Table 2.

Case formulation based on biopsychosocial model

	Biological	Psychological	Social
Predisposing factors	Introvert and shy personality Strong family history of cancer Current cancer diagnosis and associated severe pain	Parents died due to cancer when she was young and strong fear of cancer with death Enmeshed family system	Lower socioeconomic background Poor access to health care in their village Poor knowledge and negative attitude toward the cancer among the caregivers
Precipitating factors	Medical and surgical interventions Treatment related side effects Issues associated with the colostomy bag	Since she lost her parents when she was young, she has this fear of abandoning her child and repeating the history Trauma associated with medical and surgical procedure Guilt and fear of young mother who us not caring her child due to her medical condition Guilt associated with being a burden to family members Fear associated with word “cancer” Fear of unknown Fear of pain and suffering Fear of loss of control Feeling confined and loss of hope Adjustmental issues with the colostomy bag	Staying away from the husband and child due to the treatment Missing her home town and her neighbors Thirty lakh rupees’ debts associated with her treatment Intense sense of helplessness in her brothers
Perpetuating factors	Continuous generalized body pain Fatigue Aggravated disease condition	Feeling of helplessness Limited insight Vulnerable, feeling of burden to her family Overly attached to the family which leads to feel guilty	Unable to see her child and husband/lack of husband’s presence in Delhi Inability to perform social roles and responsibilities
Protective factors	Resilience	Coping mechanism (prayer)	Religious belief Good support from the health-care team