Introduction
Cancer is a common disease that has caused the health system to face challenges in controlling it. Patients with cancer are exposed to psychological disorders from the time of diagnosis until the end of their life. Psychological support is one of the basic aspects of care for these patients and needs to examine its dimensions and characteristics to help patients with cancer systematically deal with sudden or gradual changes in daily life and also help nurses have a specific framework for patient care. Patients’ care needs are influenced by cultural and social factors and contextual conditions, which can lead to the formation of different care programs. This study aims to investigate healthcare providers’ perceptions of psychological support in providing care to cancer patients. 

Methods
This is a qualitative study that was conducted in 2021. Nineteen healthcare providers were purposefully selected for the study to explore their experiences about psychological support in providing care for cancer patients using an interview that lasted for 45-75 minutes. At the beginning of the interview, the study objective was explained to them. After recording their demographic information, the main open-ended questions were asked. Then, according to their answers, exploratory questions were asked to collect more information. All the interviews were recorded with the permission of the participants by a digital recorder. The recorded information was transcribed and read. Then, the analysis was carried out based on Graneheim and Lundman’s content analysis method. Guba and Lincoln’s criteria were used to determine the validity and strength of the research. 

Results
Based on the content analysis results, four main themes including “highlighting positive mental connection with oneself and others”, “positive awareness”, “positive change in the patient’s point of view”, and “ strengthening the perceived value” were extracted:
Highlighting positive mental connection with oneself and others: Patients have positive abilities and capacities. The healthcare providers give them psychological support by emphasizing and reminding these aspects such as the positive presence of family members and others.
Positive awareness: According to the participants, awareness paves the patient’s way of dealing with the situations which is one of the main features of psychological support. This awareness is made by healthcare providers in a positive way regarding the symptoms and complications of the disease, current situation, and self-care methods.
Positive change in the patient’s point of view: Healthcare providers try to change the patients’ perceptions in a positive way so that the patient, by correcting his/her views, reach a proper understanding of the reality and accept the current situation sooner.
Strengthening the perceived value: This concept indicates the healthcare providers’ special attention to the patient’s values. They emphasize the opinions and spiritual beliefs of the patients and provide care to them with dignity.
These categories reflect the healthcare providers’ effort in “strengthening the positive mindsets” in the patient and shows the formation of psychological support in caring for patients with cancer. These patients suffer from various disorders, which psychologically put them in an exhausting path. During patient care, the patient tries to distance himself from this path. For this purpose, strengthening the patient’s positive mindset puts him in a path of good feelings towards the surrounding events.

Conclusion 
The findings of the present study showed that the basis of psychological support for cancer patients is strengthening of their positive mindsets. This can be helpful for the development of future educational and training programs for the management of cancer. Strengthening of a positive mentality in the patients with cancer should be considered by healthcare providers to meet the psychological needs of patients and provide effective psychological support. In addition, by creating an environment in clinical settings for psychological support, it is possible to direct the necessary educational and administrative programs related to strengthening the positive mentality in patients with cancer.  

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Ardabil University of Medical Sciences (Code: IR.ARUMS.REC.1400.308). A written informed consent was obtained from all participants after explaining the study objectives and methods to them. They were assured of the confidentiality of their information and were free to leave the study at any time.

Funding
This article is extracted from a research project approved in Ardabil University of Medical Sciences.

Authors contributions
Conceptualization: Mir Hossein Aghaei and Saber Azami Aghdash; Methodology, Investigation: Mir Hossein Aghaei, Reza Ebrahimoghli and Somayeh Bodaghi; Writing-Review & Editing: all authors.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to express their gratitude to the Deputy for Research and Technology of Ardabil University of Medical Sciences and all participants for their support and cooperation in this study.


Refrences

1. Mattiuzzi C, Lippi G. Current cancer epidemiology. Journal of Epidemiology and Global Health. 2019; 9(4):217-22. [DOI:10.2991/jegh.k.191008.001] [PMID]
2. Pitman A, Suleman S, Hyde N, Hodgkiss A. Depression and anxiety in patients with cancer. BMJ. 2018; 361:k1415. [DOI:10.1136/bmj.k1415] [PMID]
3. Cillessen L, Johannsen M, Speckens AEM, Zachariae R. Mindfulness-based interventions for psychological and physical health outcomes in cancer patients and survivors: A systematic review and meta-analysis of randomized controlled trials. Psycho-Oncology. 2019; 28(12):2257-69. [DOI:10.1002/pon.5214] [PMID]
4. Pichler T, Dinkel A, Marten-Mittag B, Hermelink K, Telzerow E, Ackermann U, et al. Factors associated with the decline of psychological support in hospitalized patients with cancer. Psychooncology. 2019; 28(10):2049-59. [DOI:10.1002/pon.5191] [PMID]
5. Dempster M, Howell D, McCorry NK. Illness perceptions and coping in physical health conditions: A meta-analysis. Journal of Psychosomatic Research. 2015; 79(6):506-13. [DOI:10.1016/j.jpsychores.2015.10.006] [PMID]
6. Ahmadi F, Mohamed Hussin NA, Mohammad MT. Religion, culture and meaning-making coping: A study among cancer patients in Malaysia. Journal of Religion and Health. 2019; 58(6):1909-24. [DOI:10.1007/s10943-018-0636-9] [PMID]
7. Rassouli M, Sajjadi M. Palliative care in Iran: Moving toward the development of palliative care for cancer. The American Journal of Hospice & Palliative Care. 2016; 33(3):240-4. [DOI:10.1177/1049909114561856] [PMID]
8. Van Keer RL, Deschepper R, Huyghens L, Bilsen J. Challenges in delivering bad news in a multi-ethnic intensive care unit: An ethnographic study. Patient Education and Counseling. 2019; 102(12):2199-207. [DOI:10.1016/j.pec.2019.06.017] [PMID]
9. Grassi L, Spiegel D, Riba M. Advancing psychosocial care in cancer patients. F1000Research. 2017; 6:2083. [DOI:10.12688/f1000research.11902.1] [PMID]
10. Aghaei MH, Vanaki Z, Mohammadi E. Psycho-emotional recovery, the meaning of care in the process of providing palliative care to Iranian people with cancer: A grounded theory study. Nursing Open. 2023; 10(2):889-900. [DOI:10.1002/nop2.1357] [PMID]
11. Graneheim UH, Lindgren BM, Lundman B. Methodological challenges in qualitative content analysis: A discussion paper. Nurse Education Today. 2017; 56:29-34. [DOI:10.1016/j.nedt.2017.06.002] [PMID]
12. Streubert H, Carpenter D. Qualitative research in nursing: Advancing the humanistic imperative. Philadelphia: Lippincott Williams & Wilkins; 2011. [Link]
13. Casellas-Grau A, Font A, Vives J. Positive psychology interventions in breast cancer. A systematic review. Psycho-Oncology. 2014; 23(1):9-19. [DOI:10.1002/pon.3353] [PMID]
14. Zhang X, Xiao H, Chen Y. Effects of life review on mental health and well-being among cancer patients: A systematic review. International Journal of Nursing Studies. 2017 Sep;74:138-48. [DOI:10.1016/j.ijnurstu.2017.06.012] [PMID]
15. Sekse RJT, Hunskår I, Ellingsen S. The nurse's role in palliative care: A qualitative meta-synthesis. Journal of Clinical Nursing. 2018; 27(1-2):e21-38. [DOI:10.1111/jocn.13912] [PMID]
16. Walshe C, Roberts D, Appleton L, Calman L, Large P, Lloyd-Williams M, et al. Coping well with advanced cancer: A serial qualitative interview study with patients and family carers. Plos One. 2017; 12(1):e0169071. [DOI:10.1371/journal.pone.0169071] [PMID]
17. Linardon J, Fairburn CG, Fitzsimmons-Craft EE, Wilfley DE, Brennan L. The empirical status of the third-wave behaviour therapies for the treatment of eating disorders: A systematic review. Clinical Psychology Review. 2017; 58:125-40 [DOI:10.1016/j.cpr.2017.10.005] [PMID]
18. Hulbert-Williams NJ, Storey L, Wilson KG. Psychological interventions for patients with cancer: Psychological flexibility and the potential utility of acceptance and commitment therapy. European Journal of Cancer Care. 2015; 24(1):15-27. [DOI:10.1111/ecc.12223] [PMID]
19. Sheybani F, Dabaghi P, Najafi S, Rajaeinejad M. [Effectiveness of mindfulness-based stress reduction (MBSR) on patients with chronic pain: A randomized clinical trial (Persian)]. Iranian Journal of Psychiatry and Clinical Psychology. 2022; 28(2):182-95. [DOI:10.32598/ijpcp.28.2.1627.2]
20. Salander P, Bergknut M, Henriksson R. The creation of hope in patients with lung cancer. Acta Oncologica. 2014; 53(9):1205-11.[DOI:10.3109/0284186X.2014.921725] [PMID]
21. Nierop-van Baalen C, Grypdonck M, van Hecke A, Verhaeghe S. Associated factors of hope in cancer patients during treatment: A systematic literature review. Journal of Advanced Nursing. 2020; 76(7):1520-37. [DOI:10.1111/jan.14344] [PMID]
22. Drageset S, Lindstrøm TC, Underlid K. I just have to move on: Women's coping experiences and reflections following their first year after primary breast cancer surgery. European Journal of Oncology Nursing. 2016; 21:205-11. [DOI:10.1016/j.ejon.2015.10.005] [PMID]
23. Bai M, Lazenby M. A systematic review of associations between spiritual well-being and quality of life at the scale and factor levels in studies among patients with cancer. Journal of Palliative Medicine. 2015; 18(3):286-98. [DOI:10.1089/jpm.2014.0189] [PMID]
24. Herlianita R, Yen M, Chen CH, Fetzer SJ, Lin EC. Perception of spirituality and spiritual care among Muslim nurses in Indonesia. Journal of Religion and Health. 2018; 57(2):762-73. [DOI:10.1007/s10943-017-0437-6] [PMID]
25. Gijsberts MHE, Liefbroer AI, Otten R, Olsman E. Spiritual care in palliative care: A systematic review of the recent European Literature. Medical Sciences. 2019; 7(2):25. [DOI:10.3390/medsci7020025] [PMID]
26. Bylund-Grenklo T, Werkander-Harstäde C, Sandgren A, Benzein E, Östlund U. Dignity in life and care: The perspectives of Swedish patients in a palliative care context. International Journal of Palliative Nursing. 2019; 25(4):193-201. [DOI:10.12968/ijpn.2019.25.4.193] [PMID]
27. Franke RJ. Palliative care and the humanities: Centralizing the patient at the end of life. The Yale Journal of Biology and Medicine. 2016; 89(1):105-8. [PMID] [PMCID]

28. Sinclair S, Beamer K, Hack TF, McClement S, Raffin Bouchal S, Chochinov HM, et al. Sympathy, empathy, and compassion: A grounded theory study of palliative care patients' understandings, experiences, and preferences. Palliative Medicine. 2017; 31(5):437-47. [DOI:10.1177/0269216316663499] [PMID]
29. Seccareccia D, Wentlandt K, Kevork N, Workentin K, Blacker S, Gagliese L, et al. Communication and quality of care on palliative care units: A qualitative study. Journal of Palliative Medicine. 2015; 18(9):758-64. [DOI:10.1089/jpm.2014.0408] [PMID]