Abstract

This study is a descriptive analysis using social survey approach. The sample of the study is a group of cancer patients in many of Riyadh's hospitals. The sample is tested on patients generally; married and single women at the age of eighteen and above. It also includes female specialists who have one-year experience and more in working with cancer patients. The aims of the study were to address socio economic and psychological alterations that affect cancer patients and to determine the role of social workers to support cancer patients. The main outcomes of the study were to address the support of social workers in solving psychological problems as a result of cancer. The noticed feeling of cancer patients was the feeling upset that resulted from others' sympathy on their health condition. Whereas, the main economic problem was their requirements for housemaid that burden their families. The major attitudes of cancer patients towards the social worker was the significant needs to their assistant.

1. Introduction

Cancer is one of the major diseases which affects people at all ages. It causes a problematic situation for different patients as it may exist for some patients for their whole lives. Also, cancer medicine is challenging when trying to find a complete cure at different types of cancer because it might lead to a crisis for the patients. It also makes them on a permanent alert because of requiring a periodic follow-up, accurate observation, and a regular diet. Cancer danger appears in the risk of a lot of severe complications that affect different parts of the body and have a negative impact on its functions ¹. There is no clear and specified professional intervention tasks for social worker as performing a professional role to practice social work in the field of chronic patient care and the poor relationship between the teamwork (attending physician, hospital administration, nurse, nutritionist, other services). In addition, the social worker does not have a background on social associations and private charitable associations or has a superficial knowledge of these associations. The social worker does not know the association's goals, why it has established, what categories that it serves, and what its conditions are.

2. The Significance of the Study

The significance of the study lies in the researcher's work in health field especially with patients. The researchers found out the importance of this research to know the mechanisms, methods, skills and guidance in dealing with a patient infected by a chronic disease, or dealing with the patients' relatives to accept the new circumstances, and to mitigate the shock. Here is the briefing of the significance of this study as follows:

1. Providing the scientific contribution in the field of social studies, especially in the field of medical social work.

2. Knowing the effect of the shock on patients with cancer and their family members, and searching for some solutions that can help them and their family to accept their fact and practice their life properly.

3. Creating new ways to improve the contribution of social workers to support cancer patient using the perspective of crisis theory.

4. Enriching researches that handled this category of cancer patients with the increased cases and ascending the infection's percentage annually.

Last years witnessed increasing in the percentage of infected people with cancer diseases and spreading cancerous tumours with its different types in different areas in Saudi Arabia, leaving a large number of citizens infected of these tumours of different races and ages. This made an urgent need to recognize this disease, its reasons, its methods of treatment and the need of preventing it. Numbers and statistics of national registry for tumours related to Ministry of Health assure increasing cancer cases in Saudi Arabia about 11.6% between 2002 and 2003. Regarding years before 2001 and according to national registry publications of tumours, new cases increase near 30% every year. There is not an official register until now for the years 2004, 2005 and 2006. Researchers and workers on registering and following up statistics in medical statistics and records acknowledge that registration may lack deficiency in following up some cases that have not been checked in hospitals and centers which record tumours cases. This happens whether because of the travelling abroad of these patients for treatment, going to traditional doctors and not monitoring their cases in official hospitals which insert them within statistics or deficiency in monitoring the case. It may also due to lack of sufficient knowledge, non- suspicious and inaccuracy of diagnosis, mistaken in diagnosis or the patient's disappearance before making sure of his case whether because of death, travelling abroad for treatment or accessing to medical medicine. This deficiency may reach in some expectations to near or exceed 10% of officially registered cases. With an overall look to the increase percentage (11.6 %) per year between 2002 and 2003 and the deficiency factor in registration, the predicted cases for recent year may reach 10.000 cases in 2004, 11.000 new cases in 2005, 12.000 new cases in 2006, and may reach 13.000 cases in 2007 AD ². The social worker treats cancer patients through assisting some cases that need intervention of the medical social worker to solve a professional and economic problem that prevent the patient from completing the treatment for a while. Also, explaining some social and medical aspects that affect patient's case for specialists, his family and the patient himself, and following up morbidity such as heart disease, paralysis and cancer to facilitate enjoying life for those patients ³. Crisis Theory is considered one of the new approaches that takes care of short treatments that individuals who are living with problems resulting from exposure to the cancer shock can benefit from. It targets quick professional intervention of individuals and groups. Crisis is a specific type of problems or situations that individual confronts because it has aspects of a problem in serving a person as there is a deficiency in social recruiting. No one can fix this deficiency by his own capacities without asking for help from specialists such as social worker. This means that crisis is called on those types that a person feels nervous and extremely pressured when it constitutes a threat on his life and security. ⁴

3. Aims of the Study

1. To recognize the major social problems that cancer patients suffer from.

2. To recognize the major economic problems that cancer patients suffer from.

3. To recognize the major psychological problems that cancer patients suffer from.

4. To recognize cancer patients' attitudes towards the work of social workers.

5. To recognize the role of social workers to face social problems of cancer patients.

6. To recognize the role of social workers to face economic problems of cancer patients.

7. To recognize the role of social workers to face psychological problems of cancer patients.

4. Concepts of the Study

Social work is considered an important way of the ways of developing society resources and increasing its safety, health and security. It also has preventive objectives such as early detection to medical individual, community problems, facing them through health awareness, and culture to prevent patient's deterioration again. Participating in awareness-raising campaigns to rationalize awareness, family planning, creation and providing atmosphere, and suitable social conditions for patients after their return and recovery of their disease to their natural environment. Medical social work processes is based on the professional relationship that a social worker seeks to do with teamwork; individuals, groups and communities. This relationship is an institutional objective and neutral to the social worker who makes it with patient's beneficiary of association services that works for, and his professional intervention is on this base to provide success basics to serve patients ⁵. Medical social worker should be prepared professionally in a scientific proper way to be able to do his professional role and practice his technical methods at medical treatment institutions to be able to apply what he has theoretical learned in a scientific way. This preparation helps him to acquire essential skills to work in this domain because dealing with friends is difficult, so what about dealing with patients with psychological and social pathological pressure ⁶.

The intervention of crisis model is one of the modern models in the field of social work that had a theoretical basis through the fifty previous years which witnessed the emergence of the model through the application and practice. There is a need to understand the crisis, how it happens, entrances and technical methods of treating it, to help the social worker to succeed in doing his professional roles efficiently while intervening into a crises ⁷.

5. Concept of Crisis

Crisis constitutes a specific type of problems or situations that a person face and it has all the aspects of the problem, but we should indicate that it is not true to call this name on each problem. Each crisis is a problem, but not each problem is a crisis. This name is confined to this type of problems that humans feel pressure and extreme agitation on, and feel that it constitutes a threat to his life or safety. Crisis as defined is an accident, experience and situation threads human life, and his abilities and methods are incapable of adaption or dealing with them ⁸. While (Fink, 1967) ⁹ defines crisis as a transformation stage in individual’s life that needs arrangement to some psychological aspects for individual. Sadek, 1992 ¹⁰ defined crisis as an obstacle or barrier that faces someone and prevent achieving his essential life goals, and it cannot be treated by traditional usual adaptive methods. Crisis is divided into two main types, expected and unexpected crises.

This is like different growth crises such teen aging, agedness crisis and the crisis of retirement.

Such as collapse of buildings, floods, torrents, mass diseases, epidemics, cases of drowning and accidents. Crises may be hard to get over due to the subject of the crisis if it is psychological crisis, health crisis, family crisis. There are also financial crises, morale crises, natural crises and unnatural crises. Therefore, it is clear that crisis is a problem in its concept of serving individuals, but this type of problems that do not have the feeling of nervousness or extreme pressure towards them and feel that it constitutes a threat to his life or safety in life. Cancer patient capabilities have become limited to do all his fully social roles in life because of the disease and incapability, and also his family became suffering as a result of the disease of psychological, family, economic and social problems.

6. Methods of Intervention of Crises Treatment

Second: treatment methods that aim to remove or reduce negative feelings accompanying to the crisis and this includes number of methods mainly:

To reduce negative feelings such as anxiety, tension, feeling guilt and shame that is related to the crisis, patient may be aware of these feelings, but he fears expressing them or may not be aware of them. There are specific steps for arousal, encouragement and recruiting.

This is with people whom crisis do not run out with their power when their ego do. It is meant to divide crisis into small parts and considering each part as a treatment objective and starting with the easiest parties that can be solved to give the patient more confidence and reduce the sharpness of negative feelings that he has.

Patients who are disturbed by the crisis lost their balance and their ego reached out a large level of anxiety. These negative feelings are reduced by investing self-resulting from removing external pressures that cause the crisis and discussing the development that he has achieved during meetings. This could make the patient regain his balance again.

Feelings are accompanying to the crisis that the patient consider it insoluble, or it is the end and there is no hope to solve or go through it. It aims to assure putting the problem at its right position neither disproportionate nor patronizing by giving hope in solution without denying the amount of requested effort.

The treatment methods included in this group treatment aims to support the client's ability to cope with the crisis described below.

A client in a crisis situation and deeply related to the past and immersed in his thoughts and feelings does not give the future the attention that suits it. His look to future seems to be desperate and hopeless. That’s why it is necessary to attract the client towards the present and future instead of focusing on the past and getting absorbed in it. Where this method is intended to raise the client's expectations about the future, his desired and undesirable possibilities, how he can be affected in order to avoid the undesirable possibilities, to be as he pleases. In addition, giving him hope about what raised by these possibilities provided that this expectation doesn't raise unrealistic hopes.

Providing the client with the information and skills he needs to get out of the crisis and this information and skills vary from one client to another according to the client's personality and the type of problem. Details about the crisis, how it occurs, its relationship to events, and other people in the client's life, which makes him understand the crisis better and makes him more fixable to deal with it. Information about the available environmental sources that may participate in solving the crisis and how to whether benefit institutions or people. Information about treatment methods used in dealing with the crisis and how they can be effective in dealing with it and explain the causes that led to the failure of methods that he does not enable him to succeed in achieving his objectives.

Direct methods of influence, which are aimed at informing the client the specialist's point of view in how to behave properly in a particular part of the problem. These methods include, in particular Inspiration, weighting and advice. This method is largely used when intervening in crises, especially at the beginning of intervention where the client is regarded as a prey to negative emotions that weaken his ability to think properly. Then, the crisis is in its serious development and the need to use these methods reduce gradually with the recovery of the customer to his strengths.

The heat position includes some cases of loss of a loved one or a basic relationship in his life as a result of death, divorce, abandonment or detachment the client from the communities to which he belongs in some cases of financial disasters and this leads to a sense of isolation and emptiness and make him seclude himself and may lead him to mental disorders. Therefore, it is necessary in this case to find alternative relationships and affiliations to those lost by the client through helping him to return to the communities from which he was detached and to join new alternative communities or to provide other people instead of those lost by the client.

It requires facing the crisis from effort and capacities that are out of an individual capability, so it should recruit environmental capacities as one of the steps that he goes on with a great importance, and it includes the following environmental capacities: Every available capacity whether financial or human in the patient's family. The institution's capacity where the social worker works whether it is financial or technical, or other institutions' capacities and other professionals in the local community. Volunteers' capacities and non-official local leadership that can be recruited to serve the patient. All these methods have an importance regarding the crisis nature that cancer patient passes and its complicated dimensions that need many methods and non- traditional to face the crisis because it includes many personal, social dimensions and the need to exert efforts to face them. Cancer patients need methods that support him, methods invest his capabilities, and trying each path to contribute in facing the crisis.

7. Cancer

Cancer is one of the major reasons of death all over the world, it caused death to 9.6 million people in 2018. Cancer is a disease that fears mankind and it may turns its infected people to despair, fear or psychological pain. Many researches and studies have handled many reasons that leads to cancer and also many methods that are used in treatment, but there is not a restrict reason or restrict treatment until now. Cancer is a malignant and harmful disease, forms as a result of an anomalous growth of the cell. It is unlike the normal cells and the growth of these cells do not stop when it is connected to other cells. Cancer cells spread by invading of these anomalous cells on the surrounding tissue, through blood or vessels lymphoma that constitutes of blood plasma and white cells to other parts of the body. Cancer cells wrestle with normal cells for food that finally leads to killing the normal cells by depriving them from food ¹¹.

Psychological health for an individual means psychological equilibrium that aims to character cohesion and unity, accepting one's himself, accepting from society that results in a feeling of happiness and psychological well-being. Psychological equilibrium impacts for diagnostic and treatment of cancer for many factors such as: family, friends, religious beliefs and all of them are important for giving hope to patients. The fact that cancer patients suffer from is the psychological stress which leads to restricting social activities, as many of them face difficulties concerning activities due to this illness. it is clear that psychological stress and less psychological support affect the level of melancholia cause of relation disorders with persons after getting this illness, some relatives and friends avoid them, while some close friends feel pity and sympathy for them, if family and friends show friendly and calmness, this will help them.

Quit their social duties due to illness either his fear or others fear to contact cause of piety and suffering. Social problems are connected situations, deeds and reactions affects the human life and make the problem harder and more complexity by time. Depending on this, there are many social problems that will affect the patient's life and put burdens, in addition to his illness.

Fragility of family relation concerning the patient relation with family members cause of staying away especially if he stayed in the hospital for a long time. Increasing the stress factors on the family due to some economic factors, which will lead to increased family problems and aggravate them will lead to separation and divorced.

The economy factor is the most important one in the active life which contributes positively or negatively on the patient's life. The patient's present in the hospital acquires more costs to meet the medical needs, the matter becomes more complex if the head of the household is the patient, as his illness will affect his income and his ability to work as usual. This situation will affect him and his family income at the same time they are in bad need for more money to meet his family needs. Difficulty to get medicine due to their bad economic situation, such as changing medicine system and high cost nutrition, quitting work for a long period of time, reducing work hours to satisfy his illness or move to a new house suitable for his state.

A proposal role for the social workers dealing with the cancer patients to face social, economic, psychological problems which they suffer from. There are many problems and feelings of the patient with cancer resulting or associated with the situation or problem: such as anxiety, fear, depression, indifference, lack of motivation, contradiction, acceptability, resistance, disturbance, confusion and more of the feelings which the patient suffers due to some situations or problems connected the illness and how the patient adhere to it and how is her attitude towards the situation, defining the patient abilities, her readiness to do more effort and doing her efforts to solve the problem. The social worker should estimate the social, economic and psychological dimensions of cancer patients in preparation for the development of the social treatment plan beside the medical treatment, linking the patient with the sources of service that can be provided to her, holding seminars for citizens and inviting specialists in all medical, psychological and legal to aware the gravity of cancer and the reasons for its spread.

8. The Study Sample

Twenty-nine of the study samples of the social workers represent 78.4% of the total study sample are BD qualified and they are the largest share of the study sample of the social workers. Thirty-one of the study samples of the social workers represent 83.8% of the total study sample are specialized in social service and they are the largest share of the study sample of the social workers. Twenty-three of the study samples of the social workers represent 78.4% of the total study sample are experienced more than seven years and they are the largest share of the study sample of the social workers.

9. Methodological Study Procedures

The methodological study is the scientific methods and organizes procedures. Following these procedures lead to answering the questions and achieving the study's objectives. The researchers used the descriptive approach and this as Al-Asaf defines: "This kind of research happens by interviewing all or a great number of the study's sample to describe phenomenon examined in terms of its nature with an eye to deducing results ¹². The researchers used a questionnaire to collect information. This is a tool of collecting information methods that depend on a form constitutes of some questions are sent by email or are delivered to whom are chosen to answer questions and resend them without any help from researchers whether in answering questions or understanding them. Researches did two questionnaires. The first questionnaire was for social workers and the second one was for patients with cancer. Subsequently, researchers followed the following steps to assure its validity for field application:

To measure the validity of the study's tools, they proposed to a group of arbitrators. In the light of their views, researchers prepared a final edition of this study.

Researchers applied this study in field and on the sample. They calculated the Pearson correlation coefficient to assure the validity of the internal coherence, as correlation coefficient is calculated between the degree of each sentence of the questionnaire with total degree to the column that this sentence relates to.

10. Results

First: Describing study samples vocabulary of cancer patients: Thirteen of the study samples of the cancer patients represent 36.1% of the total study sample, their ages are 45 and more, and they are the largest share of the study sample for the patients' cancer. Eighteen of the study samples of the cancer patients represent 50.0% of the total study sample are married, and they are the largest share of the study sample for the cancer patients. Twelve of the study samples of the cancer patients represent 33.3% of the total study sample are able to read and write, and they are the largest share of the study sample for the cancer patients. Twenty-eight of the study samples of the cancer patients represent 77.8% of the total study sample are housewives, and they are the largest share of the study sample for the cancer patients.

11. Recommendations

Working on activation the social worker's role, concerning, solving the cancer patient's social, psychological and economic problems. Setting ways to limit the cancer patient's social, psychological and economic problems. Alarming the society that showing piety in front of the cancer patients is fault, and we should reduce asking about their health. Concerning the loss of appetite which the patient's face. Supporting the patient's families to solve the financial burdens which patients face due to their illness. Providing the cancer patients a leave paid to complete their treatment. Doing more studies and future searches concerning solving problems which patients suffer. Encouraging male/female social workers to work in this field. Providing professional specialized courses for social workers to help them dealing with the cancer patient. Labor authorities will make benefit of caring cancer's patient through this study and other specialized study to activate decentralization. Encourage the private and charitable sector to provide more assistance to cancer patients both morally and physically. Activating the role of the media to define this category and its needs.

References