Usual care: refers to the hospital’s routine care activities which are used for survivors of breast cancer conducted by a nursing team and other health care providers at an out-patient department including regular check-ups, medication, and health education.
Data Collection:
Preparing the researcher: The PI studied Buddhist thought, encompassing critical reflection theory, teaching methods, and research. This included practicing critical reflection based on the Four Noble Truths by herself for three months before conducting the program.
Preparing the research assistants: Two research assistants helped to approach and screen survivors of breast cancer at the outpatient surgical/oncology clinic. In addition, two research assistants (a monk or a nun), taught the Four Noble Truths. They received a manuscript of the Four Noble Truths prior to teaching, to ensure consistency and formalization of their expertise.
Data collection procedure: At week 0 (baseline assessment), all three instruments were administered to the participants, and the PI conducted the intervention for the experimental group, with the control group receiving the hospital’s routine care activities. All data were obtained again immediately, 2 weeks, and 1 month after finishing the intervention.
Data analysis: Descriptive statistics were used to analyze the participants’ demographic characteristics. The Chi-square test and independent t-test were used to examine the difference of demographic data and the dependent variables (FCR and hopelessness) between the participants in the experimental group and the control group at baseline. Due to non-normal distribution of the data sets, the Friedman Test was used to test the difference of the FCR scores and the hopelessness scores over a period of time. The Mann-Whitney U Test was used to test the difference between the control and the experimental group at each point of measurement.
Results
All participants in the control group and the experimental group were female (100%). Both groups were similar in all demographic data at baseline in terms of age, marital status, number of a children aged less than or equal to 12 years, educational level, monthly income, sufficiency of income, occupation, and health service expenditure. Also, both groups were similar in time since diagnosis, stage of cancer, and type of treatment (Table 2).