Correlations of Ambivalence over Emotional Expression and Social Support with Adherence to Treatment in Cancer Patients

Cancer is a common chronic disease that leads to numerous psychological reactions in patients and affects the reactions of individuals to the physical symptoms of the disease and adherence to treatment in patients. According to forecasts, the number of new cases of cancer in 2025 will reach more than 130,000 people in Iran, which is about 35% more than the present time. The complex and longitudinal process of cancer treatment leads to many psychological complications in patients and their families and causes severe damage to their mental health and quality of family and social life. Various studies have identified several psychological factors that affect people's reactions to physical symptoms of the disease and adherence to treatment in patients. One of the psychological factors affecting health and illness is emotion. It is believed that expressing or not expressing emotion alone cannot be problematic. What causes the problem is the conflict or ambivalence that one experiences in expressing emotion. On the other hand, expressing emotions towards others has a positive relationship with social support. Those who are ambivalent about expressing their emotions toward others are more likely to miss out on the opportunity to receive support from others; while, supporting cancer patients protects them against the negative consequences of this disease and acts like a cure, and has a strong relationship with patients' psychological performance. On the other hand, one of the important issues about patients with chronic diseases which affects the effectiveness of planned therapies is the patient's adherence to treatment. In chronic diseases in which the treatment process takes a long time, adherence to treatment usually decreases; while, adherence to treatment is one of the most important factors in controlling these diseases, and poor adherence to treatment is an alarm for both patients and health care delivery systems, because from a clinical point of view, not following the treatment can reduce the beneficial therapeutic effects, increase complications, and increase hospitalization or even death in patients. The above mentioned points and review of previous researches indicate that many studies have examined psychological variables in cancer patients. However, less attention has been paid to ambivalence over emotional eexpressions in patients and following the medication and treatment regimen and cognitive-behavioral factors involved in them. Therefore, the present study aims to investigate the relationship between ambivalence over emotional eexpressions and social support with adherence to treatment in the cancer patients.

The present study is a descriptive correlational study and has employed Pearson correlation and stepwise regression methods for data analysis due to the nature of the design. The statistical population of the present study consisted of all cancer patients (based on the diagnosis of oncologist), referred to Dezful medical centers from April to June 2020. The sample of the study included 206 people (men and women) with each type of cancer selected from the mentioned population based on convenience sampling. The samples completed Demographic Characteristics Questionnaire, Ambivalence over Emotional Expression Questionnaire (AEQ), Social Support Scale (MOS-SSS), and General Adherence Scale (GAS). Statistical analyses were conducted in SPSS version 16 using Pearson correlation coefficient and stepwise regression.

Based on data, the average age of the sample was 44.90 years. The sample included 175 females (85%) and 31 males (15%). They had high school to master's degrees. In terms of marital status, 26 (12.6%) were single, 169 (82%) were married, and 11 (5.3%) were divorced. Regarding the stage of the disease at the time of diagnosis, 23 patients (11.2%) were in stage one, 95 patients (46.1%) in stage two, 73 patients (35.4%) in stage three, and 15 patients (7.3%) in stage four of the disease. Also, 37 patients (18%) reported metastatic disease and 83 patients (40.3%) reported a family history of cancer. Thirteen patients (6.3%) reported drug and tobacco use and alcohol consumption. In terms of insurance coverage and medical services, 169 (82%) of the samples were covered by insurance. Among the dimensions of ambivalence over emotional expression, the highest mean belonged to expressing negative emotions (42.59). Among the various dimensions of social support, the highest mean belonged to the emotional/information support dimension (25.53). And in general, among the three variables of ambivalence over emotional expressions, social support, and adherence to treatment, the highest mean belonged to the variables of ambivalence over emotional eexpressions (76.04), and there was a negative and significant relationship between ambivalence over emotional expressions and adherence to treatment (r=-0.184; P<0.05). However, there was no significant relationship between social support and adherence to treatment. In addition, ambivalence over emotional expressions predicted a total of 3% of adherence to treatment in cancer patients (R2=0.034).

Emotional changes that cancer patients experience during the various stages of diagnosis to treatment and even afterwards, as well as, the length and complexity of the treatment process and the complications of treatment and disease, can have significant effects on treatment adherence in patients. On the other hand, non-adherence to treatment is associated with several individual and social consequences, and imposes high costs on patients and their families. Given that nurses, as part of the treatment team, have the closest relationship with patients and their families during the treatment process, they can identify behavioral, cognitive, and emotional factors involved in poor adherence or non- adherence to treatment instructions to develop the necessary training and provide it to patients and their families. Also, according to the results of research on the high level of ambivalence over emotional expressions in cancer patients and its negative effects on adherence to treatment, nurses can have a significant role in reducing ambivalence over emotional expressions in patients by communicating and empathizing with patients and encouraging them to recognize and express their emotions and concerns and promote their self-expression. This way, the nurses can provide better treatment and higher quality of life for patients. The research had some limitations, including the limited and specific statistical community and it is suggested that this research be conducted in other cities and provinces and with different cultures in order to increase the generalizability of the research results. It is also suggested that due to the different complications and problems of different types of cancers in patients, this study be performed on different types of cancers separately and review the results.