连接：适应肾癌生活的定性分析。
Interconnection: A qualitative analysis of adjusting to living with renal cell carcinoma.
机构信息
Department of Palliative, Rehabilitation, and Integrative Medicine,The University of Texas MD Anderson Cancer Center,Houston,Texas.
School of Nursing at the University of Texas Health Science Center,Houston,Texas.
出版信息
Palliat Support Care. 2018 Apr;16(2):146-154. doi: 10.1017/S1478951517000074. Epub 2017 Mar 6.
UNLABELLED
ABSTRACTObjective: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.
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摘要
目的
适应癌症是一个持续的过程，但很少有研究从定性的角度探讨这种调整。我们这项定性研究的目的是了解患者如何构建他们适应癌症生活的体验。
方法
对 37 名接受肾细胞癌治疗的患者在 4 次单独写作过程中所写的叙述进行定性分析，这些叙述是更大规模的表达性写作临床试验的一部分。采用主题分析和恒定比较的方法，将数据中的主要模式编码为主题，直到达到 37 名参与者的主题饱和。数据解释受到社会建构主义观点的启发。
结果
相互联系描述了适应癌症过程的总体主题，包括四个相互关联的主题：（1）不连续性——诊断后感到脱节和失落；（2）重新定位——从心理和身体上接受癌症的现实；（3）重建——通过存在困扰重新建立联系；（4）扩展——在与他人的联系中找到意义。参与者描述了一种辩证运动，即破坏和损失促使人们不断寻找意义。
结果的意义
我们的研究结果表明，适应癌症的过程是一个持续的、迭代的、非线性的过程。在这个过程中，不同主题之间的动态相互作用描述了参与者在应对不断变化的症状和医疗新闻时，通过重新访问之前的主题，对意义的转变。临床医生认识到适应癌症的动态和持续过程非常重要，这可以帮助他们满足患者在整个疾病轨迹变化中未满足的心理社会需求。
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