Setting "survivorship" in context : the role of everyday resources in adjusting to life after cancer treatment with curative intent

Bravington, Alison

Medicine
March 2018

Thesis or dissertation


Rights
© 2018 Alison Bravington. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.
Abstract

Background: The number of people living beyond cancer in the UK is rapidly increasing, and their supportive care needs are a pressing issue. Patients treated with curative intent move on to a self management pathway, which uses checklists to measure care requirements. Patients are expected to consider ways of addressing their own psychosocial needs. The focus of care on the quantification of needs and the cognitive strategies used to manage them fails to take the subtleties of patients’ social and material context into account. Research suggests that the self management agenda does not adequately acknowledge the challenges of day-to-day experiences of illness, and how people engage with their resources to adapt to life after treatment.

Aim of the study: To explore how everyday social and material resources can be used to adapt to life in the year beyond cancer treatment with curative intent.

Methods: In 2014–15, in-depth interviews were conducted with twenty-six people recently treated for breast, colorectal or prostate cancer (twenty using photo elicitation), followed by seventeen longitudinal interviews approximately six months later. Participants from a range of social backgrounds were recruited through clinics in Yorkshire and the Humber. The method of analysis was constructivist grounded theory.

Findings: Treatment with curative intent is interpreted as turning a curve in life’s pathway, requiring gradual reorientation. This is shaped by three processes. In Responding to diagnosis and treatment, participants drew on past identities to reinforce their sense of self, and personalised care was crucial. In Using social resources for meaning-making, perspectives from the worlds of the family, clinic and workplace contributed to participants’ understanding of their situation, and the “survivor” label was rejected. Developing assets for recovery involved consolidating the meaning of their illness, negotiating personal change, and using material and environmental resources to regain control, create comfort and chase continuity.

Conclusion: People with good prognoses have a unique outlook on adaptation after treatment. Finding ways of assessing the assets that people do have, rather than what they do not have, is a good starting point for follow-up care. Everyday resources can be used to address three key objectives in adaptation: control, comfort and continuity.

Publisher
Hull York Medical School, The University of Hull and The University of York
Supervisor
Macleod, Una; Johnson, Miriam (Miriam J.)
Qualification level
Doctoral
Qualification name
PhD
Language
English
Extent
7 MB
Identifier
hull:16872
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