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… 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.”