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\begin{document}

\title{Post-traumatic growth in thyroid cancer patients after surgery:A
qualitative study Key words:thyroid cancer;post-traumatic
growth;qualitative research;head and neck cancer;positive psychology}



\author[1]{Jingyu Meng}%
\affil[1]{Nanjing University of Chinese Medicine}%


\vspace{-1em}



  
  \date{May 24, 2024}


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\selectlanguage{english}
\begin{abstract}
Objective:To gain insight into the real experiences of post-traumatic
growth of thyroid cancer patients and to provide reference for
optimizing postoperative care measures for thyroid cancer
patients.Design: a qualitative study.Methods:Using a phenomenological
study method in qualitative research, 15 patients within six months
after radical thyroid cancer surgery in our hospital from March to April
2022 were interviewed in a semi-structured manner by purposive sampling,
and the data were analyzed using the Colaizzi 7-step method.Results: Two
first-level themes were summarized: (1) post-traumatic growth
facilitators for thyroid cancer patients (cognitive processing, positive
coping strategies, multiple sources of support); and (2) post-traumatic
growth experiences for thyroid cancer patients (personal changes,
improved relationships).Conclusion: Post-traumatic growth can occur in
thyroid cancer patients after surgery, and healthcare professionals
should guide patients' positive psychology and tap into their inner
positive potential in order to promote healthy recovery and improve the
quality of life of thyroid cancer patients.%
\end{abstract}%



\sloppy


\textbf{Post-traumatic growth in thyroid cancer patients after surgery:A
qualitative study}

\textbf{Abstract:Objective:} To gain insight into the real experiences
of post-traumatic growth of thyroid cancer patients and to provide
reference for optimizing postoperative care measures for thyroid cancer
patients.\textbf{Design:} a qualitative study.\textbf{Methods:} Using a
phenomenological study method in qualitative research, 15 patients
within six months after radical thyroid cancer surgery in our hospital
from March to April 2022 were interviewed in a semi-structured manner by
purposive sampling, and the data were analyzed using the Colaizzi 7-step
method.\textbf{Results:} Two first-level themes were summarized: (1)
post-traumatic growth facilitators for thyroid cancer patients
(cognitive processing, positive coping strategies, multiple sources of
support); and (2) post-traumatic growth experiences for thyroid cancer
patients (personal changes, improved
relationships).\textbf{Conclusion:}Post-traumatic growth can occur in
thyroid cancer patients after surgery, and healthcare professionals
should guide patients' positive psychology and tap into their inner
positive potential in order to promote healthy recovery and improve the
quality of life of thyroid cancer patients.

\textbf{Key words} :thyroid cancer;post-traumatic growth;qualitative
research;head and neck cancer;positive psychology

\textbf{Key points} :(1)As a physical and psychological disease, thyroid
cancer cannot develop without the influence of psychosocial
factors.Patients' psychological status affects their disease prognosis
and recurrence.Therefore, the psychological needs of thyroid cancer
patients deserve external attention.

\begin{enumerate}
\tightlist
\item
  Current research on surgical treatment of thyroid cancer tends to
  focus on cancer eradication, potential complications, and negative
  emotions, while positive growth seen in patients after surgery has
  been rarely reported.
\item
  With the dual trauma of disease and COVID-19, thyroid cancer patients
  of all genders and ages exhibited varying degrees of post-traumatic
  growth.
\item
  Previously, health education was focused on patients after
  hospitalization, but it is recommended that some level of knowledge be
  provided when patients are diagnosed.
\item
  It is recommended that health care professionals should pay timely
  attention to the psychological condition of postoperative thyroid
  cancer patients, and can guide patients to make positive psychological
  adjustment and cope by identifying PTG-promoting factors.
\end{enumerate}

\textbf{Acknowledgments} :Special thanks to the government for their
financial support.Thanks to each author for their contributions.Thank
you to the hospitalized patients.

\textbf{Introduction}

As the most prevalent malignant tumor in the endocrine system(Chen W et
al.2016), the incidence of thyroid cancer has been on the rise globally
for the past 30 years, with an annual increase of 4\%(Chen A Y et
al.2009).According to 2020 statistics, there are 586,000 cases of
thyroid cancer worldwide, with the 9th highest incidence rate(Sung H et
al.2021).Although the ATA guidelines support the option of active
surveillance for patients with low-risk thyroid cancer, a Japanese study
showed that 10\% of patients opted for surgery for various
reasons(Sugitani I et al.2010).Some studies have reported that surgery
is still the standard of care for most thyroid cancer patients(Laha D et
al.2020).Patients commonly experience a range of physical and
psychological symptoms after surgery, and current studies have focused
on cancer eradication, potential complications(Filetti S et al.2019),
and negative emotions in the surgical treatment of thyroid cancer(Randle
R W et al.2017), while positive growth in postoperative patients has
rarely been reported.

Traumatic events are experiences that may threaten an individual's life,
physical and mental health, and cause unusual suffering. While some
people can only feel pain in the face of trauma, others can experience
positive changes in their lives after a traumatic event(Sumall E C et
al.2009), which is defined as Post-traumatic Growth (PTG)(Ochoa C et
al.2017).A meta-analysis has shown that cancer patients who experience
PTG are more likely to adapt to their disease, will experience less
distress and post-traumatic stress symptoms, as well as exhibit
healthier behaviors and higher treatment adherence(Sawyer A et al.2010).
Thus, the successful occurrence of PTG in cancer patients is critical to
their recovery and quality of life.

As a physical and mental disease, thyroid cancer cannot develop without
the influence of psychosocial factors, and the positive psychological
needs of thyroid cancer patients deserve external attention.Therefore,
understanding the positive psychology of postoperative thyroid cancer
patients and actively identifying and tapping into their positive
regulatory potential are of great clinical significance in promoting
both postoperative recovery and quality of life for thyroid cancer
patients.

\textbf{1.Methods}

1.1Recruitment

Using a purposive sampling method, patients who underwent surgery at our
hospital or came to the hospital for review 6 months after surgery in
March to April 2022 were selected for interview.Inclusion criteria:(1)
Patients who meet the diagnostic criteria for thyroid cancer and are
within six months of radical thyroid cancer surgery;(2) Age
\textgreater{} 18 years;(3) Clear awareness and articulate language;(4)
Voluntary participation in this study.Exclusion criteria:(1) Failure of
the patient to provide valid information;(2) Also involved in other
studies.The sample size is considered saturated when no new themes
emerge.

1.2Research Methods

1.2.1Develop interview outline

Before the formal interview, a pre-interview outline was prepared by
reviewing the literature and consulting with our thyroid surgery
specialists, taking into account the purpose of the interview.After
pre-interviewing the 2 patients, the outline was revised based on the
results of the pre-interview, and professionals trained in qualitative
interviewing were asked to validate the outline and finalize the
interview outline.

1.2.2Data Collection Methods

Face-to-face, semi-structured interviews were conducted with patients
according to a defined interview outline.The purpose, content, and
method of this interview were explained to the patients before the
interview to protect their privacy. Select a quiet, private, empty
demonstration room as the interview site.The interviews were recorded,
and the patients' body movements, emotions, and expressions were
recorded. The duration of each interview was 15-30 minutes.

1.2.3Data Analysis Methods

The audio files were listened to and manually transcribed into text
within 24 h after the interview, and the data were analyzed using the
Colaizzi 7-step method by another researcher who checked the audio
recordings against the textual data.

1.3Quality Control

(1) The researchers were trained systematically in qualitative research
and then conducted interviews and established a good trusting
relationship with the patients before the interviews. (2) Two
researchers independently transformed, analyzed, and checked the data,
and held subject group discussions when differences in opinion arose,
and finally formed themes of the real experiences of thyroid cancer
patients after surgery. (3) The integrated themes and descriptions were
explained to the patients to ensure the rigor of the study.(4)This study
followed the COREQ guidelines.

1.4Ethics

This study was approved by the hospital ethics committee.(Blinded for
review)

\textbf{Result}2.1General information of interview subjects

Fifteen patients were finally established for interview in this study.
The general information of the study population is shown in Table 1.

Table 1 General information of study subjects\selectlanguage{english}
\begin{longtable}[]{@{}lllllllll@{}}
\toprule
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Patient No.\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Gender\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Age\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Marital Status\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Education level\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Place of origin\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Career\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Whether there is medical insurance\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Interview timing\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
1\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Female\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
29\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Married\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Bachelor\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
City\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Staff\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
One month after surgery\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
2\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Female\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
27\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Divorce\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Junior college\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Rural\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Self- employed\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Day 2 after surgery\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
3\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Female\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
43\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Married\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Junior college\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Rural\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Unemployed\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Day 3 after surgery\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
4\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Female\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
39\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Married\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Bachelor\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
City\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
teacher\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Day 2 after surgery\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
5\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Male\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
45\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Married\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Bachelor\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
City\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Worker\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Day 4 after surgery\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
6\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Female\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
49\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Married\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Bachelor\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
City\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Salesman\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Six months after surgery\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
7\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Female\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
35\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Married\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
technical secondary school\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
City\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Staff\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
40 days after surgery\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Male\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
52\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Married\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Bachelor\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
City\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Driver\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
30 days after surgery\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
9\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Female\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
52\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Married\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Junior High School\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
City\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Unemployed\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Six months after surgery\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
10\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Male\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
65\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Married\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
technical secondary school\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Rural\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Retirement\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Day 4 after surgery\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
11\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Female\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
30\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Married\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Bachelor\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
City\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Nurse\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
30 days after surgery\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
12\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Female\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
31\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Married\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Junior college\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
City\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Self- employed\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Six months after surgery\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
13\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Female\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
32\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Married\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Junior High School\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
City\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Farmer\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Day 4 after surgery\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
14\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Male\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
47\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Married\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Junior college\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Rural\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Retirement\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Day 4 after surgery\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
15\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Female\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
29\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Married\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Bachelor\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
City\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Civil Service\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Day 3 after surgery\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

2.2Interview Results

After analyzing the interview data, three themes were finally derived:
(1) patients' psychological distress after experiencing thyroid cancer;
(2) patients' post-traumatic growth-promoting factors; and (3) patients'
post-traumatic growth experience. Among them, psychological distress
after experiencing thyroid cancer included two sub-themes of multiple
stressors and stress reactions; post-traumatic growth-promoting factors
of patients included three sub-themes of cognitive processing, positive
coping and multi-source support; post-traumatic growth experience of
patients included two sub-themes of personal change and interpersonal
relationship improvement.The thematic framework is shown in Figure 1.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image1/image1}

\end{center}
\end{figure}

Figure 1 Thematic framework of postoperative PTG in thyroid cancer
patients

2.3PTG-promoting factors in thyroid cancer patients

Some studies have shown that cognitive processing, positive coping
strategies, and high-quality support are all facilitators of
PTG(Barskova T et al.2009).

2.3.1Cognitive processing

Ending Reflection:After diagnosis, patients often reflect on the causes
of their illness and gain strength in the face of adversity.P7:''I think
I have this disease may be related to my love of sulking and impatient
nature.'' (2)Disclosure:After the illness, the patient will communicate
and confide in others in order to achieve a positive outcome in the
trauma.P8:''I was uncomfortable in my heart and told my wife, and after
that I was much more comfortable.''

2.3.2Positive coping strategies

Downward comparison:Patients engage in psychological self-protection
through comparison, resulting in greater gratitude for the present
moment.P2:''In fact, I think I am very lucky that this thyroid cancer is
so much better than other cancers.''

Focus on the present:Patients who have experienced the trauma of thyroid
cancer are more inclined to focus on the present moment and promote
post-traumatic growth in a range of ways.P13:''The epidemic has slowed
down the city, so I can finally slow down a little bit too. In the
future, emotions must be controlled and relaxed when things go wrong.''
2.3.3High quality support

Support from medical and nursing staff:Health care professionals
contribute to the occurrence of post-traumatic growth by providing
knowledge support, therapeutic care support, and psychological support
to patients.P1:''The doctors and nurses at your hospital were very nice
and gave me a very friendly feeling, which made me feel much more
comfortable.''Currently, the Internet has become the safest and most
convenient channel for patients to consult and seek medical treatment,
breaking the spatial limitation between doctors and patients and
accelerating the post-traumatic growth of patients.P7:''The epidemic
made everything inconvenient, but fortunately doctor built a group chat,
I forgot to take Levothyroxine last time,so I asked him in the group
chat what to do, and he soon replied to me.'' (2)Support from family
members:Family support, a major support system, has a sustained positive
contribution to post-traumatic growth in thyroid cancer
patients.P13:''Since being hospitalized, my daughter often cares about
me through WeChat, and my lover has learned to cook and wash clothes by
herself when I am not at home, which is quite gratifying.''

(3)Peer Support:During a patient's visit, the support and encouragement
of the patient's friends are an important factor in contributing to the
patient's post-traumatic growth.P1:''Before the surgery, I was very
nervous and couldn't sleep, so the aunt in the bed next to me kept
comforting me and encouraging me.''

2.4 Post-traumatic growth experience for thyroid cancer patients

2.4.1Personal changes

(1)Life Philosophy Change:Affected by the trauma of the disease, the
patient re-examines the meaning of life.P13:I used to save money for my
family and come here to work hard, but now I have some money in my hand,
but my health is broken. My daughter says it's best for the family to be
healthy and safe.''

(2)Self-efficacy Enhancement:Self-efficacy is an important part of the
patient's growth from trauma and belongs to the category of positive
psychological activity(Lotfi-Kashani F et al.2014).Patients see the
traumatic event of thyroid cancer as a life path exercise and feel more
confident to tackle future challenges.P1:''I used to think I was
fragile, but I've really come through this.''

(3)Envisioning a New Life:Although the patients experienced the trauma
of thyroid cancer, they still had hope for their future lives,
indicating that the traumatic event brought real benefits and growth to
the patients.P1:''Now that medicine is so advanced, the epidemic will
pass, and by the time I'm feeling better, I'll be able to have a baby.
(smile)''

2.4.2Changes in relationships with others

(1)More harmonious family relationships:After experiencing the traumatic
event of thyroid cancer, patients feel warmth from family members as
well as others, which is an important experience for post-traumatic
growth.P15:''I used to be so busy at work that I rarely had time to chat
with my parents for a long time, but now that I'm in the hospital, I can
video chat with them every day, which is a blessing in
disguise.''P13:``Since being hospitalized, my daughter often cares
about me through WeChat. If I wasn't sick, there are some things she
wouldn't say to me.''

(2)Increased empathy:Because patients have experienced the pain of a
traumatic event, they are more likely to develop empathy for others on
top of that.P7:''I can't understand the pain of surgery when I'm not
sick, but now I can feel it\ldots{} I will cheer up my friends who are
going to have surgery around me.''

(3)Judgmental psychology is reduced:Respondents generally reported that
the experience of thyroid cancer as a disease had made them more
tolerant of others and less judgmental of their behavior.P7: ''After I
got sick, I was a lot less judgmental of others.We are all carrying a
lot of weight with the epidemic, and we all have our own difficulties,
so we need more tolerance and understanding.''

\textbf{3.Discussion}

PTG theory suggests that traumatic events such as cancer cause
individuals to change their original worldview and cognitive-behavioral
patterns, to cope with traumatic events while experiencing pain, and to
actively seek solutions to problems(Tedeschi R G \& Calhoun L G 1996).
The post-traumatic growth experiences of thyroid cancer patients in this
study are largely consistent with PTG theory.

3.1 Seek effective responses to promote positive transformation of
negative emotions

It has been suggested that negative emotions, such as anxiety, seriously
affect the prognosis of patients(Sharpe L et al.2018). With the outbreak
of the new crown epidemic, a series of adverse reactions occur in
individuals and society, and the physical and mental health and
well-being of individuals are seriously threatened(Minihan E et
al.2020).The results of this interview showed that thyroid cancer
patients usually experience negative emotions such as shock and sadness.
And, there was a positive trend of shifting the negative emotions of
thyroid cancer patients during the treatment.In Fujimoto's study of PTG
in cancer patients, it was concluded that a future-oriented positive
coping style plays a key role in the patient's reintegration into the
social environment and reestablishment of social functioning as an
extremely valuable spiritual resource(Fujimoto T \& Okamura H
2021).Several patients in this study showed a vision of a new life. The
hope that patients perceive in the pain of trauma contributes to
post-traumatic growth, and the expectation of new possibilities is an
important part of motivating patients to cope positively.Health care
professionals should conduct a comprehensive assessment of the patient's
coping style and apply individualized coping strategies to shift the
patient's perspective on grief. Patients may be guided to engage in
patient-to-patient communication or to vent negative emotions through
disclosure, etc.

3.2 Strengthened support systems to help patients through difficult
times together.

As an inert cancer, thyroid cancer has a high survival rate, a low
recurrence and metastasis rate. However, some patients in this interview
still expressed traumatic stress reactions such as fear and even
collapsed after diagnosis. Our research found that patients with low
knowledge of thyroid cancer exhibited more severe physical and
psychological stress, and that psychological stress decreased with
increasing knowledge, which is consistent with Morton's findings(Morton
R P 2003). Currently, health education provided by health care
professionals is mostly focused during hospitalization and follow-up.
Therefore, it is necessary to provide early knowledge support at the
time of patient screening and diagnosis.

It has been shown that social support system has a positive contribution
to PTG in cancer patients(Ruf M et al.2009).It has been argued that
patients with a harmonious and stable family structure have a stronger
desire to overcome the disease(Barnett M E et al 2014).This interview
found that in addition to support from within the family, social support
from friends, co-workers, and health care professionals inspired
patients.Therefore, medical and nursing staff can start with the
different family characteristics of the patient and focus on
strengthening the internal support system of the patient's family,
taking into account the social support of the patient.

3.3Guiding patients to perceive PTG and promoting good psychological
adjustment

The occurrence of PTG in thyroid cancer patients depends on factors such
as personal traits, cognitive processing, and mental strength. Good
personality traits and personal past experiences are favorable
conditions for traumatized individuals to achieve growth. Therefore,
under the dual trauma of the epidemic and the disease, healthcare
professionals should provide positive guidance to patients, tap into
their inner resources, and create conditions for their growth.

Cognitive processing is a key part of the patient's acceptance of trauma
toward growth, the patient's ability to make efforts to regulate pain is
extremely important to the process of PTG production, and whether or not
cognitive processing is perfect influences the occurrence of PTG(Ban\selectlanguage{ngerman}ík G
\& Gajdo\selectlanguage{polish}š\selectlanguage{english}ov\selectlanguage{ngerman}á B 2014), while disclosure plays a key role in cognitive
processing.Therefore, health care workers should patiently guide
patients in cognitive processing, listen to their stories, and respond
positively with empathy, which will help strengthen patients' perception
of personal value, stimulate their inner potential, and make them brave
to fight against trauma.

In terms of spiritual perception, this study did not conclude that
growth in religious beliefs in thyroid cancer patients.The reason for
this analysis may be related to the differences in cultural beliefs
between China and the West. The increase in empathy is seen as an
increase in the power of religious beliefs in the West, while in China
it is attributed to Confucianism.Therefore, when guiding patients to
perceive PTG, health care professionals should fully consider the
differences between Chinese and Western cultures, respect the cultural
backgrounds of different countries.

\textbf{4 Conclusion}

In this study, we conducted semi-structured interviews with 15
post-operative thyroid cancer patients and found that the patients'
post-traumatic growth experiences could be categorized into two themes:
positive transformation at the personal level and more harmonious
relationships with others, and the positive impact on patients' physical
and psychological recovery should not be overlooked.In addition, the
patient's mention of caregiver growth was noted during the interviews in
this study, and future research could further explore the post-traumatic
growth experiences of caregivers of thyroid cancer patients.

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\emph{https://doi.org/10.3322/caac.21660}\selectlanguage{english}
\begin{figure}[H]
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\includegraphics[width=0.70\columnwidth]{figures/Figure/Figure}

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\textbf{Hosted file}

\verb`Table. General information of study subjects.docx`  available at \url{https://authorea.com/users/502922/articles/582800-post-traumatic-growth-in-thyroid-cancer-patients-after-surgery-a-qualitative-study-key-words-thyroid-cancer-post-traumatic-growth-qualitative-research-head-and-neck-cancer-positive-psychology}

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