Deciding treatment options for breast cancer : a grounded theory of the women's perspective : a thesis submitted in partial fulfilment of the requirements for the degree of Master of Arts in Nursing, Massey University
Fallowfield and Hall (1991, p. 387) state: "Coping with the diagnosis and treatment of breast cancer is problematic for both the women with the disease and their doctors who must treat it". A variety of surgical techniques and types of adjuvant therapy are now available. As well as advances in medical and surgical care, marked cultural changes have also occurred in western health care over the past 30 years, with increasing concern for individual autonomy and consumer rights. Increasing emphasis is now placed on the provision of information to patients and on their participation in decision making about their prospective treatment. Questions remain, however, as to whether patients benefit from being offered choice, and evidence is currently limited. The aim of the present study was to discover the women's perspective on having to make choices regarding their preferred treatment options for breast cancer. The Glaserian (after Barney Glaser) school of grounded theory was chosen as the research method. Fourteen participants were recruited. Each woman participated in a loosely structured interview lasting 1-1 1/2 hours, which was taped and transcribed. Together these interviews became the data for analysis. Substantive codes and theoretical categories were developed from this data and finally a conceptual framework was constructed. Three main categories were identified. These were: • Detecting a cancer - the crisis evolves. • Discerning value priorities. • Reaching a point of salience and commitment to choice. The over-arching or core category identified was "Unifying 'the self' with treatment choices". It was identified in the present study that freedom of choice is part of the life project of 'choosing oneself'. The self is not a ready-made being but an existent always in the process of becoming, or as Macquarrie (1972, p. 145) states: "A unitary self as distinct from a series of unconnected acts". Women made their choices based on their past, their present life situation and their projection, for themselves, of their future. These decisions were made within the context of provisionality versus permanence; a diagnosis of cancer brought with it a renewed awareness life's uncertainty and also one's mortality.