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Exploring the First Days of Adjustment to Cancer: A Modification of Acclimating to Breast Cancer Theory

Lally, Robin M. PhD, BA, RN, AOCN, CNS; Hydeman, Jennifer A. PhD; Schwert, Kathleen BSN, RN; Henderson, Heather MS, RN, PMHNP; Edge, Stephen B. MD, FACS

doi: 10.1097/NCC.0b013e318227ca62

Background: Psychological adjustment may not be achieved by some women even years after breast cancer diagnosis. Although level of adjustment to diagnosis in the earliest (pretreatment) period is associated with future adjustment, limited research has explored this early period. Greater knowledge of women’s thoughts and behaviors as adjustment is initiated is needed to target interventions for women at risk for future adjustment problems.

Objectives: This study was intended to expand what is known about the pretreatment experiences, thought processes, and behaviors of women diagnosed with breast cancer and further define concepts and increase the scope of Acclimating to Breast Cancer, a grounded theory of adjustment in the pretreatment period.

Methods: Forty-five semistructured interviews were conducted with 26 women prior to and again within 30 days after breast cancer surgery. Women were 39 to 81 years old with stage 0 to stage II disease and primarily varied from the original sample geographically and on length of, and care coordination during, the pretreatment period. A multidisciplinary team performed directed content analysis, comparing new data to the original theory.

Results: Although generally consistent with the original theory, findings contributed to renaming 1 and adding 2 theory categories plus expanding 7 of 8 existing categories. Additional personal and situational influences on the process were identified.

Conclusion: The grounded theory of Acclimating to Breast Cancer was modified with new data from women currently experiencing the pretreatment period following diagnosis.

Implications for Practice: This theory modification provides a framework to guide needed assessment, psychoeducation, and research aimed at supporting psychological adjustment during the pretreatment period.

Author Affiliations: School of Nursing, University at Buffalo, the State University of New York (Dr Lally); Departments of Nursing Education (Dr Lally), Psychology (Dr Hydeman), Nursing and Ambulatory Services (Ms Schwert), and Surgical Oncology (Dr Edge), Roswell Park Cancer Institute, Buffalo, NewYork; Syracuse Recovery Services, New York (Ms Henderson); and Department of Surgery, University at Buffalo, the State University of New York (Dr Edge).

Funding was received from the University at Buffalo, The State University of New York, Patricia H. Garman Behavioral Health Nursing Fund.

The authors report no conflicts of interest.

Correspondence: Robin M. Lally, PhD, BA, RN, AOCN, CNS, School of Nursing, University at Buffalo, 3435 Main St, 304D-Wende Hall, Buffalo, NY 14214 (

Accepted for publication June 4, 2011.

© 2012 Lippincott Williams & Wilkins, Inc.