This study investigated latent distress and coping mechanisms existing in the experiences of relapsed breast cancer patients in order to identify strategies for improving support structures for this population. Semi-structured interviews were performed with 26 subjects receiving care from two medical facilities in the Tokyo Metropolitan area. In this study, the life-line methodology was selected as a tool to express the subjective QOL of subjects. Specifically, we used life-lines to examine the changing processes of the subjective QOL and to explore latent distress and coping mechanisms. We found that 1) the life-lines of approximately half of the subjects regained a pre-initial diagnosis level of psychosocial equanimity after both the initial diagnosis of cancer and the first episode of recurrence ; however, the life-lines of some subjects remained depressed as they suffered multiple recurrences and a concomitant loss of hope, 2) relapsed patients faced an awareness of death and a sense of uncertainty, a decline in pleasures, and a declining ability to find meaning in life, 3) the recovery of the level of the life-line accompanied changes corresponding to a scale recalibration, a change in values, and a reconceptualization as described in response shift theory. These changes were confirmed in two areas : those related to sickness, treatment and survival, and those related to finding a significance in life itself and asserting one's reasons for living. Furthermore, as a result of cognitive coping strategies, the maintenance of life-line levels after recovery were attained in the same two areas as stated above, 4) when compared with a SF-8 survey methodology measuring a health-related QOL, the life-line methodology was more consistent with the mental health rather than the physical health domains, especially as related to identifying a personal meaning in one's life, and 5) relapsed patients combined characteristics of patients in both treatment and terminal stages of the disease. Study results reinforce the recognition that relapsed breast cancer patients have an unmet need for support systems tailored to respond to their individual psychological characteristics.
Objective : The objective of this research was to identify the factors behind the tendency of youth not to get married and to delay marriage by quantitatively measuring attitudes towards marriage among youth and investigating and examining the impact that information on and experience with marriage and childbirth have on attitudes towards marriage. Methods : A unanimous questionnaire was used to perform cross-sectional research on a population of 362 male and female students at two universities in Okinawa Prefecture aged 18 to 24 years and who were never married. The Attitude Toward Marriage Scale (ATM scale) was used to assess attitudes towards marriage. Twenty four items relating to information and experience that were thought to have an impact on attitudes towards marriage based on the results of prior research were prepared and multiple regression analysis was performed regarding the relationship with those items using four models. Results : It was determined that the percentages of youth who had information or experiences concerning marriage, childbirth, and childrearing are high regardless of whether the subjects had positive or negative attitudes. Scores on the ATM scale showed a positive relationship with items regarding information and experience such as attendance at a wedding ceremony, while there was a negative relationship with items relating to negative information and experiences such as a lack of affection from parents and advice that work should be prioritized over marriage. Conclusion : The results suggest that when youth obtain information or have experiences relating to marriage, childbirth, or childcare that are positive, attitudes towards marriage become positive, while negative information and experiences have a negative impact on attitudes towards marriage. These results indicate the importance of establishing conditions in which youth can develop positive attitudes towards marriage and children when formulating countermeasures to the low birthrate.
This study investigates the social support networks, health-related behaviors, and indigenous theories influencing these of mentally or physically disabled residents of Japan's skid row for the purpose of gaining insights that may improve the quality of care provided for this population. Ethnographic data was collected on fifteen subjects who received welfare and who attended either a disabled workshop or a psychiatric daycare in the skid row known as Kotobuki. Participatory fieldwork and semi-structured interviews were used to collect this data, which was analyzed qualitatively. We found that most subjects no longer maintained close relationships with family outside of Kotobuki, and that social support networks within Kotobuki were characterized by lack of depth and usefulness. Reasons for the weakness of the social support networks observed in Kotobuki included awareness of the dangers of the neighborhood, a fundamental lack of trust and wariness towards the other highly mobile residents, a desire to avoid money-related troubles, and the extremely small sizes of the rooms. Those subjects who did maintain close relationships with family outside of Kotobuki and those who had significant experience of regular company work as opposed to day laboring, demonstrated little sense of belonging and even weaker relationships within Kotobuki than the other subjects. Subjects spent little time with anybody else outside of either a workshop or a daycare, and they tended to fill the remaining hours of the day with walks, watching TV, and lying down. However, health itself did not serve as subjects' primary motivation for the walks or medical visits. Support provided by medical and social service workers was invaluable to the subjects, who despite their medical issues did not have a social structure to support each other. How best to foster relationships with emotional support is a subject requiring long-term consideration.