Experiences and perception of character strengths among patients with breast cancer in China: a qualitative study

Tingting Yan, Carmen Wing Han Chan, Ka Ming Chow, Mingzi Li, Tingting Yan, Carmen Wing Han Chan, Ka Ming Chow, Mingzi Li

Abstract

Objective: To explore the patients' experiences on character strengths that Chinese patients experience after the diagnosis of breast cancer.

Design: A qualitative, exploratory study using semistructured interviews based on the patients' lived experience after being diagnosed with breast cancer. Ethics approval was granted. Interviews were audiorecorded and transcribed verbatim. Values in Action Classification of Strengths provided conceptual framework for analysing strengths. Directed content analysis based on the classification of strengths and framework analysis were used to analyse transcribed data. The Standards for Reporting Qualitative Research guideline was followed.

Setting: The Second Affiliated Hospital of Zhengzhou University and Henan Provincial Cancer Hospital in China.

Participants: Adult patients over 18 years, diagnosed with breast cancer between October 2019 and December 2020 were recruited. We used purposive sample method to collected data from 24 participants diagnosed with breast cancer.

Results: Six themes (virtues) emerged from our analysis. In addition, two new subthemes (character strengths) emerged in this study, selflessness and pragmatism, respectively. Patients with breast cancer described a large repertoire of character strengths they used or wished for during survivorship, including gratitude, hope, humility, kindness, humour, honesty and forgiveness. Cultural values (eg, collectivism, familyism, Confucianism and Buddhist beliefs) helped structure the experiences of Chinese patients' character strengths. Patients wanted their character strengths to be more noticed, appreciated and encouraged by others and reported their psychological trajectory of using personal strengths.

Conclusion: The findings indicated that patients with breast cancer believing character strengths are important to them. Medical staff should pay more attention to motivating and cultivating character strengths of patients with breast cancer. Attention to make strength-based practices workable in clinical health promotion programmes is necessary. The healthcare system should develop tailored individualised psychological services that specifically address patients' needs for the application of personalised character strengths.

Trial registration number: NCT04219267, Pre-results.

Keywords: adult palliative care; adult psychiatry; breast tumours; psychiatry; qualitative research.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

References

    1. Moyle W, Parker D, Bramble M. Care of older adults. A strengths-based approach. Sydney: Cambridge University Press, 2014.
    1. Waterworth S, Raphael D, Gott M, et al. . Uncovering strengths within community dwelling older adults: what does it mean for health care practice? Health Soc Care Community 2020;28:1–9. 10.1111/hsc.12924
    1. Gottlieb LN, Gottlieb B. Strengths-based nursing: a process for implementing a philosophy into practice. J Fam Nurs 2017;23:319–40. 10.1177/1074840717717731
    1. Duan W, Bu H. Development and initial validation of a short three-dimensional inventory of character strengths. Qual Life Res 2017;26:2519–31. 10.1007/s11136-017-1579-4
    1. Jeste D, Palmer BW, Boardman S. Integrating Positive Psychiatry Into Clinical Practice. In: Positive psychiatry, 2015. 10.1176/appi.books.9781615370818.dj12
    1. McGrath RE, Hall-Simmonds A, Goldberg LR. Are measures of character and personality distinct? Evidence from observed-score and true-score analyses. Assessment 2020;27:117–35. 10.1177/1073191117738047
    1. Peterson C, Seligman ME. Character strengths and virtues a Handbook and classification. New York: Oxford University Press, 2004.
    1. Pieters HC. "I'm still here": resilience among older survivors of breast cancer. Cancer Nurs 2016;39:E20–8. 10.1097/NCC.0000000000000248
    1. Seligman M. Flourish: a visionary new understanding of happiness and well-being. Choice Reviews, 2011: 48–7217. 10.5860/choice.48-7217
    1. Shimai S, Otake K, Park N, et al. . Convergence of character strengths in American and Japanese young adults. J Happiness Stud 2006;7:311–22. 10.1007/s10902-005-3647-7
    1. Baumann D, Ruch W, Margelisch K. Character strengths and life satisfaction in later life: an analysis of different living conditions. Appl Res Qual Life 2019. 10.1007/s11482-018-9689-x
    1. Chan CWH, Chang AM. Stress associated with tasks for family caregivers of patients with cancer in Hong Kong. J Adv Nurs 1999;29:484–9. 10.1097/00002820-199908000-00002
    1. So WKW, Choi KC, Chen JMT, et al. . Quality of life in head and neck cancer survivors at 1 year after treatment: the mediating role of unmet supportive care needs. Support Care Cancer 2014;22:2917–26. 10.1007/s00520-014-2278-0
    1. Rotegård AK, Fagermoen MS, Ruland CM. Cancer patients’ experiences of their personal strengths through illness and recovery. Cancer Nurs 2012;35:E8–17. 10.1097/NCC.0b013e3182116497
    1. Niemiec R, Rashid T, Spinella M. Strong mindfulness: integrating mindfulness and character strengths. J Ment Health Couns 2012;34:240–53. 10.17744/mehc.34.3.34p6328x2v204v21
    1. Fang S-Y, Lin Y-C, Chen T-C, et al. . Impact of marital coping on the relationship between body image and sexuality among breast cancer survivors. Support Care Cancer 2015;23:2551–9. 10.1007/s00520-015-2612-1
    1. Wagner L, Ruch W. Good character at school: positive classroom behavior mediates the link between character strengths and school achievement. Front Psychol 2015;6:1–13. 10.3389/fpsyg.2015.00610
    1. Lim Y-J. Relations between virtues and positive mental health in a Korean population: a multiple indicators multiple causes (mimic) model approach. Int J Psychol 2015;50:272–8. 10.1002/ijop.12096
    1. McGrath RE. Character strengths in 75 nations: an update. J Posit Psychol 2015;10:41–52. 10.1080/17439760.2014.888580
    1. Hanks RA, Rapport LJ, Waldron-Perrine B, et al. . Role of character strengths in outcome after mild complicated to severe traumatic brain injury: a positive psychology study. Arch Phys Med Rehabil 2014;95:2096–102. 10.1016/j.apmr.2014.06.017
    1. Macaskill A. Review of positive psychology applications in clinical medical populations. Healthcare 2016;4:66. 10.3390/healthcare4030066
    1. Yan T, Chan CWH, Chow KM, et al. . A systematic review of the effects of character strengths-based intervention on the psychological well-being of patients suffering from chronic illnesses. J Adv Nurs 2020;76:1567–80. 10.1111/jan.14356
    1. Ruch W, Proyer RT. Mapping strengths into virtues: the relation of the 24 VIA-strengths to six ubiquitous virtues. Front Psychol 2015;6:1–12. 10.3389/fpsyg.2015.00460
    1. Markus HR, Kitayama S. Culture and the self: implications for cognition, emotion, and motivation. Psychol Rev 1991;98:224–53. 10.1037/0033-295X.98.2.224
    1. Chan CWH, Law BMH, So WKW, et al. . Novel strategies on personalized medicine for breast cancer treatment: an update. Int J Mol Sci 2017;18:2423. 10.3390/ijms18112423
    1. O'Brien BC, Harris IB, Beckman TJ, et al. . Standards for reporting qualitative research: a synthesis of recommendations. Acad Med 2014;89:1245–51. 10.1097/ACM.0000000000000388
    1. Lusardi P. Qualitative research in nursing: advancing the humanistic imperative. Nurs Res 1996;45:62. 10.1097/00006199-199601000-00014
    1. Henderson PD, Gore SV, Davis BL, et al. . African American women coping with breast cancer: a qualitative analysis. Oncol Nurs Forum 2003;30:641–7. 10.1188/03.ONF.641-647
    1. Pitre NY, Myrick F. A view of nursing epistemology through reciprocal interdependence: towards a reflexive way of knowing. Nurs Philos 2007;8:73–84. 10.1111/j.1466-769X.2007.00298.x
    1. Palinkas LA, Horwitz SM, Green CA, et al. . Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health 2015;42:533–44. 10.1007/s10488-013-0528-y
    1. Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Analyzing qualitative data, 2010: 173–94. 10.4324/9780203413081_chapter_9
    1. Barasteh S, Rassouli M, Parandeh A, et al. . Palliative care in the health system of Iran: a review of the present status and the future challenges. Asian Pac J Cancer Prev 2020;21:845–51. 10.31557/APJCP.2020.21.3.845
    1. Fox DE, Quinn RR, James MT, et al. . Social support in the peritoneal dialysis experience: a qualitative descriptive study. Can J Kidney Health Dis 2020;7:2054358120946572. 10.1177/2054358120946572
    1. Sandelowski M. The problem of rigor in qualitative research. ANS Adv Nurs Sci 1986;8:27–37. 10.1097/00012272-198604000-00005
    1. Guse T, Hudson D. Psychological strengths and posttraumatic growth in the successful reintegration of South African ex-offenders. Int J Offender Ther Comp Criminol 2014;58:1449–65. 10.1177/0306624X13502299
    1. Niemiec RM. Character strengths interventions. A field guide for practitioners. Boston, MA: Hogrefe Publishing, 2018.
    1. Li J. Humility in learning: a confucian perspective. J Moral Educ 2016;45:147–65. 10.1080/03057240.2016.1168736
    1. Spiegel D. Psychosocial aspects of breast cancer treatment. Semin Oncol 1997;24:S1-36–S1-47.
    1. Guo Z. Chinese confucian culture and the medical ethical tradition. J Med Ethics 1995;21:239–46. 10.1136/jme.21.4.239
    1. Moale AC, Rajasekhara S, Ueng W, et al. . Educational intervention enhances clinician awareness of Christian, Jewish, and Islamic teachings around end-of-life care. J Palliat Med 2019;22:62–70. 10.1089/jpm.2018.0077
    1. Lundman B, Aléx L, Jonsén E, et al. . Inner strength--a theoretical analysis of salutogenic concepts. Int J Nurs Stud 2010;47:251–60. 10.1016/j.ijnurstu.2009.05.020
    1. Tang X, Li Y, Duan W, et al. . Character strengths lead to satisfactory educational outcomes through strength use: a longitudinal analysis. Front Psychol 2019;10:1–9. 10.3389/fpsyg.2019.01829
    1. Ling M, Wang X, Ma Y, et al. . A review of the current state of hospice care in China. Curr Oncol Rep 2020;22:1–7. 10.1007/s11912-020-00959-y
    1. Waters LE. Strength-based parenting and life satisfaction in teenagers. Adv Soc Sci Res J 2015;2:158–73. 10.14738/assrj.211.1551
    1. Roux G, Dingley C, Bush H. Inner strength in women: metasynthesis of qualitative findings in theory development. J Theory Constr Test 2002;6:86.
    1. Janssen BM, Van Regenmortel T, Abma TA. Identifying sources of strength: resilience from the perspective of older people receiving long-term community care. Eur J Ageing 2011;8:145–56. 10.1007/s10433-011-0190-8
    1. Duan W, Ho SMY. Three-dimensional model of Strengths: examination of invariance across gender, age, education levels, and marriage status. Community Ment Health J 2017;53:233–40. 10.1007/s10597-016-0038-y
    1. Niemiec RM. Six functions of character strengths for thriving at times of adversity and opportunity: a theoretical perspective. Appl Res Qual Life 2020;15:551–72. 10.1007/s11482-018-9692-2
    1. Park N, Peterson C, Seligman MEP. Strengths of character and well-being. J Soc Clin Psychol 2004;23:603–19. 10.1521/jscp.23.5.603.50748

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