University of Southern Queensland
Faculty of Sciences
Centre for Rural and Remote Area Health
Spirituality in men with
advanced prostate cancer
“It’s a holistic thing … it’s a package”
A dissertation submitted by:
Laurence Lepherd BA, MEd (Hons)
For the award of Doctor of Philosophy
Abstract
The aim of this doctoral research was to explore the nature of spirituality in men with
advanced prostate cancer, and to discover the role that spirituality might have in
these men as they face the challenges associated with living with their disease. The
concept of spirituality is widely discussed in literature but definitions of it can be
confusing. The term is often used synonymously with religion but such juxtaposition
can be misleading. This research sought to describe the concept of spirituality
through an analysis of literature and through an understanding of what spirituality
meant to men in specific circumstances. A qualitative approach using a methodology
that incorporated hermeneutic and dialectic principles, case study and narrative
method was used to explore the spirituality of nine men with advanced prostate
cancer who volunteered to participate and to tell the story of their cancer journey
with particular focus on their spirituality. In this study, advanced prostate cancer
referred to the condition existing when the cancer had become non-localised by
spreading beyond the prostate gland to other parts of the pelvic area, or had
metastasised to other parts of the body. The study found that spirituality for these
men was a “holistic thing” that involved physical, psychosocial and spiritual matters
that enabled them to transcend the everyday difficulties of their journey and obtain
greater comfort and peace of mind during what was for many of them a traumatic
time. The central theme in the men’s stories was that of Connectedness – to
themselves, to their partners, sometimes to a higher being and also to other people
such as their family and friends. It was also observed that their physical and spiritual
journeys progressed in parallel. The findings of this research will have considerable
benefit to healthcare practitioners who are frequently involved in caring for men in
this condition who have a need to discuss their spirituality as their life’s journey ebbs
Certification of dissertation
I certify that the ideas, work, results, analyses, interpretations and conclusions
reported in this dissertation are entirely my own work, except where otherwise
acknowledged. I also certify that the work is original and has not been previously
submitted for any other award.
___________________________________ __________________
Signature of Candidate Date
Endorsement
___________________________________ ___________________
Signature of Supervisor/s Date
Acknowledgements
This research could not have taken place without the generous involvement of nine special men. They were all enthusiastic about telling their stories in the hope that others would gain benefit. Unfortunately, two of the participants did not live to see the finished project. I sincerely trust that the conclusions reached in this research will achieve what they and the other men anticipated.
I have special gratitude for my supervisor, Professor Cath Rogers-Clark who has been a source of infinite wisdom, patience and encouragement. Her experience and expertise have been a source of inspiration for me. My long-time friend and colleague Dr Des Coates was always perceptive and incisive in his observations as an Associate Supervisor. His insight and encouragement are also appreciated.
During the course of my research I have had the pleasure of having frequent discussions with, and the support of, a number of colleagues. I especially thank Dr Susanne Pearce for her challenging and good humoured discussions, and Dr Jenny Moffatt for providing perspectives that I have found informative. I have appreciated the support of my colleagues in the Department of Nursing and Midwifery at USQ, especially those also undertaking the PhD journey. I thank colleagues in the Centre for Rural and Remote Area Health who have shown considerable interest in my work and always offered encouragement.
I gratefully acknowledge the help of my colleagues at Cancer Council Queensland – Megan, Sylvia, Brigid and Alex, the Prostate Cancer Foundation of Australia, particularly David and Daryl, the Toowoomba Prostate Cancer Support Group, and Pastoral Carers at the Toowoomba Hospital, especially Lyn, for their diverse assistance, interest and encouragement. I have also received support from many other friends and colleagues and I am very grateful for this.
I owe a debt of gratitude to Dr Denise Miner-Williams, whose work, acknowledged during this dissertation, was a catalyst for some of my thinking on spirituality. I also acknowledge with thanks the proofreading carried out by Ms Judy Brewer.
We join spokes together in a wheel,
but it is the centre hole
that makes the wagon move.
We shape clay into a pot,
but it is the emptiness inside
that holds whatever we want.
We hammer wood for a house,
but it is the inner space
that makes it liveable.
We work with being,
but non-being is what we use.
Page i
Table of Contents
CHAPTER 1 – INTRODUCTION ... 1
Background ... 3
Aim of the study ... 4
Research questions ... 5
The researcher ... 5
Research outline ... 7
CHAPTER 2 – LITERATURE REVIEW ... 11
About spirituality ...13
Spirit and spirituality ... 14
Multidimensional nature of spirituality ...20
Manifestation of spirituality through behaviour ...29
Outcomes of spirituality ...34
Transcendence – fundamental to spirituality ...36
Other considerations ... 41
Spiritual depth or intensity ...41
Measurement of spirituality ...43
Spiritual needs and distress ...43
About prostate cancer ...46
The disease and its prevalence ... 46
Medical issues ... 47
Advanced prostate cancer and treatments ... 49
Stress ... 51
Coping with stress ... 52
Spirituality, well-being, cancer and prostate cancer ...55
Spirituality and well-being ... 55
Spirituality and cancer ... 58
Spirituality and prostate cancer, and advanced prostate cancer . 61 Conclusion ...67
CHAPTER 3 – RESEARCH METHODOLOGY ... 68
Paradigm and methodology ...68
Page ii
Qualitative paradigm – constructivist position ... 70
Research process ... 73
Phase 1 – The researcher ... 74
Phase 2 – Interpretive paradigms ... 75
Phase 3 – Strategies of inquiry ... 77
Phase 4 – Methods of collection and analysis ... 78
Phase 5 – Interpretation and evaluation ... 80
Conclusion ... 80
CHAPTER 4 – DESIGN AND METHOD ... 81
Participants ... 81
Selection ... 81
Recruitment assistance ... 82
Interviews ... 83
Unstructured, semi-structured or structured interviews? ... 84
Interviewing process ... 86
Interviewing men ... 88
Working with participants ... 90
Difficulties ... 90
Ethical considerations ... 91
Analysis ... 93
Narrative analysis ... 93
Thematic analysis ... 95
Research rigour and quality ... 97
Personal statement ... 99
Conclusion ... 100
CHAPTER 5 – MEN’S STORIES ... 102
Michael ... 102
Craig ... 109
Wayne ... 117
Colin ... 124
Ben ... 131
Jason ... 138
Stephen ... 147
Alan ... 158
Ken ... 166
Page iii
CHAPTER 6 – THE JOURNEY ... 178
Two perspectives ... 178
The journey – medical, physical, psychological and social ... 182
Medical matters – climbing a mountain ... 183
Beginnings – “a hell of a shock” ... 183
Diagnosis – “a knock in the face” ... 183
Treatments – “that’s it?” ... 184
Physical matters – “look after your own body” ... 187
Age – “I feel robbed” ... 187
Sex – “I’m no longer a man!” ... 188
Keeping active – “dancing lifts me” ... 190
Food – “If it comes out of the ground, we eat it” ... 191
Psychological matters – “I have a good mindset” ... 192
Attitude – “it’s not going to get me!” ... 192
Stress – sometimes “the chips were down” ... 192
Emotional volatility – from “Beauty!” to “blubbering mess” .. 193
Suffering – “the pain … worries me” ... 195
Social matters – “they were a great help to me” ... 196
Support – “Wow, I’m not alone in this journey!” ... 196
Dissatisfaction – “my GP really let me down” ... 198
The journey – spiritual ... 199
Connectedness – “a problem shared” ... 200
Connectedness with self ... 201
Connectedness with a partner ... 205
Connectedness with a higher being ... 207
Connectedness with other(s) ... 210
Connectedness – being lifted ... 214
Process and journey ... 214
Values ... 218
Purpose and meaning ... 221
Peace of mind, fulfilment and alleviation of suffering ... 224
“It’s the holistic approach … it’s the whole package” ... 226
Page iv
CHAPTER 7 – “THE WHOLE PACKAGE THAT HAS COME TOGETHER”
... 228
Introduction ... 228
Spiritual dimensions and outcomes – were they evident? ... 232
Spiritual – or psychosocial? ... 236
What is spiritual depth? ... 239
Transcendence – a “lift” ... 240
Does holistic spirituality help in coping with stress? ... 241
Holism and inductive reasoning ... 244
Conclusion ... 244
CHAPTER 8 – CONCLUSIONS AND RECOMMENDATIONS ... 245
Outcomes of this research ... 245
Significance, future research and recommendations ... 247
Conclusion ... 252
REFERENCES ... 253
APPENDICES ... 287
A Consent Form ... 287
B News release to Prostate Cancer News ... 289
C Second news release to Prostate Cancer News ... 291
D Letter to individuals ... 292
E Cancer Council Queensland Helpline ... 293
Page v
List of Conceptual Maps
Conceptual Map 2.1 – Spirituality: synthesis of the literature ... 40
Conceptual Map 6.1 – Thematic analysis: the medical, physical, social and psychological journey ... 182
Conceptual Map 6.2 – Thematic analysis: the spiritual journey ... 200
Conceptual Map 7.1 – Thematic analysis: the “Holistic Package” ... 231
List of Figures Figure 3.1 – Paradigm and process for this inquiry ... 74
List of Tables Table 2.1 – Overview of five sections in the literature review of spirituality... 14
Table 2.2 – Concept and practice of values: summary of references ... 33
Table 2.3 – The chance of occurrence of prostate cancer ... 47
Table 3.1 – Basic beliefs of alternative inquiry paradigms – updated ... 71
Table 3.2 – Five philosophical assumptions about a constructivist paradigm ... 72
Table 6.1 – Age-related matters ... 180
