PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

“A Study to assess the effectiveness of mindfulness based stress reduction meditation on level of stress among cancer patients in cancer ward in selected general hospital of mandya district’’.

By,

MR.RAGHURAMA G.N

FIRST YEAR M.Sc (NURSING)

PSYCHIATRIC NURSING

YEAR 2012-2013.

NEW NAVODAYA INTITUTE OF NURSING (NION)

MANDYA-571401, KARNATAKA

0

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,

KARNATAKA

1.NAME OF THE CANDIDATE

AND ADDRESS

Mr. RAGHURAMA G.N

First year M.Sc (Nursing)

2.NAME OF THE INSTITUTE

NEW NAVODAYA INSTITUTE OF

NURSING,MANDYA,KARNATAKA-

571401

3. COURSE OF THE STUDY AND

SUBJECT

Ist year M.Sc (Nursing)

Psychiatric Nursing

4. DATE OF ADMISSION TO THE

COURSE

15 -06-2012

5. TITLE OF THE STUDY

“A Study to assess the effectiveness of

mindfulness based stress reduction

meditation on level of stress among

cancer patients in cancer ward in

selected general hospitals of mandya

district ”.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

Cancer is the result of uncontrolled cell growth. Our bodies are composed of trillions of cells,

all working together. In cancer, one of those cells stops paying attention to the normal signals

that tell cells to grow, stop growing or even to die. Cancer cells still share many of the same

needs and properties of normal cells but they become independent of the controls that make our

body function smoothly. The process by which a normal cell changes into one that behaves so

abnormally can take a long time and is often triggered by outside influences. The next few

sections describe the differences between normal and cancer cells and outline the steps leading

to the creation of a cancer cell from a normal cell.

Cancer is actually a general term that describes a large group of related diseases Every case

of cancer is unique, with its own set of genetic changes and growth properties. Some cancers

grow quickly while others can take years to become dangerous to the patient. The many

differences between cases of cancer, even of the same organ (i.e. different cases of breast cancer)

is one of the main reasons that treatment is so difficult Despite the differences between different

types of cancer, all cancers do share some common features, and these shared properties are the

basis for many cancer treatments and research efforts. It is important to understand the basic,

shared, features of cancer.  This will allow for an understanding of detection, diagnosis and

treatment options.

Cancer prevalence is affected both by the incidence of a cancer and by how long people

normally live with the disease, but it is not a measure of cancer occurrence. This number is the

cancer incidence, which is the number of people newly diagnosed with cancer in a given time

period (usually a year). For example, lung cancer is the second most common cancer in both

men and women, but lung cancer prevalence is not as high as that of some less common cancers.

This is because people with lung cancer tend not to live as long after diagnosis.

2

There are many causes of cancer, including:

Benzene and other chemicals

Drinking excess alcohol

Environmental toxins, such as certain poisonous mushrooms and a type of poison that

can grow on peanut plants (aflatoxins)

Excessive sunlight exposure

Genetic problems

Obesity

Radiation

Viruses

However, the cause of many cancers remains unknown. The most common cause of cancer-

related death is lung cancer.

The three most common cancers in men in the United States are:

Prostate cancer

Lung cancer

Colon cancer

In women in the United States, the three most common cancers are:

Breast cancer

Colon cancer

Lung cancer

Some cancers are more common in certain parts of the world. For example, in Japan, there

are many cases of stomach cancer, but in the United States, this type of cancer is unusual.

Differences in diet or environmental factors may play a role.

3

Some other types of cancers include:

Brain cancer

Cervical cancer

Hodgkin's lymphoma

Kidney cancer

Leukemia

Liver cancer

Non-Hodgkin's lymphoma

Ovarian cancer

Skin cancer

Testicular cancer

Thyroid cancer

Uterine cancer1

Stress is one of the common problems in cancer patients, much research demonstrating that

cancer patients suffer from a significant amount of psychological distress. The assessment of

psychological distress does not only play a role within epidemiological/basic research but also

increasingly within routine clinical practice.

Usually ‘psychological distress’ is interpreted and assessed as psychiatric morbidity or

prevalence of psychiatric disorders, especially anxiety disorders and depression. The prevalence

rate for psychiatric disorders in general among cancer patients varies between 5 and 50%, for

depressive disorders between 0 and 46% and for anxiety disorders between 1 and 49%. The most

frequently used screening instruments on which these findings are based on the Profile of Mood

4

States, the Symptom Checklist or its short form, the Brief Symptom Inventory the State Trait

Anxiety Inventory, the General Health Questionnaire and the Sickness Impact Profile. 2

On the one hand, tumor patients are asked questions that have little relevance for most of

them (psychiatric symptom items) and on the other hand, the specific needs and distress of such

chronic physically ill are only insufficiently recognized, for example, non-neurotic fears,

communication disorders, feelings of physical imperfection, somatic and social consequences as

a result of treatment, This makes for a distorted picture, for instance, in patients whose

psychological findings are not consistent with those of a psychiatric disorder but nevertheless

exhibit signs of high subjective distress and require psychosocial support.

In general, disease-specific questionnaires deliver results that more adequately mirror the

experiences of the patient; they are more clinically relevant, because they more clearly pinpoint

treatment consequences . The findings from a large German cross-sectional screening study that

are based on a measuring instrument specifically developed to determine psychosocial stress in

cancer patients, the Questionnaire on Stress in Cancer Patients revised version.

Herschbach et al,(2003), A little stress can do us good it pushes us to compete and innovate.

But chronic stress can increase the risk of diseases such as depression, heart disease and even

cancer. Studies have shown that stress might promote cancer indirectly by weakening the

immune system's anti-tumor defense or by encouraging new tumor-feeding blood vessels to

form.

In normal cells to thrive in the body, "they need to be attached to their neighbors and their

surroundings," says the study's lead author Anil Sood from The University of Texas M. D,

Anderson Cancer Center in Houston. Cells that detach from their environment undergo a form

of programmed cell death called anoikis. "But cancer cells have come up with way to bypass

this effect they avoid anoikis," Sood says. This allows cancer cells to break off from tumors,

5

spread throughout the body (in blood or other fluid) and form new tumors at distant sites a

process called metastasis. So Sood wondered: Could stress affect anoikis? "It surprised us that

this biology hadn't been studied before," he notes. "Stress influences so many normal

physiological processes. 3

Mindfulness stress reduction Meditation is a mind-body process that uses concentration or

reflection to relax the body and calm the mind. It is defined as “It is a technique that promotes

relaxation through the nonjudgmental awareness of moment to moment sensation experiences

and relaxation”. Meditation is one of several relaxation methods evaluated and found to be of

possible benefit by an independent panel convened by the National Institutes of Health. The

panel found that it might be a useful complementary therapy for treating chronic pain and

sleeping problems such as insomnia. Some cancer treatment centers offer meditation or

relaxation therapy with standard medical care. Available scientific evidence does not suggest

that meditation is effective in treating cancer or any other disease. however, it may help to

improve the quality of life for people with cancer.4

6.2 NEED FOR THE STUDY

According to world cancer report in Geneva, 3 April 2012 - Cancer rates could increase

by 50% to 15 million new cases in the year 2020, the most comprehensive global examination

of the disease to date. However, the report also provides clear evidence that healthy lifestyles

and public health action by governments and health practitioners could stem this trend, and

prevent as many as one third of cancers worldwide.

Malotra T M (2012)In India, which accounts for over thirty per cent of all type of cancers

reported and cancer control is quickly becoming a global health priority. This paper provides a

synopsis of the incidence of oral cancer in India by focusing on its measurement in cancer

registries across the country. . In the year 2000, malignant tumors were responsible for 12 per

cent of the nearly 56 million deaths worldwide from all causes. In many countries, more than a

6

quarter of deaths are attributable to cancer. In 2000, 5.3 million men and 4.7 million women

developed a malignant tumor.5

“The study also tells us that cancer rates are set to increase at an alarming rate globally. We

can make a difference by taking action today. We have the opportunity to stem this increase.

This report calls on Governments, health practitioners and the general public to take urgent

action. Action now can prevent one third of cancers, cure another third, and provide good

palliative care to the remaining third who need it, "said Dr. Paul Kleihues, Director of the

International Agency for Research on Cancer and co-editor of the World Cancer Report.

The National Center for Complementary and Alternative Medicine reports that regular

meditation can reduce chronic pain, anxiety, high blood pressure, cholesterol, substance abuse,

post-traumatic stress disorder in Vietnam veterans, and blood cortisol levels that are increased

by stress (sometimes called “stress hormones”), as well as reducing the use of health care

services.

Senugupta p(2011) Thousands of years ago yoga and meditation originated in India, and in

present day, an alarming awareness was observed in health and natural remedies among people

by yoga and meditation which has been proven an effective method for improving health in

addition to prevention and management of diseases. With increasing scientific research in yoga,

its therapeutic aspects are also being explored. meditation is reported to reduce stress and

anxiety, improves autonomic functions by triggering neurohormonal mechanisms by the

suppression of sympathetic activity, and even, now-a-days, several reports suggested meditation

is beneficial for physical health of cancer patients. Such global recognition of meditation also

testifies to India's growing cultural influence.6

There are different forms of meditation. Meditation may be done while sitting, but there are

also moving forms of meditation, like tai chi, qigong, walking, and the Japanese martial art

aikido. One commonly practiced type is Transcendental Meditation, which involves repeating a

word or phrase, called a mantra, either silently or aloud. Another is mindfulness meditation, in

7

which a person observes sensations, perceptions, and thoughts without judgment as they arise.

There are other types of meditation that focus one’s attention through walking or visualizing.

Meditations that focus on words or images and do not strive for a state of thoughtless awareness

are sometimes called quasi meditative. Meditation can be self-directed, or guided by doctors,

psychiatrists, other mental health professionals, or yoga masters. It can also be guided by

masters from different schools of meditation (for example, Zen meditation, Tibetan meditation,

Transcendental Meditation), as well as those from tai chi and martial arts.

Mindfulness stress reduction meditation may be done by choosing a quiet place free from

distraction, sitting or resting quietly with eyes closed, noticing one’s breathing and physical

sensations, and letting go of all intruding thoughts. The person may also achieve a relaxed yet

alert state by focusing on a pleasant idea or thought, or by chanting a phrase or special sound

silently or aloud. The ultimate goal of meditation is to separate oneself mentally from the outside

world by suspending the usual stream of consciousness. Some practitioners recommend two

sessions of fifteen to twenty minutes a day. Meditation is an important part of ancient Eastern

religious practices, particularly in India, China, and Japan, but can be found in all cultures of the

world. Meditation began to attract attention in the West in the 1960s when the Indian leader

Maharishi Mahesh Yogi brought his method called Transcendental Meditation.

Benson later developed a popular relaxation technique called the relaxation response.

Interest in the use of meditation in the treatment of people with cancer began in the 1970s and

early 1980s, when Ainslie Meares, MD, an Australian psychiatrist, studied the use of meditation

for enhancing the immune system in order to reduce the size of tumors.

Mcdiillion (2011 )In a controlled study of ninety cancer patients who did mindfulness

meditation for 7 weeks, 31% had fewer symptoms of stress and 65% had fewer episodes of

mood disturbance than those who did not meditate. Some studies have also suggested that more

meditation improves the chance of a positive.7

8

6.3 REVIEW OF LITERATURE

Literature review is a key in the research process, the task of reviewing involves the

identification and selection of critical analysis and reporting of existing information on

topic of interest. Literature review can serve the number important functions in the

research process and they also play critical role for nurse seeking to develop evidence

based practice. Stress is the commonest problem in the cancer patients and that’s reduce

the lifespan of cancer patients. The application of mindfulness stress reduction meditation

on cancer patients reduce the stress, so this study is useful for now a days, and conducting

study in cancer hospitals is reliable.

Review of literature has been presented under the following headings.

1. Studies related to the psychological problems and stress problems in cancer patients.

2. Study related to the effectiveness of mind fullness stress reduction meditation on stress reduction in patients.

1. Studies related to psychological problems and stress problems in cancer patients.

Moussaoui et al(2011) conducted a study on prevalence of depressive symptoms in patients

with cancer in Saudi city. In this study a special emphasis on suicidal thoughts and behaviors.

183 cancer patients were included. The mean age was 34.3 +/- 8 years; 90% of the sample were

males; 12.6% were married and 17% had children. The findings shows that, the mean age at

onset of the illness was 24 +/- 5.9 years and its mean duration was 4.8 +/- 1.3 years.. These

results confirm the ones of other studies in the field: depression is frequent among patients with

cancer.8

Chaturvedi S.K (2012) Conducted study on the psychological and emotional problems

encountered in persons with malignancy in Baroda city. Psychosocial oncology is an upcoming

area of interest, which deals with numerous psychiatric, psychological, and social aspects of

9

malignancies. Psychiatric oncology relates to some of the common psychological and emotional

problems encountered in persons with malignancy and their formal and informal caregivers. This

oration will discuss the importance of this field of Consultation Liaison Psychiatry, with a focus

on the research and practice in the Indian setting. This presentation will also share the findings

and researches of the presenter. The findings on researches on somatization and illness behavior

in cancer patients would highlight newer challenges in this field. Caregivers of persons with

cancer are as important as the patient, but usually ignored. The stress, strain, burden, positive

emotions, and coping in the context of care giving for persons with cancer are being increasingly

realized. Professional caregivers should be aware of caregiver difficulties and support them

through their ordeal. Lastly, the importance of dealing with staff stress and burnout among

health professionals looking after families with cancer patients and survivors will be

emphasized.9

McCall WV et al (2010) conducted a study on relationship between insomnia and cancer

during the course of a clinical trial for depression with insomnia in Winston Salem city . A total

of Sixty patients aged 41.5±12.5 years (2/3 women) with cancer and symptoms of insomnia

received open-label fluoxetine for 9 weeks and also received blinded, randomized eszopiclone

3mg or placebo at bedtime after the first week of fluoxetine .this study showed that cancer

patients had severe stress that led to depression among cancer patients.10

Choi C.H (2012) Conducted study on Identifying psychosocial needs and problems in

cancer patients in korea city. The aim of this study was to investigate the psychosocial needs of

cancer patients and its related factors, based on a nationwide sample of cancer patients in

Korea. A multi-center survey was administered to 2661 cancer patients from 10 cancer centers

in Korea. The survey measured the needs for psychosocial support, using the Comprehensive

Needs Assessment Tool in Cancer, and potential correlates, such as socio-demographic and

clinical factors. Multivariate ordinal regression and binary logistic regression were conducted to

identify factors that may predict psychosocial needs. On the measure for psychosocial needs, the

median score of psychological problems was 2.73 points and that of social support was 1.92

points, as the standardized score on a scale of10 points. Needs for psychological problems were

positively correlated with intensive treatment, and degree of stress. 11

10

2. studies related to the effectiveness of mindfulness stress reduction meditation on

reducing stress in cancer patients

Prakash R et al, (2012) Conducted study on examining the practice of mindfulness stress

reduction meditation and the difference in the stress level of cancer patients in Calcutta city . In

this study, we planned the preliminary idea, examining the practice of concentrative meditation

and the differences in the stress level of cancer patients. This was a cross-sectional study

comparing the stress level of mediators and non-meditators in the cancer patients group. 20 long-

term practitioners of meditation were recruited in the present study and were applied tests for

assessment of stress level. The tests is also applied to 20 cancer patients who have not practiced

the meditation technique. The study finally shows that stress level was more in cancer patients

who were not practiced meditation than who were practiced meditation. 12

Branstrom R et al (2007) conducted study on effects of MBSR on level of cortisol that

impair stress level in a cancer patients in England city. The aims of this study were to examine

the effects of a mindfulness-based stress reduction (MBSR) training intervention among cancer

patients on levels of salivary cortisol, and further to explore if changes in psychological

variables mediate intervention effects on cortisol. Patients with a previous cancer diagnosis (n

= 71) were recruited and randomized into an intervention group or a waiting-list control group.

The intervention consisted of an 8-week MBSR training course There were no overall effects of

the intervention on cortisol levels at 3-month or 6-month follow-up. However, a significant

effect of moderation was found showing a different intervention effect on awakening cortisol

among participants. Among those with initial low levels of cortisol, there was an increase from

baseline to 3-month follow-up, and among those with initial high levels there was a decreased

level of cortisol at 3-month follow-up. There was no association between changes in

psychological outcomes and cortisol levels .The results suggest that impaired cortisol level

change stress level in Cancer patient. 13

11

Robins CJ (2012) Conducted study on effectiveness of stress reduction meditation to reduce

psychological distress in medical and psychiatric and non clinical samples in california.

Mindfulness-based stress reduction (MBSR) has been found to reduce psychological distress

and improve psychological adjustment in medical, psychiatric, and nonclinical samples. We

examined its effects on several processes, attitudes, and behavior patterns related to emotion

regulation. Fifty-six adults were randomly assigned to MBSR or to a waiting list

(WL).Compared with WL completers (n = 21), MBSR completers (n = 20) reported significantly

greater increases in trait mindfulness and decreases in absent-mindedness, greater increases in

self-compassion, and decreases in fear of emotions, suppression of anger, aggressive anger

expression, worry, and difficulties regulating emotions. The WL group subsequently received

MBSR, and the two groups combined showed significant changes on all of these variables from

pre-MBSR to post-MBSR, and on all except the 2 anger variables from pre-test to 2-month

follow-up, as well as significant reductions in rumination. An 8-week mindfulness training

program might increase mindful awareness in daily life and have beneficial impact on clinically

relevant emotion regulation processes. 14

Senders A et al(2004) Conducted study on use of meditation therapies on managing physical

and psychological symptoms in chronic health problems in jeuras city. Meditation therapies are

used to manage physical and psychological symptoms in many chronic health conditions.

Objective To assess the published evidence for using meditation techniques for stress

management of cancer patients. Methods, MEDLINE, PsycINFO, and Cochrane Clinical Trials

Register were searched from inception to March 24, 2012. mind-body studies were reviewed

(meditation, yoga, biofeedback, hypnosis, relaxation, and imagery) were found helpful for

reducing stress in cancer patients. The mind-body therapies are relatively safe and may provide

a nonpharmacological benefit for cancer patients. 15

Bohus M,(2011) conducted study on the effectiveness of mindfulness based stress reduction

meditation on reduction of risk of relapse in patients with recurrent depression in Mavora city.

Mindfulness-based meditation is rooted in the Far East meditation culture. In the context of

psychotherapy mindfulness-based treatment programs mostly include mindfulness as modular

components aiming at acceptance of aversive circumstances or emotions and on improvement

12

of metacognitive awareness. Currently there are five mindfulness-based concepts with different

proof of effectiveness: mindfulness-based stress reduction therapy (MBCT) can be classified as

effective in reducing the risk of relapse in patients with recurrent depression, whereas the

popular mindfulness-based stress reduction program (MBSR) reveals only small effect sizes. In

summary, mindfulness used as one component in modular conceptualized treatment programs

seems to be both acceptable and effective. 16

Weber B,(2012) Conducted study on mindfulness based stress reduction therapy and chronic

diseases biopsychosocial adjustements tax the limits of modern conventional medicine in

Canada. Chronic diseases and their associated biopsychosocial adjustements tax the limits of

modern conventional medicine, with the need then to turn towards resources. Among these,

Mindfulness-Based Stress Reduction (MBSR) is a therapeutic approach developed more than 30

years ago, Designed as an adjuvant to medical care, in particular in the case of chronic pain and

chronic disorder like cancer which is the scope of our article, MBSR is usually provided in

group format and based on a meditative practice. After having presented this approach, several

results from studies confirming the legitimacy of MBSR as a nonreligious and nonesoteric

scientific approach for the treatment of various diseases like cancer and HIV will be reported. 17

Lehto (2012) conducted study on the need of effective strategies to modify symptom burden

and improve health related quality of life in cancer patients in east lancing city. Patients with

cancer are in need of effective strategies to modify symptom burden and improve health-related

quality of life (HRQOL). One promising approach to symptom management is an 8-week

mindfulness-based intervention, which incorporates meditation, breathing, and gentle yoga

exercises. It requires few resources to implement. The purpose of this study was to obtain

cancer patient perceptions of a mindfulness-based intervention. Eleven cancer patients

participated in audio-taped focus group sessions led by the investigator. Discussion questions

probed patient perceptions of mindfulness in terms of symptom management. Specific

perceptions included the importance of targeting key symptoms such as dyspnea, worry, and

insomnia.. The design of mindfulness-based intervention protocols must consider unique

characteristics of this vulnerable group, such as targeting specific symptoms, and the 8-week

protocol, and a home-based offering. As cancer survivorship is extended, it becomes

13

increasingly imperative that a range of supportive resources is available for patients to manage

symptoms and improve. 18

Gordon AM (2004) Conducted study on isolation can augment stress among leukemia patients

in Singapore city. Treatment under conditions of genotobiotic isolation can augment the stress

of adaptation to a diagnosis of leukemia. Identification of the psychological problems

experienced in isolator treatment can contribute to the effective maintenance of therapy.

Individual patterns of adjustment to treatment relate to the psychological mechanisms of defence

employed to contend with the dependent position enforced by isolation. Psychiatric assessment

can assist both patients and nursing staff with the management of their separate difficulties in

this unfamiliar treatment situation. Psychological features of isolator treatment in ten patients

with acute leukemia are described and suggestions proposed for psychological management of

patients under isolator conditions. 19

Herzet,S et al (2003) Conducted study on effectiveness of mindfulness based intervention

for anxiety and depressive disorders in salt in kazak. Growing research literature has

documented the effectiveness of mindfulness-based interventions for anxiety and depressive

disorders. Mindfulness-based stress reduction (MBSR) teaches a series of mindfulness

meditation and yoga practices, delivered in a group format during eight weekly sessions plus

one full-day session. This case report demonstrates how MBSR was associated with dramatic

clinical improvement of an individual with symptoms of panic, generalized anxiety, and

depression. Scores on clinical assessment measures suggested clinically severe levels of anxious

arousal, generalized anxiety, worry, fear of negative evaluation, and depression at the beginning

of the intervention. The scores on all these measures fell well within normal limits 7 weeks later

at the end of the intervention, and no remaining symptoms were reported afterward. Increased

life satisfaction and quality of life were documented as well. This case illustrates the potential

benefit of MBSR as an alternative or adjunctive treatment for comorbid anxiety and depressive

disorder symptoms. 20

14

Marchand WR (2003) Conducted a study on reduction of psychological distress from

mindfulness stress reduction meditation in medical and psychiatric patients in salt lake city.

Mindfulness has been described as a practice of learning to focus attention on moment-by

moment experience with an attitude of curiosity, openness, and acceptance. This paper provides

an overview of three mindfulness interventions that have demonstrated effectiveness for

psychiatric symptoms and/or pain. The goal of this review is to provide a synopsis that

practicing clinicians can use as a clinical reference concerning Zen meditation, mindfulness-

based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT). MBSR and

MBCT are secular, clinically based methods that employ manuals and standardized techniques.

Studies indicate that MBSR and MBCT have broad-spectrum antidepressant and antianxiety

effects and decrease general psychological distress. MBCT is strongly recommended as an

adjunctive treatment for unipolar depression. The evidence suggests that both MBSR and MBCT

have efficacy as adjunctive interventions for anxiety symptoms. MBSR is beneficial for general

psychological health and stress management in those with medical and psychiatric illness as

well as in healthy individual. 21

STATEMENT OF THE PROBLEM

“A Study to assess the effectiveness of mindfulness based stress reduction

meditation on level of stress among cancer patient in cancer wards in selected

general hospitals of mandya district”

6.4 OBJECTIVES 1. To plan and implement mindfulness stress reduction meditation on cancer patients.

2. To compare the level of stress before and after meditation therapy among cancer patients.

.3. To determine the association between mean difference in stress level and selected background factors among cancer patients.

4. To assess the influence of meditation on health improvement in cancer patients.

15

6.5 HYPOTHESISH1. There will be significant difference in the level of stress before and after

meditation

H2. There will be significant association between socio-demographic data mean

difference in level of stress

6.6 OPERATIONAL DEFINITIONS

1. Effectiveness

It refers to significant reduction in stress as determined by significant differences in pre and

post test scores.

2. Cancer patients

It refers to patients suffering from any kind of malignant tumours

3. Stress

It refers to the level of psychological distress a person is experiencing due to cancer and its

consequences. In this study stress was assessed using the Sheldon Cohen perceived stress scale.

4. Mindfulness based stress reduction meditation

Mindfulness based stress reduction Meditation is a mind-body process that uses concentration

or reflection to relax the body and calm the mind. It has been defined as the It is a technique that

promotes relaxation through the non judgmental awareness of moment to moment sensation

experiences and reactions. In this study it is carried out for 15 minutes twice a day.

6.7ASSUMPTIONS The study assumes that cancer patients are more prone get stress and mindfulness stress

reduction meditation can minimize the level of stress.

6.8 DELIMITATIONS

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1. Who are willing to participate during the time of studies. 2. Who are available during the data collection period. 3. The sample size is limited to 50 cancer patients at selected cancer hospital in mandya.

6.9 PILOT STUDY

The pilot study conducted on cancer patients to assess the reliability and Feasibility of the

study.

RESEARCH VARIABLES

Study variable:

This study aimed at investigating the level of stress among cancer patients

Independent variable: mindfulness stress reduction meditation

Dependent variables: level of stress in cancer patients

Demographic variable: It includes baseline characteristics of cancer patients such as age,

sex, marital status, occupational status, income, education, diet type, locality, type of family,

duration of illness, type of treatment, type of family, number of close friends.

7. MATERIALS AND METHOD

7.1 SOURCE OF DATA

The data will be collected from the selected in cancer hospitals at mandya district.

7.1.1. RESEARCH DESIGN

One group pre test-post test design will be adopted to asses the effectiveness of mind fullness

stress reduction meditation among cancer patients

17

.7.1.2. RESEARCH APROACH

An evaluative approach will be designed to assess the effectiveness of mindfulness based

stress reduction meditation on stress reduction among cancer patients in order to accomplish the

objectives of the study.

7.1.3. RESEARCH SETTING

The study will be conducted in caner wards in selected general hospitals at mandya district.

7.1.4. POPULATION

All cancer patients of cancer ward in selected general hospital at mandya district.

7.2 METHODS OF DATA COLLECTION

The data collection procedure is carried out for the period of 3 months. The study will be

initiated after obtaining prior permission from the selected cancer hospitals concerned authorities

The data will be collected in three phases.

Phase-1. A pre test will be administered to cancer patients using a perceived stress assessment

scale.

Phase-2. A structured mindfulness stress reduction meditation programe on cancer patients will

be conducted 15 minutes twice a day up to 3months after pre test.

Phase-3. After an interval of 7 days a post test will be conducted for sample using structured

perceived stress assessment scale to assess the effectiveness of mindfulness meditation on

reducing stress in cancer patients.

7.2.1. SAMPLING PROCEDURE

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Non probability convenient sampling technique will be used to select the samples.

7.2.2. SAMPLE SIZE

Sample size for the study will be 50 cancer patients.

CRITERIA FOR SAMPLING

7.2.3. INCLUSION CRITERIA

The study includes,

1. Those who are suffering with cancer

2. Those who are interested to participate and attend meditation.

3. Those who reads Kannada and English.

4. Irrespective of sex and income

7.2.4. EXCLUSION CRITERIA

The study excludes,

1. who cannot read Kannada and English.

2. who are all not available at the time of data collection.

3. Those who are not interested to participate and attend meditation

7.2.5. TOOLS FOR DATA COLLECTION

19

The tools will be prepared by the investigator for data collection and Sheldon perceived stress

assessment scale is used to collect data regarding stress level among cancer patients.

Phase 1-sheldon perceived stress assessment scale containing stress related questions.

7.2.6. DATA ANALYSIS METHOD

The data obtained will be analyzed in terms of the study by using descriptive and inferential

statistics.

a. DESCRIPTIVE STATISTICS

Mean, mean percentage and standard deviation will be used

b. INFERENTIAL STATISTICS

“Paired t-test” will be used to compare the pre test and post test result of the

cancer patients.

7.2.7. TIME AND DURATION

The time and duration of the study will be limited to 3 months or as per guidelines of

university.

PROJECTED OUTCOMES

The investigator believes that the cancer patients will suffer from stress. The result of the

study enables the investigator to reduce stress level in cancer patients by providing structured

mind fullness stress reduction meditation program.

7.3. DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR

INTERVENTIONS TO THE PATIENTS OR OTHER HUMAN BEINGS OR

ANIMALS?

20

No, there is no active manipulation on the subjects.

7.4 HAS ETHICAL CLEARANCE OBTAINED FROM YOUR

INSTITUTION?

The pilot study and the main study will be conducted after the approval of the research

committee. Permission will be obtained from the concerned head of the institution. The purpose

and details of the study will be explained to the study study subjects and an informed consent

will be obtained from them. Assurence will be given to the study subjects regarding the

confidentiality and anonymity of the data collected from them.

8. REFERNCES:

1. Journal of cancer epidemiology. India, Jan 2012 vol 155/2012 pp- 120-126.

2. Indian Journal of Psychiatry.Apr 2012 ;54(2) pp-111-8.

.

3. Asian pacific Journal of cancer. Sep 2012 ;13(9) pp- 4637-4643.

4. Journal Of Stress Health (Philadalphi).Dec 2012 ;28(5) pp-397-407.

5. Journal of Psychiatric Practice salt lake city. July 2012 ;18(4) pp-233-5.

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9. SIGNATURE OF THE CANDIDATE :

10. REMARKS OF THE GUIDE :

11. NAME AND DESIGNATION OF

11.1 GUIDE :

11.2 SIGNATURE :

11.3 CO-GUIDE (IF ANY) :

11.4 SIGNATURE :

11.5 HEAD OF DEPARTMENT :

24

11.6 SIGNATURE :

12.1 REMARKS OF THE PRINCIPAL :

AND THE CHAIREMEN

12.2 SIGNATURE :

25