Decision-making process for breast-conserving therapy from the perspective of women with breast cancer: A grounded theory study.

PURPOSE: To explore the decision-making and coping processes of women with newly diagnosed breast cancer receiving breast-conserving therapy. METHODS: The grounded theory methodology approach was employed in this study. Purposive and theoretical sampling methods were used to enroll 27 women with stage I-III breast cancer. Individual interviews were conducted using a semi-structured interview guide, and data were analyzed using open, axial, and selective coding. RESULTS: The core category is "limitations of boundaries," which includes three categories: feminine body boundary, emotional boundary, and knowledge boundary. Clusters, conflicts, and changeability were among the unique contextual conditions. The decision-making process became more challenging because of the differences between the levels of knowledge of physicians and patients receiving treatment information. Women's actions and interactions included information seeking, controlling, negotiating, and accepting nondecision-making support. The consequences of decisions included redecision and reoperation, and most women did not regret receiving breast-conserving therapy. CONCLUSION: Even after choosing breast-conserving therapy, some women may experience changes in treatment procedures. Medical professionals should identify women's challenges and limitations during their decision-making process, explain the benefits and drawbacks of different surgical modalities, address concerns about the outcome of breast-conserving surgery, and provide intellectual and emotional support for decision-making.

[The Experience and Coping Process of Women With Breast Cancer Undergoing Neoadjuvant Chemotherapy].

BACKGROUND: Neoadjuvant chemotherapy is commonly performed to reduce the size of tumors before partial mastectomy to improve the rate of breast-conservation. Few studies have been conducted to assess the neoadjuvant chemotherapy experience of women diagnosed with breast cancer and their responses to it. PURPOSE: To explore the experience of women diagnosed with breast cancer who received neoadjuvant chemotherapy and their responses to it. METHODS: The grounded theory was adopted as the methodology. Participants were recruited using purposive sampling. The data were collected using semi-structured, in-depth interviews and analyzed using open, axial, and selective coding. RESULTS: A total of 15 women newly diagnosed with breast cancer participated in this study, with information showing that the core category oscillated between the sizes of the tumor. The three categories included difficulty in coping with the physical response to chemotherapy, absence of role fulfillment, and uneasy emotions. The coping strategies used by the participants included: body and mind adjustment, hiding, family labor adjustment, and changing the pace of social life. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The participants experienced tremendous physical and psychological stress during their neoadjuvant chemotherapy, in which tumor response assessment served as a critical time point. Medical professionals, in addition to noting changes in women's physiological response, must pay attention to their psychological burden and provide emotional support and treatment information as needed.

Integrative review of breast cancer survivors' transition experience and transitional care: dialog with transition theory perspectives.

The health of breast cancer survivors (BCSs) is an essential concern worldwide. This review summarizes current knowledge and proposes a novel framework for understanding BCSs' transition experiences and adopting a more holistic view of transitional care to ensure a successful shift from patient-to-survivor. An integrative review was applied whereby we searched CINAHL, MEDLINE, PubMed, and ProQuest. Eleven qualitative and 16 experimental articles were extracted and evaluated. Constant comparison and matrix classification were used for data analysis, extraction, and synthesizing, which were circulated between the study findings and transitions theory. The breast cancer survivors' incorporated transition theory (BCSITT) encompasses the concepts of transition nature, conditions, intervention strategies, and patterns of response as developed from the data analysis. Facilitators and inhibitors of BCSs' transition experience in the personal, interpersonal, organizational, communal, societal dimensions as well as an empirical intervention of BCSs' transitional care from micro to macro levels are proposed. In conclusion, the BCSITT could provide comprehensive insights for understanding the phenomenon of BCSs' transition from primary treatment completion to self-management and serve as a holistic framework to guide clinical practice and research for BCSs' transitional care. Health care professionals need to assess the readiness of BCSs for transition and provide early interventions for enhancing BCSs' mastering of new skills to manage the challenges of transition. Incorporating stakeholders at each level and providing a comprehensive continuum of care may successfully assist BCSs' patient-to-survivor transition.

[A Survey of the Factors of Influence and Interventional Strategies for Breast Cancer Survivors' Transition Care Across Multiple Theoretical Perspectives].

Breast cancer significantly threatens the life of women, while the adverse effects of cancer treatment degrade quality of life and psychological well-being. The quality of transitional care following the completion of treatment significantly affects the ability of breast cancer patients to transition successfully into survivorship. This paper introduces multiple theoretical perspectives and provides an overview of the tenets of each in order to identify the positions of breast cancer survivors and to highlight the factors and strategies that influence their transitional care. The theoretical perspectives that are introduced include the social-ecological model, transition theory, and the strengths perspective. In order to improve the holistic care of women with breast cancer, factors relevant to transition are categorized into the individual, interpersonal, organizational, community, and policy levels. Furthermore, empirical interventions, which are based on the respective advantages of the various levels of the social-ecological model, are proposed in order to conform to the sociocultural context and clinical practices. Healthcare providers should leverage the strengths and resources at each level to develop feasible strategies and to provide quality of care in order to assist breast cancer patients to transition successfully from treatment to survivorship and to holistically improve their subsequent quality of life and function.

[Exploring the Primary Adaptation Process of First-Ever Stroke Patients].

BACKGROUND: Stroke is a leading cause of death worldwide and the third leading cause of disease-related mortality in Taiwan. Furthermore, stroke is a major cause of functional disability in adults, causing physiological, psychological, and social impacts. Little qualitative research has been conducted on the primary adaptation process of patients with first-ever stroke in Taiwan. PURPOSE: The present study explored the primary adaptation process of patients with first-ever stroke. METHODS: This qualitative study used purposive sampling to enroll 12 patients with first-ever stroke for interviews, followed by theoretical sampling. Grounded theory guided the methodology and data analysis. Data analysis was performed simultaneously in accordance with the coding process. RESULTS: The primary adaptation process used by the participants involved the two main categories of "impacts of stroke" and "adaptation after stroke", with three subcategories associated, respectively, with the former (loss of physical autonomy, diminishing perceptions of self-value, and stroke-related hardships turning into social isolation) and with the latter (regaining autonomy after rehabilitation, receiving support from family without being a burden, and release from suffering/becoming more positive). The core category that emerged from the present study was: "Facing stroke, hoping for the best, transforming lives." CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The above findings on the primary adaptation process of stroke patients provide an important reference for clinical nurses/healthcare professionals who have responsibilities to care for patients with first-ever stroke. In addition, healthcare professionals should offer more health education and psychological support to stroke patients based on individual patient needs.

The desire to survive: the adaptation process of adult cancer patients undergoing radiotherapy.

AIM: Radiotherapy is one of the primary treatment strategies for cancer. However, patients not only deal with the side-effects of radiotherapy, but they must also endure the psychological distress caused by cancer. This study explores how cancer patients adapt to the treatment process when receiving radiotherapy. METHODS: This study used a grounded theory approach, and eight in-depth interviews were conducted with newly diagnosed cancer patients who received radiotherapy as a primary treatment. RESULTS: The core category that emerged from this study was "the desire to survive". The categories and subcategories that emerged from the data include facing unknown situations (e.g. searching for relevant information and decision-making considerations, and listening to healthcare professionals' suggestions), experiencing the pain of treatment (e.g. tolerating side-effects, tolerating inconvenience during the treatment, accepting support during the treatment, and adjusting lifestyles), and chances to extend life (e.g. accepting fate, determination to undergo the treatment, and adjusting negative emotions). CONCLUSION: The study results provide a better understanding of the experiences of cancer patients undergoing radiotherapy. Healthcare professionals should provide effective medical management for side-effects and psychological support to cancer patients during the journey of radiotherapy.