The Effect of Hope Therapy-Based Training on the Rumination of Patient with Breast Cancer: A Quasi-Experimental Study

Background and purpose: Cancer is one of the most important diseases of the century and the third leading cause of death in the world. Breast cancer is one of the most common types of cancer among women. Breast cancer constitutes about one third of all women's cancers and is the most common malignancy of women worldwide, the incidence of breast cancer in Iranian women is increasing. This disease endangers various aspects of women's physical and mental health. Cancer patients behave in different ways when facing the disease and continuing the treatment process. The belief that the disease is fatal and helplessness in cancer patients leads to mental rumination in these patients. Rumination is one of the psychological problems that develop hopelessness in women with breast cancer. Rumination is known as constant preoccupation with an idea or topic and thinking about it; It is a class of conscious thoughts that are defined around an axis and are repeated without dependence on environmental demands. Rumination can increase the effects of negative mood on problem solving and motivation. Considering the psychological effects of cancer, the use of psychological treatments and training can be important in reducing the psychological effects of breast cancer. Therefore, the present study was conducted with the aim of determining the effect of education based on therapeutic hope on the rumination of women with breast cancer. Materials and methods: The present study is a semi-experimental research that was conducted in the first half of 2019. All women with breast cancer referred to chemotherapy departments of Zahedan University of Medical Sciences formed the research population. The sampling method was initially continuous, so that the samples were continuously selected from among the patients who met the criteria for entering the study. Then the samples were randomly divided into intervention (50 people) and control (50 people) groups. The samples were randomly drawn with cards prepared for the number of people in the intervention and control groups and were placed in the intervention and control groups by choosing the desired card (red and blue). The inclusion criteria include completing a course of chemotherapy, not having a history of metastasis (according to the report in the file), lack of mental disorders before the diagnosis of the disease according to the patient himself, not suffering from other chronic physical diseases except cancer, lack of crisis experience. The most recent problems in life, except cancer (such as divorce and the death of loved ones), were the ability to participate in group therapy sessions and not participate in other educational programs at the same time. Also have the ability to participate in educational programs. Exclusion criteria included absence from more than one session in the educational program and worsening of the patient's condition during the implementation of the intervention. The intervention was conducted for eight group sessions, twice a week for the intervention group. Education based on hope is a therapeutic program designed based on Snyder's theory of hope in order to increase hopeful thinking. In this training program, the participants were first familiar with the principles of hope theory and then they were taught how to apply these principles in their lives. The data collection tool included personal information form and rumination questionnaire. The rumination questionnaire was created by Nolen-Hoeksema. This questionnaire consists of 22 questions rated on a Likert scale from almost never (1), sometimes (2), often (3), to almost always (4). The score ranges from 22 to 88. A higher score means more rumination. The data were analyzed with the help of SPSS-16 software and using descriptive statistics of mean, standard deviation and percentage frequency and inferential independent t and paired t. The significance level for the tests was considered less than 0.05. Results: The average age of patients in the intervention group was 48.04 ± 6.82 years and in the control group was 47.72 ± 5.59 years. Most of the participants in both groups (68% of the intervention group and 72% of the control group) had no family history of breast cancer. In addition, 50% of women in the intervention group and 47% of women in the control group had undergone mastectomy. The average score of rumination before the intervention did not have a statistically significant difference between the two groups (p = 0.29), but after the intervention of the therapy group based on hope therapy, the comparison of the average score of rumination in the two groups was significant (p = 0.0001). The paired t-test showed that there was a statistically significant difference between the average score of rumination before and after the intervention in the intervention group (p=0.003), and there was no statistically significant difference in the average score of rumination in the control group (p=0.89). Conclusion: The findings showed that education based on therapeutic hope is effective on the rumination of women with breast cancer. These results show that women with breast cancer who are involved in psychological issues such as rumination can reduce their disturbing thoughts, which are mostly related to illness and despair, with intervention based on hope therapy. Therefore, it is recommended that an educational intervention based on therapeutic hope be implemented in oncology departments. Considering the fact that women with breast cancer suffered from extensive psychological problems and on the other hand their emotional conditions are very effective on improving their physical health, it is suggested that the nurses in the care departments not only pay attention to physical issues but also to their health. Pay attention to the psyche of these patients, who are involved in disturbing and disappointing thoughts, and consider their physical and mental health in the education of these patients. ‎