The effect of the "Femininity Identity Improvement Program" based on cognitive behavioral and expressive techniques applied to gynecological cancer patients on prolonged grief reactions and determining the perception of femininity

The study employed the mixed-methods approach, combining quantitative and qualitative methods, to investigate the impact of the "Femininity Identity Improvement Program", grounded in cognitive-behavioral and expressive techniques, on prolonged grief responses in patients with gynecological cancer. Additionally, the research aimed to determine patients' perceptions of femininity. The research protocol was registered in the Clinical Trials registry with the number NCT05529303. The study was conducted at Afyonkarahisar Health Sciences University Health, Practice, and Research Hospital from August 2022 to October 2023. The sample for the study consisted of a total of 80 gynecological cancer patients, with 40 participants in the intervention group and 40 in the control group, who agreed to participate and met the inclusion criteria based on a power analysis. Quantitative data were collected through the Personal Information Form and the Prolonged Grief Disorder Scale-Patient Form at pretest, posttest, and follow-up test stages. Analyses revealed that the changes in PG-12-Patient Form scores over time between the intervention and control groups were statistically significant (p<0.05). The analysis revealed statistically significant differences between the intervention and control groups in terms of the median values of the PG-12-Patient Form pre-test and post-test score differences, as well as the mean values of the pre-test and follow-up test score differences (p<0.001). Additionally, a statistically significant difference was found between the groups in terms of the median values of the PG-12-Patient Form post-test and follow-up test score differences (p = 0.033). When the effects of P PG-12-Patient Form pre-test and post-test measurements were controlled, ANCOVA analysis results indicated a statistically significant difference in PG-12-Patient Form follow-up test scores between the intervention and control groups (p=0.006). Post-intervention PG-12-Patient Form mean scores of the patients in the intervention group were significantly lower than those in the control group, and the effect size (η^2: 0,110) was close to a strong level (0.114). Qualitative analyses revealed six main themes related to the patients' perceptions of femininity after the sessions. Based on the results, it is recommended that the "Femininity Identity Improvement Program," incorporating cognitive-behavioral and expressive techniques, be utilized to address prolonged grief responses associated with the losses linked to femininity experienced by gynecological cancer patients.