Congress Abstracts 2006

25

FROM "IT" TO "I": ACCLIMATION IN THE FIRST DAYS FOLLOWING BREAST CANCER DIAGNOSIS. Robin Lally, PhD(c), RN, AOCN^®, CNS, and Marsha Lewis, PhD, RN, University of Minnesota School of Nursing, Minneapolis, MN.

Over 200,000 women are diagnosed with breast cancer annually in the U.S. Multiple decisions and stress typically characterize the post-diagnosis period. Long-term survivorship (e.g. adjustment, satisfaction, and quality of life) may be adversely affected if women's needs are unmet at that time. Retrospective, quantitative research has focused on meeting specific decision-making needs during this period but not on the context in which these needs arise, nor on determining the appropriate focus of interventions.

The purpose of this study was to explore and conceptualize the experience of women during the immediate post-breast cancer diagnosis period, developing a grounded theory explaining the context and behavior of patients and providing focus for interventions to mitigate potential long-term effects.

The core category of this grounded theory relates to actions toward self and thus symbolic interactionism has been chosen.

A grounded theory study was conducted in a Midwestern, U.S. multi-disciplinary breast center. Eighteen women, ages 37 to 87 years, and a mean of 12 days post-diagnosis of first breast cancer, but in the pre-operative period, formed the sample. Unstructured to semi-structured interviews ranged from 25 to 90 minutes. Observations and informal interviews with staff were conducted within the breast center. Survivor artwork and a published survivor's diary were also used in theory development. Theoretical sampling, constant comparative analysis, and memoing were used to identify a core category, achieve data saturation, and develop the theory.

A three stage, multi-phase, process of "acclimation" emerged as a basic social psychological process used by women to resolve the post-diagnosis problem of maintaining self-integrity. Women moved from Disembodiment (seeing cancer as "It" and distancing from it, themselves, and others), to Reconstruction (mental work of meaning-making, introspecting, cocooning, anticipating, and taking-it-on) and Incorporation ("I have breast cancer") at differing rates dependent on what they brought to the process. All demonstrated varying degrees of Incorporation, just day's post-diagnosis. This theory identifies a primary concern of women with breast cancer during the post-diagnosis period, and a resolution process on which nursing intervention and future research may focus, in order to support successful survivorship.

Funding provided by: ONS, MNRS, and U of MN