Department of Counseling Psychology, Morgridge College of Education, University of Denver, 1999 E. Evans Avenue, Denver, CO, USA.
J Cancer Surviv. 2019 Feb;13(1):21-33. doi: 10.1007/s11764-018-0724-6. Epub 2018 Nov 9.
To review the empirical qualitative literature on cancer survivor's experiences with loneliness to inform assessments and interventions for improving cancer survivors' social well-being.
A rigorous systematic review of qualitative studies published in five databases between 1993 and 2016 was conducted. Three coders reviewed 285 titles and abstracts and, after applying a critical review process, 20 manuscripts were synthesized using meta-ethnography.
The synthesis of the 20 studies provided a framework for understanding survivors' layers of loneliness at the level of the individual, their social support system, the healthcare system, and society. Internally, survivors described loneliness resulting from feelings of inauthenticity, of being alone in their cancer experience, and of lack of control. In their social networks, survivors attributed loneliness to others' avoidance, misperceptions of cancer, and others' failure to recognize the effects of cancer after active treatment. Unmet needs after treatment contributed to feelings of loneliness within the healthcare system. Further, societal stigma around cancer and pressures to experience growth after cancer created another layer of loneliness. The results suggest the need to move beyond an individual level perspective in assessing and treating loneliness in cancer survivors.
This meta-ethnography presents an integrated framework of loneliness in cancer survivors as a multi-layered experience. Implications for Cancer Survivors Conceptualizing loneliness from a systemic perspective adds missing pieces to the loneliness puzzle by encouraging assessment and intervention at interacting levels of functioning; considering how individuals respond to and are affected by their social systems can deepen our understanding of cancer survivorship.
回顾癌症幸存者孤独经历的实证定性文献，为评估和干预措施提供信息，以改善癌症幸存者的社会幸福感。
对 1993 年至 2016 年间在五个数据库中发表的定性研究进行了严格的系统评价。三名编目人员对 285 个标题和摘要进行了审查，在经过严格的审查程序后，使用荟萃定性分析综合了 20 篇论文。
20 项研究的综合分析为理解幸存者在个体层面、社会支持系统、医疗保健系统和社会层面的孤独感的各个层次提供了一个框架。在内部，幸存者描述了由于不真实感、在癌症经历中感到孤独以及缺乏控制感而导致的孤独感。在他们的社交网络中，幸存者将孤独感归因于他人的回避、对癌症的误解以及他人在积极治疗后未能认识到癌症的影响。治疗后未满足的需求导致在医疗保健系统中感到孤独。此外，社会对癌症的污名化以及在癌症后体验成长的压力也造成了另一种孤独感。结果表明，在评估和治疗癌症幸存者的孤独感时，需要超越个体层面的视角。
这项荟萃定性分析提出了癌症幸存者孤独感的综合框架，即一种多层次的体验。从系统的角度概念化孤独感，通过在相互作用的功能层面上进行评估和干预，增加了孤独感的缺失部分；考虑个体如何应对和受到其社会系统的影响，可以加深我们对癌症生存的理解。
