Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, United States.
College of Nursing, University of Missouri, St. Louis, St. Louis, MO 63121, United States.
Cancer Treat Res Commun. 2021;29:100459. doi: 10.1016/j.ctarc.2021.100459. Epub 2021 Sep 21.
Breast cancer-related lymphedema (BCRL) is a lifelong condition. Millions who develop breast cancer are younger than retirement age and at a lifetime risk for developing BCRL. Rural and small-town survivors may face unique challenges in terms of access to health care and BCRL/survivorship resources. This multiple-case study describes how BCRL influences the work experiences and quality of life (QoL) of survivors living in rural and small towns in Missouri.
Thirteen survivors from rural and small towns in Missouri completed semi-structured interviews and a standardized QoL instrument. Cases were analyzed using in-vivo and open-coding techniques and constant cross-case comparative methods. Twelve of the 13 participants' data are synthesized into themes to represent an illustrative case. The 13 case is presented as a contradictory (rival) case.
Four themes are represented within the illustrative case - multiple medical encounters; the development of self-care routines; the reciprocity of work/live activities, triggers, and adjustments; and rural/small-town cultural impact. Upon BCRL diagnosis, survivors received intensive treatments, eventually establishing self-care routines. Survivors identified strategies for working around their BCRL when completing work and home responsibilities. The contradictory (rival) case was more recently diagnosed and, as such, had not established self-care and coping mechanisms in the same way.
Survivors alleviate BCRL symptoms and improve their QoL by establishing self-care strategies. This provides guidance for client-centered survivorship care-planning and occupational rehabilitation of rural survivors with BCRL. This study provides the foundation for developing information for rural survivors that supports mental preparation and coping skills for BCRL self-management.
乳腺癌相关淋巴水肿（BCRL）是一种终身疾病。数以百万计的乳腺癌患者年龄小于退休年龄，终生有发生 BCRL 的风险。农村和小镇的幸存者在获得医疗保健和 BCRL/生存资源方面可能面临独特的挑战。本多项案例研究描述了 BCRL 如何影响密苏里州农村和小镇的幸存者的工作经历和生活质量（QoL）。
密苏里州农村和小镇的 13 名幸存者完成了半结构化访谈和标准化的 QoL 工具。使用体内和开放式编码技术以及恒常跨案例比较方法对案例进行分析。13 名参与者中的 12 名数据综合为主题，以代表一个说明性案例。13 个案例被呈现为一个矛盾（对立）案例。
说明性案例中代表了四个主题 - 多次医疗接触；自我护理常规的发展；工作/生活活动、触发因素和调整的互惠性；农村/小镇文化的影响。在 BCRL 诊断后，幸存者接受了密集的治疗，最终建立了自我护理常规。幸存者确定了在完成工作和家庭责任时围绕 BCRL 工作的策略。矛盾（对立）案例的诊断时间较晚，因此没有以同样的方式建立自我护理和应对机制。
幸存者通过建立自我护理策略来缓解 BCRL 症状并提高生活质量。这为以患者为中心的生存护理计划和农村 BCRL 幸存者的职业康复提供了指导。本研究为为农村幸存者提供支持 BCRL 自我管理的心理准备和应对技能的信息奠定了基础。
