Online Exclusive Article
Reclaiming Life on One's Own Terms: A Grounded Theory Study of the Process of Breast Cancer Survivorship
Purpose/Objectives: To develop a substantive theory of the process of breast cancer survivorship.
Research Approach: Grounded theory.
Setting: A LISTSERV announcement posted on the SHARE Web site and purposeful recruitment of women known to be diagnosed and treated for breast cancer.
Participants: 15 women diagnosed with early-stage breast cancer.
Methodologic Approach: Constant comparative analysis.
Main Research Variables: Breast cancer survivorship.
Findings: The core variable identified was Reclaiming Life on One's Own Terms. The perceptions and experiences of the participants revealed overall that the diagnosis of breast cancer was a turning point in life and the stimulus for change. That was followed by the recognition of breast cancer as now being a part of life, leading to the necessity of learning to live with breast cancer, and finally, creating a new life after breast cancer. Participants revealed that breast cancer survivorship is a process marked and shaped by time, the perception of support, and coming to terms with the trauma of a cancer diagnosis and the aftermath of treatment. The process of survivorship continues by assuming an active role in self-healing, gaining a new perspective and reconciling paradoxes, creating a new mindset and moving to a new normal, developing a new way of being in the world on one's own terms, and experiencing growth through adversity beyond survivorship.
Conclusions: The process of survivorship for women with breast cancer is an evolutionary journey with short- and long-term challenges.
Interpretation: This study shows the development of an empirically testable theory of survivorship that describes and predicts women's experiences following breast cancer treatment from the initial phase of recovery and beyond. The theory also informs interventions that not only reduce negative outcomes, but promote ongoing healing, adjustment, and resilience over time.
Jump to a section
References
American Cancer Society. (2012). Breast cancer. Retrieved from http://www.cancer.org/cancer/breastcancer
Aranda, S., Schofield, P., Weih, L., Milne, D., Faulken, R., & Voudouris, N. (2005). Mapping quality of life and unmet needs of urban women with metastatic breast cancer. European Journal of Cancer Care, 14, 211-222. doi:10.1111/j.1365-2354.2005.00541.x
Arman, M., Rehnsfeldt, A., Lindholm, L., Hamrin, E., & Eriksson, K. (2004). Suffering related to health care: A study of breast cancer patients' experiences. International Journal of Nursing Practice, 10, 248-256. doi:10.1111/j.1440-172x.2004.00491.x
Bauer-Wu, S., & Farran, C. J. (2005). Meaning in life and psycho-spiritual functioning: A comparison of breast cancer survivors and healthy women. Journal of Holistic Nursing, 23, 172-190. doi:10.1177/0898010105275927
Boehmke, M. (2004). Measurement of symptom distress in women with early-stage breast cancer. Cancer Nursing, 27, 144-152. doi:10.1097/00002820-200403000-00008
Bonanno, G. A. (2004). Loss, trauma, and human resilience. American Psychologist, 59, 20-28. doi:10.1037/0003-066X.59.1.20
Budin, W. C., Hoskins, C. N., Haber, J., Sherman, D. W., Maislin, G., Cater, J. R., … Shulka, S. (2008). Breast cancer: Education, counseling, and adjustment among patients and partners: A randomized clinical trial. Journal of Nursing Research, 57, 199-213. doi:10.1097/01.NNR.0000319496.67369.37
Carlsson, M., Arman, M., Backman, M., & Hamrin, E. (2005). Coping in women with breast cancer in complementary and conventional care over 5 years measured by the Mental Adjustment to Cancer Scale. Journal of Alternative and Complementary Medicine, 11, 441-447. doi:10.1089/acm.2005.11.441
Cartwright-Alcarese, F. (2004). Information needs of women with breast cancer in recovery. Retrieved from ProQuest Dissertations and Theses database (AAT No. 3155727).
Chamberlain, K. (2000). Methodolatry and qualitative health research. Journal of Health Psychology, 5, 285-296. doi:10.1177/135910530000500306
Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. Thousand Oaks, CA: Sage.
Cooper, J. M., Loeb, S. J., & Smith, C. A. (2010). The primary care nurse practitioner and cancer survivorship care. Journal of the American Academy of Nurse Practitioners, 22, 394-402. doi:10.1111/j.1745-7599.2010.00528.x
Dirksen, S. (2000). Predicting well-being among breast cancer survivors. Journal of Advanced Nursing, 32, 937-943. doi:10.1046/j.1365-2648.2000.01559.x
Eaves, Y. D. (2001). A synthesis technique for grounded theory data analysis. Journal of Advanced Nursing, 335, 654-663. doi:10.1046/j.1365-2648.2001.01897.x
Fu, M. R., Axelrod, D., & Haber, J. (2008). Breast cancer-related lymphedema: Information, symptoms, and risk-reduction behaviors. Journal of Nursing Scholarship, 40, 341-348.
Fu, M. R., & Rosedale, M. (2009). Breast cancer survivors' experiences of lymphedema-related symptoms. Journal of Pain and Symptom Management, 38, 849-859. doi:10.1016/j.jpainsymman.2009.04.030
Ganz, P. A., Desmond, K. A., Leedham, B., Rowland, J. H., Meyerowitz, B. E., & Belin, T. R. (2002). Quality of life in long-term, disease-free survivors of breast cancer: A follow-up study. Journal of the National Cancer Institute, 94, 39-49. doi:10.1093/jnci/94.1.39
Gil, K. M., Mishel, M. H., Belyea, M., Germino, B., Germino, L. S., Porter, L., … Stewart, J. (2004). Triggers of uncertainty about recurrence and long-term treatment side effects in older African American and Caucasian breast cancer survivors. Oncology Nursing Forum, 31, 633-639. doi:10.1188/04.ONF.633-639
Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research. Chicago, IL: Aldine.
Gluck, J. (2007, May 28). The survivor monologues. New York Magazine, 30-45, 105-108.
Golden-Kreutz, D., & Andersen, B. (2004). Depressive symptoms after breast cancer surgery: Relationships with global, cancer-related and life event stress. Psycho-Oncology, 133, 211-220. doi:10.1002/pon.736
Health Care for Women International. (2001). Why grounded theory and women's health? Health Care for Women International, 22, 1-3. doi:10.1080/073993301300003027
Hewitt, M., Greenfield, S., & Stovall, E. (2006). From cancer patient to cancer survivor: Lost in transition. Washington, DC: National Academies Press.
Hoybye, M. T., Johansen, C., & Tjornhoj-Thomsen, T. (2005). Online interaction. Effects of storytelling in an Internet breast cancer support group. Psycho-Oncology, 14, 211-220. doi:10.1002/pon.837
Hutchinson, S., & Wilson, S. (2001). Grounded theory: The method. In P. L. Munhall (Ed.), Nursing research: A qualitative perspective (3rd ed., pp. 209-218). Sudbury, MA: Jones and Bartlett.
Knobf, M. T. (2002). Carrying on: The experience of premature menopause in women with early stage breast cancer. Nursing Research, 51, 9-17. doi:10.1097/00006199-200201000-00003
Knobf, M. T. (2007). Psychosocial responses in breast cancer survivors. Seminars in Oncology Nursing, 23, 71-83. doi:10.1016/j.soncn.2006.11.009
Landmark, B. T., Strandmark, M., & Wahl, A. K. (2001). Living with newly diagnosed breast cancer—The meaning of existential issues. Cancer Nursing, 24, 220-226.
Meneses, K., McNees, P., Loerzel, V., Su, X., Zhang, Y., & Hassey, L. (2007). Transition from treatment to survivorship: Effects of a psychoeducational intervention on quality of life in breast cancer survivors. Oncology Nursing Forum, 34, 1007-1016. doi:10.1188/07.ONF.1007-1016
Mols, F., Vingerhoets, A. J., Coebergh, J. W., & van de Poll-Franse, L. V. (2005). Quality of life among long-term breast cancer survivors: A systematic review. European Journal of Cancer, 41, 2613-2619. doi:10.1016/j.ejca.2005.05.017
National Cancer Institute. (2006). Estimated US cancer prevalence counts: Definitions. Retrieved from http://dccps.nci.nih.gov/ocs/definitions.html
Nelson, J. (1996). Struggling to gain meaning: Living with the uncertainty of breast cancer. Advances in Nursing Science, 18, 59-72.
Pavia, T., & Mason, M. (2004). The reflexive relationship between consumer behavior and adaptive coping. Journal of Consumer Research, 31, 441-454. doi:10.1086/422121
Rosedale, M. (2009). The survivor-loneliness of women following breast cancer. Oncology Nursing Forum, 36, 175-183. doi:10.1188/09.ONF.175-183
Rosedale, M., & Fu, M. (2010). Confronting the unexpected: Temporal, situational, and attributive dimensions of distressing symptom experience for breast cancer survivors [Online exclusive]. Oncology Nursing Forum, 37, E28-E33. doi:10.1188/10.ONF.E28-E33
Samarel, N., Tulman, L., & Fawcett, J. (2002). Effects of two types of social support and education on adaptation to early-stage breast cancer. Research in Nursing and Health, 25, 459-470.
Sammarco, A. (2001). Perceived social support, uncertainty, and quality of life of younger breast cancer survivors. Cancer Nursing, 24, 212-219. doi:10.1097/00002820-200106000-00007
Schmidt, J. E., & Andrykowski, M. A. (2004). The role of social and dispositional variables associated with emotional processing in adjustment to breast cancer: An Internet-based study. Health Psychology, 23, 259-266. doi:10.1037/0278-6133.23.3.259
Sinding, C., & Gray, R. (2005). Active aging—Spunky survivorship? Discourses and experiences of the years beyond breast cancer. Journal of Aging Studies, 19, 147-161. doi:10.1016/j.jaging.2004.05.001
Strauss, A., & Corbin, J. (1998). Basics of qualitative research. Grounded theory procedures and techniques. Newbury Park, CA: Sage.
Tavakol, M., Torabi, S., & Zeinaloo, A. A. (2006). Grounded theory in medical education research. Medical Education Online, 11(30), 1-6.
Thomas-MacLean, R. (2005). Beyond dichotomies of health and illness: Life after breast cancer. Nursing Inquiry, 12, 200-209. doi:10.1111/j.1440-1800.2005.00268.x
Tomich, P. L., & Helgeson, V. S. (2002). Five years later: A cross sectional comparison of breast cancer survivors with healthy women. Psycho-Oncology, 11, 154-169. doi:10.1002/pon.570
Trunzo, J. J., & Pinto, B. M. (2003). Social support as a mediator of optimism and distress in breast cancer survivors. Journal of Consulting and Clinical Psychology, 71, 805-811. doi:10.1037/0022-006X.71.4.805
Tulman, L., & Fawcett, J. (2002). A framework for studying functional status after diagnosis of breast cancer. Cancer Nursing, 13, 95-99.
Vivar, C., & McQueen, A. (2005). Informational and emotional needs of long-term survivors of breast cancer. Journal of Advanced Nursing, 51, 520-528. doi:10.1111/j.1365-2648.2005.03524.x