Transcending breast cancer: making meaning from diagnosis and treatment.

PURPOSE: This qualitative approach study describes the experience of self-transcendence in women newly diagnosed with breast cancer. METHOD: Fourteen women participated from a larger sample of women in a support group project. Each woman was interviewed three times over an 8-month period. Audiotaped transcripts were analyzed using Colaizzi's phenomenological techniques. FINDINGS: Loss of a personal perception of good health and fear of dying from cancer forced women to reach both inside and outside of themselves for support and information. Bonding with other women with breast cancer led to further expansion of self-boundaries that brought comfort, a desire to modify life priorities, and enhanced appreciation of supportive others and of life itself. Over time, clarification and modification of values and behaviors assisted women to create meaning from their experiences. IMPLICATIONS: Nurse referrals to support groups or other resources (such as cancer advocacy organizations) where women interact with similar others may facilitate transcending breast cancer.

Resolution of spiritual disequilibrium by women newly diagnosed with breast cancer.

PURPOSE/OBJECTIVES: To describe the experience of restoring and maintaining spiritual equilibrium over a 14-month period by women newly diagnosed with breast cancer. RESEARCH APPROACH: Qualitative approach, longitudinal design. SETTING: Urban breast cancer resource center. PARTICIPANTS: 10 women initially one to five months from diagnosis, 5 of whom attended an eight-week self-transcendence theory-based breast cancer support group. METHODOLOGIC APPROACH: Audiotaped interviews conducted within five months of diagnosis, two to three months later, and one year after that. Narratives were analyzed using Colaizzi's phenomenologic approach. MAIN RESEARCH VARIABLES: Spiritual disequilibrium resolution, breast cancer, self-transcendence. FINDINGS: Spiritual disequilibrium characteristics, as described in several studies of women with breast cancer, were fear of dying and a sense of aloneness in a struggle to maintain self-identity. Disequilibrium triggered all participants to reach outwardly for information and support from other people and faith resources and to reach inwardly to examine life values. Shortly after diagnosis, and continuing throughout the study period, most participants also reached outwardly to support others and conduct breast cancer advocacy work. CONCLUSION: Resolving spiritual disequilibrium for women with newly diagnosed breast cancer means restoring a sense of connection to self, others, and/or a higher power. Self-transcendence views and behaviors evolving over time help women to restore their sense of connectedness, maintain hope for a future, and find renewed purpose and meaning. INTERPRETATION: An initial breast cancer diagnosis may be associated with spiritual disequilibrium that can be as problematic as the physical effects of cancer and cancer treatment. Women restore equilibrium through resolving their sense of disconnectedness and regaining a positive self-identity.

Facilitation of self-transcendence in a breast cancer support group: II.

PURPOSE/OBJECTIVES: To pilot a second support group intervention study promoting self-transcendence perspectives and activities and to document changes over time in well-being in support group participants compared with nonparticipants. DESIGN: Quasiexperimental, partial randomization, preference trial design. SETTING: An urban breast cancer resource center established by survivors. SAMPLE: 41 women with newly diagnosed breast cancer were recruited, and 39 completed the study. 22 women participated in three intervention support groups; 17 were in a comparison group. METHODS: The intervention was an eight-week, closed support group based on self-transcendence theory. Data were collected three times during 14 months. MAIN RESEARCH VARIABLES: Support group intervention, self-transcendence, and emotional and physical well-being. FINDINGS: The intervention group had lower scores than the comparison group on self-transcendence and well-being variables at baseline (time [T] 1). Scores were higher for both groups postintervention (T2), with no differences between groups. One year postintervention (T3), intervention group scores again were lower than comparison group scores. Intervention group T3 scores were unchanged from T2. CONCLUSIONS: Most potential participants were unwilling to risk being randomized into a nonpreferred group. Activities based on self-transcendence theory were associated with expanded perspectives and activities and an improved sense of well-being in support group participants at the end of the intervention, but not one year later. Findings from the pilot studies informed a study currently in progress. IMPLICATIONS FOR NURSING: Nurses should maintain awareness of local resources for support and make that information available to women when they are newly diagnosed with breast cancer, during their treatment, and later.

Partial randomization design in a support group intervention study.

Randomized clinical trial (RCT) designs, in which participants are randomly assigned to treatment and control groups, are considered the gold standard of experimental design. However, if potential participants have a strong preference for a particular study group and/or when participatory effort must be sustained over a lengthy study time frame, they may deem randomization unacceptable, refuse to be in the study, and hence prevent the purpose of randomization from being realized. This article describes several alternative designs and the decision-making process prior to selecting a partially randomized preference trial (PRPT) design to accommodate preferences of women with breast cancer for participation in a support group intervention pilot study. Recruiting women into the two randomized arms of the PRPT was problematic because most potential participants expressed a preference for a particular study group. Possible reasons for failure to randomize more of the potential participants are discussed and suggestions for future research proposed.