Restoring embodied control following surgical treatment for colorectal cancer: A longitudinal qualitative study
Kings College, London, Florence Nightingale School of Nursing and Midwifery, Burdett Institute, St Marks' Hospital, Harrow HA1 3UJ, United Kingdom. International journal of nursing studies
(Impact Factor: 2.9).
08/2010; 47(8):946-56. DOI: 10.1016/j.ijnurstu.2009.12.008
This article presents the findings of a study about recovery following surgery for colorectal cancer. Most patients diagnosed with this cancer are treated with surgery. Few studies have employed a qualitative approach to examine their experiences and perceptions of recovering from this treatment.
The purpose of this study was to discover the process of recovery for individuals following curative surgery for colorectal cancer.
This qualitative study drew on grounded theory methods and used a prospective longitudinal design.
Ethical approval was granted by three Local Research Ethics Committees enabling patients to be recruited from three different hospitals in the South of England.
Purposive sampling was used to identify patients diagnosed with colorectal cancer who had had surgery with curative intent.
Each participant was interviewed up to four times following their surgery: at 6 weeks then at 3, 6 and 12 months. Sixty-two interviews were conducted. Emerging concepts from the analysis defined further data collection. Relevant literature was theoretically sampled and all data analysed using constant comparison. Theoretical saturation was achieved.
Sixteen participants were recruited. Analysis of study data identified four conceptual stages representing the main phases individuals can experience during their recovery. They are: disembodiment, restoring embodiment, reclaiming control and managing embodied control. These occur in a stepwise progression, reflecting the emotional, physical and social processes involved in restoring perceived control over the body. They reflect the difficulty individuals can experience in understanding and self-managing their bodies. There is a desire to regain confidence and certainty over body function but this is threatened by fears about future health.
Achieving a sense of control of one's body, after surgery for colorectal cancer, proves to be a major challenge. Greater recognition of the consequences of cancer and its treatment upon the body and individualised management is required. Addressing how individuals can regain embodied control during their recovery needs to be integral within post-treatment support.
Available from: Ann-Caroline Johansson
- "Qualitative studies describing how persons treated for CRC experience recovery have portrayed this period as a time when the body makes the rules , initiating a process of recapturing lost bodily control and restoring the relationship with the body . This period is also depicted as a time when symptoms influence emotional functioning. "
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ABSTRACT: After colorectal cancer (CRC) treatment, people reorganize life in ways that are consistent with their understanding of the illness and their expectations for recovery. Incapacities and abilities that have been lost can initiate a need to reorient the self. To the best of our knowledge, no studies have explicitly focused on the concept of self-reorientation after CRC treatment. The aim of the present study was therefore to explore self-reorientation in the early recovery phase after CRC surgery. Grounded theory analysis was undertaken, using the method presented by Charmaz. The present results explained self-reorientation as the individual attempting to achieve congruence in self-perception. A congruent self-perception meant bringing together the perceived self and the self that was mirrored in the near environs. The results showed that societal beliefs and personal explanations are essential elements of self-reorientation, and that it is therefore important to make them visible.
Available from: Joakim Öhlén
- "Accordingly, we assume that the bodily and cognitively framed pedagogical strategies prepare the patient to understand the status of the cancer disease following a bodily change. Here we would like to draw a parallel to the term " sense making " (Chapman et al., 2003; Taylor et al., 2010). O ¨ hlén et al. (2013) described sense making of receiving palliative treatment as a process of human learning characterized by an ongoing search for knowledge and understanding. "
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To explore how physicians communicatively enable patients' understanding of bodily changes in gastrointestinal cancer care consultations.
Two datasets were used. The first consisted of transcribed video-recorded palliative care consultations with three oncologists and six patients diagnosed with advanced gastrointestinal cancer, in the context of outpatient palliative care. The second dataset was audio-recorded transcriptions from diagnostic consultations with six surgeons and seven patients diagnosed with colorectal cancer, in the context of cancer surgery. An inductively driven and iterative analysis of interaction was performed, guided by Wetherell et al. (2001).
Two overarching communicative strategies were identified: (1) “visualizing strategies,” with the dimensions: visible strategies (visualizing with what you actually or potentially can see), sensory strategies (visualizing with what is possible to feel), and imaginative strategies; and (2) “contrasting strategies,” with the dimensions: contrasting subjective experiences and contrasting between the patient and other people.
Significance of results:
The visualizing and contrasting communicative strategies form parts of physicians' tacit and experience-based knowledge. The strategies employed by physicians reveal clear potentials to enable patients' understanding and sense making of bodily changes. However, these strategies need to be explicated and problematized as parts of both consultation practice and basic medical education. By means of increased awareness, physicians can more easily identify turning points in patients' levels of understanding, thereby enriching ordinary medical consultations with reflected pedagogical strategies and skills in how to dialogue in a person-centered manner.
Available from: Vibeke Zoffmann
- "This was a qualitative study in which we used grounded theory methods for analysis (Glaser, 1978; Glaser & Strauss, 1967). The approach used was similar to that of several other authors who conducted research following the processes and stages that patients experience as they overcome challenges in health and life (Halle, Duhamel, & Le, 2011; Lalor, Begley, & Galavan, 2009; Taylor, Richardson, & Cowley, 2010; Wood, Connelly, & Maly, 2010). "
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ABSTRACT: Little is known about the psychosocial effects of facial disfigurement. We present the results of a qualitative study following 15 patients who had been surgically treated for head, neck, or eye cancer over the course of their first postoperative year. Taped nurse-patient conversations and individual interviews were analyzed using the grounded theory method. The findings revealed that the main concern of the patients was feeling isolated, which was resolved using a process of interactional integration. Interactional integration begins by breaking the silence to enable the progression from a disfigured person to a person with a disfigurement. The model explains the process of adjustment and demonstrates various elements that could be used in interventions targeting patients who experience psychosocial problems.
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