Getting back to normal: the family experience during early stage breast cancer.

PURPOSE

To describe the process of normalization as it emerged from a study of families coping with early stage breast cancer.

DESIGN

Qualitative, grounded theory.

SAMPLE

Fifty-five women newly diagnosed with early stage breast cancer and their families. Fifty-eight percent had lumpectomy, and the remainder had mastectomy. Some had no further treatment, but others received radiation, chemotherapy, or tamoxifen. Nineteen women had positive nodes.

METHODS

Five semistructured family and couple interviews for each family from diagnosis to one year later.

MAIN RESEARCH VARIABLES

Process of normalization, issues and challenges faced, and problems coping.

FINDINGS

Getting back to normal, defined as a safe, desirable, and stable state, was important for these families. Strategies used to get back to normal included seeing their families as normal, maintaining or returning to usual patterns quickly, minimizing disruptiveness, deemphasizing sick role demands, reframing negatives, and putting the cancer behind them. Factors influencing the process were family perspective of cancer, visibility or disruptiveness of symptoms of and treatments for cancer, family flexibility, experience with illness, life stage, and congruency of views.

CONCLUSIONS

Families who adjust more easily view changes from normal as temporary, are flexible, see themselves as normal given the demands of their situation, share similar views, experience less major disruption or intrusiveness from treatments and their side effects, and appropriately use strategies to get back to normal.

IMPLICATIONS FOR PRACTICE

Study findings emphasize the importance of maintaining normal routines as much as possible and getting back to normal quickly. Nurses must accurately assess family coping to identify those having difficulty and those at risk for difficulty. Nurses can support families' efforts to be normal and get back to normal by providing information about what is generally expected and what resources are available that might be helpful. Nurses need to be accessible to provide counseling and/or refer as needed.