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Acclimating to Breast Cancer: A Process of Maintaining Self-integrity in the Pretreatment Period

Lally, Robin M. PhD, RN, AOCN, CNS

doi: 10.1097/NCC.0b013e3181d8200b

Background: The period between diagnosis and initial treatment is one of the most stressful times for women with breast cancer. Unresolved distress may lead to future mental health and adjustment difficulties. Adjustment is facilitated by thoughts and behaviors that integrate a threatening event into a person's worldview. Few studies, however, have explored women's pretreatment thought processes.

Objective: The purpose of this study was to develop a grounded theory of the pretreatment thought processes and behaviors of women diagnosed with breast cancer.

Methods: Grounded theory method guided theoretical sampling of 18 women from a Midwestern, US breast center who were 37 to 87 years old, diagnosed with stage 0 to II breast cancer within the past 6 to 21 days and awaiting surgical treatment. Constant comparison of interview data and open, selective, and theoretical coding identified interrelated concepts and constructs that formed the grounded theory.

Results: Threatened self-integrity was the main concern of women identified in the pretreatment period. Women addressed this problem through a continuous, nonlinear process of acclimating to breast cancer consisting of 3 stages: surveying the situation, taking action, and emerging self. Situational and personal factors influenced women's degree of engagement in 1 or more stages.

Conclusions: Women's pretreatment response to breast cancer diagnosis involves integrated thought processes to maintain self-integrity influenced by situational and personal factors hypothesized to be amenable to interventions that facilitate adjustment.

Implications for Practice: New insights provided by this theory can guide clinical practice and generate hypotheses to test pretreatment interventions to support psychological adjustment to breast cancer.

Author Affiliations: University at Buffalo School of Nursing, State University of New York.

This study was supported by an Oncology Nursing Society Foundation Nursing research grant, a Midwest Nursing Society Dissertation research grant, Helen Wells and Violet Shea Scholarship/University of Minnesota School of Nursing, and a University of Minnesota Graduate School doctoral dissertation grant.

Correspondence: Robin M. Lally, PhD, RN, AOCN, CNS, 3435 Main St, Wende Hall, Buffalo, NY 14214 (

Accepted for publication February 6, 2010.

© 2010 Lippincott Williams & Wilkins, Inc.