Department of Oncological Sciences,Integrative Behavioral Medicine Program,Icahn School of Medicine at Mount Sinai,New York,New York.
Palliat Support Care. 2018 Dec;16(6):767-776. doi: 10.1017/S147895151700075X. Epub 2017 Aug 15.
ABSTRACTObjective:Some 25% of women and 8% of men in the United States have experienced childhood sexual abuse (CSA) before the age of 18. For these individuals, healthcare visits and interactions can be retraumatizing due to perceived similarities to past abuse (e.g., pain, undressing, lack of control). However, no prior studies have provided formal qualitative analyses regarding CSA survivors' reactions to cancer treatment. Therefore, our study's objective was to identify key themes pertaining to CSA survivors' cancer treatment experiences.
Male and female members of the Amazon Mechanical Turk (N = 159, mean age = 44.27 years, SD = 10.02) participated in an anonymous online survey study. The inclusion criteria included reporting: history of CSA; a diagnosis of colorectal, gynecological, breast, or skin cancer; and experience of triggers and/or difficulties during cancer treatment. Participants' responses to open-ended questions were analyzed using inductive thematic analysis.
We identified two primary themes describing CSA survivors' experiences: Theme 1: treatment-related triggers (key subthemes: procedure-related, provider-related, and emotional triggers); and Theme 2: questioning the meaning of cumulative trauma (e.g., "Why me again?").
For CSA survivors, cancer and its treatment can trigger thoughts and emotions associated with the original abuse as well as negative evaluations of themselves, the world, and their future. Our findings are consistent with past research on CSA survivors' experiences in non-cancer healthcare settings and add to the literature by highlighting their struggles during cancer treatment. The present results can inform further research on trauma survivors' reactions to cancer treatment and give cancer care providers the context they need to understand and sensitively serve a substantial yet often overlooked patient group.
在美国，大约 25%的女性和 8%的男性在 18 岁之前经历过儿童期性虐待（CSA）。对于这些人来说，由于就诊过程中某些方面与过去的虐待经历相似（例如疼痛、脱衣、失去控制），就诊和医患互动可能会造成再次创伤。然而，先前没有研究提供过关于 CSA 幸存者对癌症治疗反应的定性分析。因此，我们的研究目的是确定与 CSA 幸存者癌症治疗经历相关的关键主题。
亚马逊土耳其机器人（MTurk）的男性和女性成员（N=159，平均年龄=44.27 岁，标准差=10.02）参加了一项匿名在线调查研究。纳入标准包括：有 CSA 史；诊断为结直肠癌、妇科、乳腺癌或皮肤癌；在癌症治疗过程中经历过触发因素和/或困难。使用归纳主题分析对参与者对开放式问题的回答进行分析。
我们确定了两个描述 CSA 幸存者经历的主要主题：主题 1：与治疗相关的触发因素（关键子主题：与程序相关、与提供者相关、与情绪相关的触发因素）；主题 2：质疑累积创伤的意义（例如，“为什么又是我？”）。
对于 CSA 幸存者来说，癌症及其治疗可能会引发与原始虐待相关的想法和情绪，以及对自己、世界和未来的负面评价。我们的研究结果与过去关于 CSA 幸存者在非癌症保健环境中的经历的研究一致，并通过强调他们在癌症治疗期间的挣扎，为文献增添了新内容。这些结果可以为进一步研究创伤幸存者对癌症治疗的反应提供信息，并为癌症护理提供者提供他们需要的背景，以理解和敏感地服务于一个数量相当大但往往被忽视的患者群体。
