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Interconnection: A qualitative analysis of adjusting to living with renal cell carcinoma

Published online by Cambridge University Press:  06 March 2017

Isabel Leal ,
Kathrin Milbury ,
Joan Engebretson ,
Surena Matin ,
Eric Jonasch ,
Nizar Tannir ,
Christopher G. Wood  and
Lorenzo Cohen
Isabel Leal
Affiliation:
Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
Kathrin Milbury
Affiliation:
Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
Joan Engebretson
Affiliation:
School of Nursing at the University of Texas Health Science Center, Houston, Texas
Surena Matin
Affiliation:
Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
Eric Jonasch
Affiliation:
Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
Nizar Tannir
Affiliation:
Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
Christopher G. Wood
Affiliation:
Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
Lorenzo Cohen*
Affiliation:
Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
*
Address correspondence and reprint requests to: Lorenzo Cohen, Department of Palliative, Rehabilitation, and Integrative Medicine, Unit 462, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030. E-mail: lcohen@mdanderson.org.
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Abstract

Objective:

Adjusting to cancer is an ongoing process, yet few studies explore this adjustment from a qualitative perspective. The aim of our qualitative study was to understand how patients construct their experience of adjusting to living with cancer.

Method:

Qualitative analysis was conducted of written narratives collected from four separate writing sessions as part of a larger expressive writing clinical trial with renal cell carcinoma patients. Thematic analysis and constant comparison were employed to code the primary patterns in the data into themes until thematic saturation was reached at 37 participants. A social constructivist perspective informed data interpretation.

Results:

Interconnection described the overarching theme underlying the process of adjusting to cancer and involved four interrelated themes: (1) discontinuity—feelings of disconnection and loss following diagnosis; (2) reorientation—to the reality of cancer psychologically and physically; (3) rebuilding—struggling through existential distress to reconnect; and (4) expansion—finding meaning in interconnections with others. Participants related a dialectical movement in which disruption and loss catalyzed an ongoing process of finding meaning.

Significance of results:

Our findings suggest that adjusting to living with cancer is an ongoing, iterative, nonlinear process. The dynamic interactions between the different themes in this process describe the transformation of meaning as participants move through and revisit prior themes in response to fluctuating symptoms and medical news. It is important that clinicians recognize the dynamic and ongoing process of adjusting to cancer to support patients in addressing their unmet psychosocial needs throughout the changing illness trajectory.

Keywords

AdjustmentQualitativeExpressive writingKidney cancerMeaning-making
Type
Original Article
Information
Palliative & Supportive Care , Volume 16 , Issue 2 , April 2018 , pp. 146 - 154
Copyright
Copyright © Cambridge University Press 2017 

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