leisure in the lives of older men: coping and adaptation

234 Pages·2004·0.89 MB·English

LEISURE IN THE LIVES OF OLDER MEN: COPING AND ADAPTATION
FOLLOWING PROSTATE CANCER DIAGNOSIS AND TREATMENT

By

DAVID KINGDON HOWARD

A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY

UNIVERSITY OF FLORIDA

2004
Copyright 2004

by

David Kingdon Howard
This dissertation is dedicated to my cousin Angelique “Angel” Adrienne Gunnell Tilby
[1964–1998], and the many people who, like her (whether in the past, present, or future),
encounter and face cancer and the challenges it presents to mind, body, and soul. And
despite those challenges, or perhaps because of them, choose to continue to live with
dignity, purpose, and tremendous courage.
ACKNOWLEDGMENTS
I would like to thank several individuals who have supported me during the
completion of my Doctorate degree and this dissertation study. Most importantly, I
extend sincere appreciation to my wife and children, for their support and patience
throughout this process. I also thank my parents for their constant interest and support of
my activities throughout the years.
I thank Dr. Candy Ashton-Schaeffer for being the type of person that drew me to
the University of Florida in the first place, and was a large influence in my first two years
within the Department of Recreation, Parks, and Tourism. And I thank Dr. Heather
Gibson and her successful efforts to instill in me an appreciation and passion for
scholarship in the area of leisure studies. It was her graduate seminar, Foundations of
Leisure Behavior, within a course project through which the seeds were planted that
eventually led to the design and implementation of what became my dissertation
research.
I express my appreciation and respect for the faculty and staff of the College of
Health Professions, and the leadership and structure of the Rehabilitation Science Ph.D.
program, where I spent the last year of my doctoral work. I wish to express my gratitude
to my supervisor, Dr. Elizabeth Swett from the Department of Rehabilitation Counseling,
for her patience and encouragement throughout the ups and downs of dissertation work. I
also want to thank and express my respect for the members of my advisory committee.
From the College of Health Professions, Drs. Robert Glueckauf (Clinical and Health
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Psychology) and Mary Ellen Young (Rehabilitation Counseling) were instrumental,
particularly Dr. Young and her expertise in the area of qualitative methodology.
I appreciate Dr. William Marsiglio from the College of Liberal Arts and Sciences,
Department of Sociology, who was with me the entire way, and provided invaluable
guidance regarding qualitative research and scholarship regarding men and masculinity. I
also express gratitude to Dr. Bryan Weber from the College of Nursing and his guidance
particularly in regard to older men, prostate cancer, and psychosocial issues relevant to
planning effective ways to make a difference in men’s lives. Assisting Dr. Weber in his
own research within this area proved to be immensely valuable. I am also grateful to Dr.
Carmen Russoniello in the Department of Recreation and Leisure at East Carolina
University (ex-officio committee member) for his oversight and recommendations
pertaining to leisure within this study.
Finally, I would like to thank the men who volunteered to participate in my study.
Almost without exception, these men stated their interest in sharing of themselves so that
others might be helped because of it.

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TABLE OF CONTENTS

page

ACKNOWLEDGMENTS ................................................................................................. iv
LIST OF TABLES...............................................................................................................x
LIST OF FIGURES ........................................................................................................... xi
ABSTRACT...................................................................................................................... xii
CHAPTER
1 STATEMENT OF THE PROBLEM............................................................................1
2 REVIEW OF RELATED LITERATURE....................................................................7
Men and Theories of Aging..........................................................................................7
Leisure and its Role in Older Men’s Lives.................................................................10
The Meaning of Leisure..............................................................................................13
Prostate Cancer Etiology and its Threat to Health......................................................15
Risk Factors and Cancer Screening.....................................................................15
Treatment for Prostate Cancer and Potential Side Effects ..................................17
Psychosocial Adaptation, Coping, and Health ...........................................................18
World Health Organization and the ICF Model ..................................................24
Coping and Leisure..............................................................................................26
Research Questions.....................................................................................................30

3 METHODOLOGY .....................................................................................................32
Overview.....................................................................................................................32
Research Design .........................................................................................................32
The Grounded Theory Approach.........................................................................33
Researcher as Instrument.....................................................................................35
Sensitizing Concepts ...........................................................................................36
Developing Grounded Theory.............................................................................38
Constant Comparison ..........................................................................................39
Peer Debriefing....................................................................................................40
Selection of Participants .............................................................................................40
Purposeful and Theoretical Sampling .................................................................41
Ethical Considerations.........................................................................................42
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Informed Consent ................................................................................................42
Potential Risks and Benefits ................................................................................43
Confidentiality.....................................................................................................43
The Setting...........................................................................................................43
Pilot Study ..................................................................................................................44
Interview Process and Data Collection.......................................................................45
The Participants ..........................................................................................................49
Analysis of the Data....................................................................................................53
Standards for the Quality of Conclusions...................................................................56
Methodological Variability.........................................................................................59
Summary.....................................................................................................................62

4 INTRODUCTION TO FINDINGS ............................................................................63
Identification of the Central Category ........................................................................66
Outline of the Report of Findings ................................................................68

5 OLDER MEN’S LIVES AND THE MANY FACES OF LEISURE.........................71
Defining Quality of Life .............................................................................................71
Fulfillment of Masculine Roles ...........................................................................71
Personal Values and Characteristics....................................................................73
Relationships with Spouse and Family................................................................76
Appreciation of Health ........................................................................................77
Productivity and Involvement in Activity ...........................................................79
Other Parameters of Quality of Life ....................................................................81
The retirement transition ..............................................................................81
Notions of masculinity .................................................................................84
Masculinity and attitudes regarding sexuality..............................................88
Generativity: Interacting with posterity .......................................................93
Older Men’s Lives – Discussion about Quality of Life..............................................96
Discussion of Older Men’s Life Transitions ..............................................................99
The Many Faces of Leisure ......................................................................................103
Time...................................................................................................................103
Activity ..............................................................................................................104
Participation and Involvement in Life Events ...................................................106
Relationships .....................................................................................................109
Antithesis of Work ............................................................................................110
Other Factors Pertaining to Leisure...................................................................111
Motivation and meaning of leisure.............................................................111
Constraining variables................................................................................118
Older Men’s Lives – Discussion about Leisure Attitudes and Behavior..................123

6 MEN’S EXPERIENCE WITH PROSTATE CANCER...........................................130
Reacting to the Diagnosis of Cancer ........................................................................130
Shock and Denial...............................................................................................131
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Anxiety and Depressive Symptoms...................................................................132
Calm and Acceptance ........................................................................................133
Spousal Reaction to Diagnosis ..........................................................................135
Discussion about Men’s Experience with Prostate Cancer ......................................135
Selecting Treatment ..................................................................................................137
Discussion about Role of Spouse .............................................................................146
Discussion of the Process of Selecting Treatment....................................................148
Discussion of Different Treatments as a Condition of Men’s Experience ...............153
Coping with Physical Side Effects ...........................................................................154
Hot Flashes ........................................................................................................154
Breast Growth/Tenderness ................................................................................155
Bowel Difficulty................................................................................................155
Fatigue ...............................................................................................................156
Dry Mouth .........................................................................................................156
Pain ....................................................................................................................157
Incontinence ......................................................................................................158
Reduction of Penis Size/Ejaculatory Changes ..................................................160
Impact on Libido ...............................................................................................160
Erectile Dysfunction..........................................................................................162
Coping with Psychosocial Side Effects ....................................................................166
Shock and Denial...............................................................................................166
Anxiety and Uncertainty....................................................................................167
Anger and Irritability.........................................................................................169
Embarrassment and Isolation ............................................................................170
Threat of Reoccurrence .....................................................................................171
Religion and Spirituality....................................................................................173
Discussion of Side Effects as a Category .................................................................177
Discussion about Physical Side Effects.............................................................177
Discussion about Psychosocial Side Effects .....................................................178
The Impact of Prostate Cancer Experience on Leisure Attitudes and Choices ........179
Leisure as a Condition of Coping and Adaptation....................................................187

7 SUMMARY AND RECOMMENDATIONS ..........................................................197
Summary...................................................................................................................197
Limitations................................................................................................................198
Implications for Practice and Research ....................................................................199
Participant’s Advice to Other Men ...........................................................................204
Conclusion ................................................................................................................206

APPENDIX
A FLYER......................................................................................................................208
B INFORMED CONSENT..........................................................................................209
LIST OF REFERENCES.................................................................................................211
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BIOGRAPHICAL SKETCH ...........................................................................................221

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LIST OF TABLES
Table page

1 Advantages and Potential Side Effects of Prostate Cancer Treatments ...................18
2 Frequency Distributions of Selected Demographic Variables .................................51

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