in years and coping strategy by using Fisher’s exact test. The Fisher’s value
obtained for the association of area of residence with coping strategy is 6.763 and p
value is 0.034 (<0.05). Hence association between area of residence with coping
strategy is statistically significant.
The Fisher’s value obtained for the association of duration of marital life in
years with coping strategy is 31.636 and p value is 0.0001 (<0.05). Hence association
between duration of marital life in years with coping strategy is statistically significant.

68
(2) Analysis of association between coping strategies and clinical variables
This section deals with the association between coping strategies and clinical
variables such as duration of diagnosis of illness, sources of previous knowledge about
cancer, support systems available, site of cancer, pattern of occurrence, stage of cancer,
treatment taken, type of surgery and comorbidities.
Table 25: Association between coping strategies and duration of illness
(n=128)
Variables
exact test
value
df p value
Poor Average Good
Duration of illness
In years
< 1
1-3
> 2
6
2
0
16
5
7
60
12
20
4.792 4 0.309
Table 25 shows association of duration of illness with coping strategy by using Fisher’s
exact test. The Fisher’s value obtained for the association of duration of illness with
duration of illness with coping strategy is not statistically significant.

69
Table 26: Association between coping strategies and sources of previous
knowledge
(n=128)
Variables
exact test
value
df p value
Poor Average Good
Sources of previous
knowledge
Family members
Social media
Tertiary health center
Nil
5
1
2
0
4
12
12
0
15
33
40
4
10.03 6 0.137
Table 26 shows association of sources of previous knowledge about cancer with coping
strategy by using Fisher’s exact test. The Fisher’s value obtained for the association of
sources of previous knowledge about cancer with coping strategy is 10.03 and p value
is 0.137 (>0.05). Hence association between sources of previous knowledge about
cancer and coping strategy is not statistically significant.

70
Table 27: Association of coping strategies with support system available and site
of cancer
(n=128)
Variables
exact test
value
df p value
Poor Average Good
Support system
available
Husband
Family members
Others
Site of cancer
Cancer of breast
Cancer of uterus
Cancer of ovary
Cancer of cervix
6
2
0
8
0
0
0
18
10
0
17
3
6
2
69
22
1
56
13
16
7
2.071
8.016
4
6
0.723
0.237
Table 27 shows association of variables like and support system available and site of
cancer with coping strategy by using Fisher’s exact test. The Fisher’s value obtained
for the association of support system available with coping strategy is 2.071 and p
value is 0.723 (>0.05). Hence association between support system available with
coping strategy is not statistically significant.
The Fisher’s value obtained for the association of site of cancer with coping
strategy is 8.016 and p value is 0.237 (>0.05). Hence association between site of cancer
and coping strategy is not statistically significant.

71
Table 28: Association of coping strategies with pattern of occurrence and stage of
cancer
(n=128)
Variables
exact test
value
df p value
Poor Average Good
Pattern of
occurrence
Primary
Metastasis
Recurrence
Stage of cancer
Stage 2
Stage 3
Stage 4
7
1
0
6
1
1
23
8
2
15
8
10
56
13
18
38
24
25
8.129
3.09
4
4
0.087
0.543
Table 28 shows association of pattern of occurrence and stage of cancer with coping
strategy by using Fisher’s exact test.The Fisher’s value obtained for the association of
pattern of occurrence with coping strategy is 8.129 and p value is 0.087 (>0.05). Hence
association between pattern of occurrence and coping strategy is not statistically
significant.
The Fisher’s value obtained for the association of stage of cancer with coping
strategy is 3.09 and p value is 0.543 (>0.05). Hence association between stage of cancer
and coping strategy is not statistically significant.

72
Table 29: Association of coping strategies with treatment taken and type of
surgery
(n=128)
Variables
exact test
value
df
P
value
Poor Average Good
Treatment taken
Surgery & chemotherapy
Surgery & radiation
therapy
Surgery, chemotherapy &
radiation therapy
Chemotherapy & radiation
therapy
Type of surgery
MRM*
Cytoreduction
TAH + BSOж
TAH#
+ MRM
Nil
7
0
1
0
0
8
0
0
0
19
1
8
5
4
15
1
7
5
50
8
22
7
8
56
3
21
7
6.6864
8.946
6
8
0.334
0.347
Table 29 shows association of variables like treatment taken and type of surgery with
coping strategy by using Fisher’s exact test.The Fisher’s value obtained for the
association of treatment taken with coping strategy is 6.6864 and p value is 0.334
(>0.05). Hence association between treatment taken and coping strategy is not
The Fisher’s value obtained for the association of type of surgery with coping
strategy is 8.946 and p value is 0.347 (>0.05). Hence association between type of
surgery and coping strategy is not statistically significant.

73
Table 30: Association between coping strategies and comorbidities
(n=128)
Variables
exact
test
value
df
p
value
Poor Average Good
Comorbidities
Hypertension
Diabetes mellitus
Hypothyroidism
Hyperthyroidism
Hypertension & Diabetes
mellitus
Hypothyroidism &
Diabetes mellitus
Hypertension &
Dyslipidemia
Nil
6
0
0
2
0
0
0
0
12
2
6
1
2
2
1
2
30
4
17
19
2
10
5
5
18.285 14 0.194
Table 30 shows association between comorbidities and coping strategy by using
Fisher’s exact test.The Fisher’s value obtained for the association of comorbidities with
comorbidities and coping strategy is not statistically significant.

74
Section H: (1) Analysis of association between spousal support and demographic
variables
This section deals with the association between spousal support and
demographic variables such as age, education and occupation of patient, economic
status, type of family, number of children, education and occupation of spouse, habits
of spouse, area of residence and duration of marital life in years.
Table 31: Association between spousal support and age
(n=128)
Age in years
Spousal support Fisher’s
exact test
value
df p value
Poor Average Good
31 – 40
41 – 50
51 – 60
61 – 70
1
0
0
0
0
2
10
9
6
42
45
13
21.66 6 0.001**
**
Table 31 shows association between age and spousal support by using Fisher’s exact
test.The Fisher’s value obtained for the association of age with spousal support is 21.66
and p value is 0.001 (<0.05). Hence association between age and spousal support is

75
Table 32: Association of spousal support with education of patient and occupation
of patient
(n=128)
Variables
exact test
value
df p value
Poor Average Good
Primary school
High school
Pre degree
Degree
Home maker
Private employee
Government employee
0
1
0
0
1
0
0
0
7
11
2
1
17
2
2
0
16
58
21
11
82
9
10
5
5.835
2.353
6
6
0.442
0.885
Table 32 shows association of variables like education of patient and occupation of
patient with spousal support by using Fisher’s exact test.The Fisher’s value obtained for
the association of education of patient with spousal support is 5.835 and p value is
0.442 (>0.05). Hence association between education of patient and spousal support is
not statistically significant.
The Fisher’s value obtained for the association of occupation of patient with
spousal support is 2.353 and p value is 0.885 (>0.05). Hence association between
occupation of patient and spousal support is not statistically significant.

76
Table 33: Association of spousal support with economic status and type of family
(n=128)
Variables
exact test
value
df p value
Poor Average Good
Economic status
APL
BPL
Type of family
Nuclear family
Joint family
1
0
0
1
10
11
14
7
50
56
86
20
1.492
5.077
2
2
0.474
0.079
Table 33 shows association of economic status and type of family with spousal support
by using Fisher’s exact test.The Fisher’s value obtained for the association of economic
status with spousal support is 1.492 and p value is 0.474 (>0.05). Hence association
between economic status and spousal support is not statistically significant.
The Fisher’s value obtained for the association of type of family with spousal
support is 5.077 and p value is 0.079 (>0.05). Hence association between type of family
and spousal support is not statistically significant.

77
Table 34: Association between spousal support and number of children
(n=128)
Variables
exact test
value
df p value
Poor Average Good
Number of children
≤ 3
> 3
0
1
6
15
74
32
14.4 2 0.0001**
**
Table 34 shows association of number of children with spousal support by using
Fisher’s exact test. The Fisher’s value obtained for the association of number of
children with spousal support is 14.4 and p value is 0.0001 (<0.05). Hence association
between number of children with spousal support is statistically significant.

Coping Strategies and Spousal Support in Women with Reproductive Cancer

Coping Strategies and Spousal Support in Women with Reproductive Cancer

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