Patients with gynecological cancer have a moderate rate of post-traumatic growth. According to the findings of this study, the total score of post-traumatic growth in gynecological cancer patients is (43.32 24.11), which is on the medium side of the scale when compared to the median 40.00. Relation to others, Personal strength, New possibilities, Appreciation of life, and Spiritual change are the scores for each dimension on a range of high to low.The reasons are as follows: first, while the diagnosis and treatment of gynecological cancer caused them considerable psychological distress, they became more conscious of the importance of family and friends and built better interpersonal ties as a result of their experience. As a result, the interpersonal relationship factor received a high score36.Second, after tumor removal, gynecological cancer patients must undergo numerous rounds of chemotherapy and radiotherapy, and the recurrence rate is high, resulting in a long course of treatment. Patients gradually develop new hobbies and perspectives as a result of their long battle with the disease.Patients gradually accept the fact of illness, become stronger than before, and hope to overcome the disease through their own strength during the diagnosis and treatment process; at the same time, illness makes them realize the value of life and the importance of health, love life more than before, and cherish every day that they have now37.Furthermore, because hospitalized gynecological cancer patients are more likely to believe in science and medical therapy, they have a low spiritual shift score. We should focus on assessing gynecological cancer patients' post-traumatic growth, guiding them to discover the joys of life, cultivate new interests and hobbies, expand their horizons, stimulate patients' own strength, encourage them to appreciate and love life more, and ultimately achieve the goal of improving their post-traumatic growth level38.
The findings of this study reveal that age is a determining factor in gynecological cancer patients' post-traumatic growth, and that age is inversely connected with post-traumatic development, meaning that the younger the age, the larger the post-traumatic growth39. The following are the reasons: To begin with, the younger you are, the more plastic your growth is, the more sensitive your perception of growth is, and the more post-traumatic growth you will experience. However, because the old have more experience and a stronger anti-Strike capacity than the young, they have less post-traumatic growth.Second, young people are better than the elderly at obtaining relevant information and social resources through various network channels, which is conducive to post-traumatic growth; third, young and middle-aged people are the backbone of the family and are in a critical period of family responsibilities and sprint career40. For them, a cancer diagnosis is more terrifying and distressing. More post-traumatic growth may result from a higher hazard. Patients who are elderly have fewer family and social commitments. Cancer has become a relatively inconsequential life event with less psychological stress since they are dealing with other more major life events associated to the aging process41.
We investigated if gynecological cancer patients' education is a determining factor. Patients with varied educational levels have significantly different post-traumatic development levels. The more education you have, the more trauma you will experience42. The reason for this could be that patients with higher educational levels are better at obtaining relevant knowledge of disease treatment, rehabilitation, and prognosis via mobile phones, the Internet, and other means43, making it easier to form a more mature and comprehensive understanding of life and disease.Patients with a high degree of education have a strong psychological adjustment ability in the face of severe trauma, and are adept at gaining experience and experience from trauma in order to sublimate and enlarge their hearts. Patients with a high educational level, on the other hand, have more opportunities for communication and emotional communication, are also better at expressing negative emotions, and approach the disease with a more positive and optimistic attitude; in addition, highly educated patients are more likely to obtain and use various forms of external social support, making them more likely to achieve post-traumatic growth44,45.
We found that perceived social support was positively correlated with post-traumatic growth among Chinese gynecological cancer patients; patients who reported more perceived social support had a higher level of post-traumatic growth. This finding is consistent with many prior studies. For example, a longitudinal study of 206 long-term cancer survivors found a significant association of perceived social support with posttraumatic growth15. And a study among 344 Chinese women with gynecological cancer also indicated that women with high levels of perceived social support tended to experience more post-traumatic growth46. Perceived social support refers to many types of assistance including emotional, instrumental, and financially provided by a network of individuals such as family, friends, and significant others in times of need47. In contrast to received social support, perceived social support refers to the available social support one believes she/he can acquire from her/his social network48. According to the literature, social support can assist women with gynecological cancer in better comprehending their situation by providing more opportunities to express their trauma and survival49. Family support was found to have a greater impact on post-traumatic growth in this study; this is likely because Chinese culture is characterized by a family-oriented approach, with the Chinese emphasizing interdependence and obligations to family members50. As a result, family members are the most essential source of social support30, and support from family members may help the Chinese more than non-family members41.
The current study revealed that family support and someone’s special support have a positive impact on spirituality. The result is consistent with other research findings that spirituality enhances participation in social support and promotes psychological and social well-being51,52. Furthermore, higher levels of meaning and purpose in life were correlated with higher levels of life satisfaction and more positive views on the future53. This research had also indicated that spiritual well-being was positively associated with post-traumatic growth, which was in line with previous studies54,55. Spiritual well-being is one of the most important aspects of human existence, as it provides a driving force to give a person stability, meaning, fulfillment in life, faith in self55. And the existential domain in spiritual well-being refers to the sense of meaning and purpose in life, peace, and life satisfaction, which brings hope to our existence23. Existential psychology, which has a long philosophical history, stresses the unique ability of everyone to freely choose to be aware of and responsible for their existence56. Some major existence themes, such as self-transcendence and the pursuit of meaning, have important implications for life when one is confronted with impending death56. According to PTG theory, PTG is the result of a struggle to cope with major crises in life (e.g., the death threat) to find meaning in such experiences13. The PTG comprises several coping strategies that lead to adaptation to traumatic events and create a more positive perspective on life38.
Clinical Implications
This research was carried out in the context of no development of formal religion. In certain research, spiritual well-being has been linked to religious faith, however, it should not be confused with religion57,58. Spirituality is a wide term that may be experienced by anybody, regardless of religious faith59,60. As a result, clinical staff should pay close attention to cancer patients' spiritual well-being, and spiritual care should be considered an integral component of cancer treatment. Our results suggest that perceived social support of gynecological cancer patients can promote post-traumatic growth through spiritual well-being, but the correlation of various dimensions of perceived social support and spiritual well-being with post-traumatic growth remains complex. Further studies should explore the interaction between these variables or conduct some quantitative studies on how cancer patients achieve post-traumatic growth through social support and spiritual well-being, which may help clinical staff better understand the relationship and promote this growth. In addition, health care workers can incorporate the important social resources from family, significant other, into some existing spiritual therapy interventions to better design culturally appropriate psychosocial interventions.
Limitations
Although this study has significant clinical implications, it also has limitations that must be noted when interpreting the results. Because the study was a cross-sectional design with a convenience sample, no causal association between the variables was found. Most of our subjects had a disease duration of one year or below, and we failed to reach more terminal patients who may have had more thinking about spirituality. As a result, our findings may not necessarily apply to such patients. Furthermore, as compared to people from other cultures, some concepts such as support from friends and significant others may have different meanings for Chinese. It should be determined whether the findings can be applied to other cultures.