Paper
Friday, 21 July 2006
This presentation is part of : Adult Women and Cancer Issues
The First Weeks after Breast Cancer Diagnosis: Interventions Guided by Grounded Theory
Robin M. Lally, RN, MS, AOCN and Marsha L. Lewis, PhD, RN. School of Nursing, University of Minnesota, Minneapolis, MN, USA
Learning Objective #1: list at least three thought processes undertaken by women in the first weeks after breast cancer diagnosis.
Learning Objective #2: describe several nursing interventions that may facilitate women's ability to maintain self-integrity immediately post breast cancer diagnosis.
Purpose/Significance:  Breast cancer is the most common cancer among women worldwide. In the U.S., over 200,000 women are diagnosed annually.  Immediately post-diagnosis, women grapple with many decisions and significant stress which may adversely affect long-term adjustment, quality of life, and satisfaction if not addressed.  Thus, intervening appropriately is essential to promote successful survivorship.  Research has focused interventions on elements of the decision-making process and decision aids, with little on the context surrounding this post-diagnosis period.  The purpose of this study was to explore and conceptualize the experience of women during the immediate post-diagnosis period, developing a grounded theory to explain the context and behavior of women with breast cancer, and ultimately develop interventions meeting their needs.
Setting:  U.S., Midwestern, breast center.
Method:  Using grounded theory method, constant comparative analysis, theoretical sampling, and memoing were utilized to identify a core category and achieve data saturation.  The sample consisted of eighteen women, ages 37 to 87 years, a mean of 12 days post-diagnosis of first breast cancer, and in the pre-operative period.  Unstructured to semi-structured interviews ranged in length from 25 to 90 minutes.  Observations and informal interviews with breast center surgeons and nurses, as well as artwork, and a survivor’s published diary also informed theory development.
Results:  A three stage process of “acclimation” (maintaining functioning in a changed environment) emerged as a basic social psychological process used by these women.  Surprisingly, women put little emphasis on gathering information or decision-making and more on maintaining self-integrity through multiple phases of this process.  Therefore, interventions aimed at guiding women through their individual, internal, mental work, such as assessing and decreasing fears and self-blame and providing strategies for interacting with others, may do more to support successful survivorship than focusing heavily on the decision process.
Grant funding from:  ONS, MNRS, and U of MN

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See more of The 17th International Nursing Research Congress Focusing on Evidence-Based Practice (19-22 July 2006)