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Betydelser av bröstcancer i ett livssammanhang
Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).ORCID iD: 0000-0001-5696-996X
2013 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Meanings of breast cancer in a life context (English)
Abstract [en]

The aim of the thesis is to describe and analyse how a group of women experience that their every-day lives are affected during and after primary breast cancer treatment. The thesis is a consecutive, longitudinal study that takes an explorative qualitative approach. Seventy-one women younger than 60 years of age with primary breast cancer were consecutively included in the study. The women were interviewed four or five times over a period of 4 to 6 years from end of radiotherapy. The analyses of the interviews were inspired by grounded theory and narrative analysis. 

The thesis encompasses four papers. Paper I focused on the women’s contact with health care. The results of this study indicate that it is crucial for patients in a vulnerable situation to be admitted into a supportive system – ‘admitted into a helping plan’ – that, more or less explicitly, displays a well-thought-out plan of care. This is a process built on individual relationships with members of the health-care staff, but it ends up in a relationship to health care as a helping system, a ‘safe haven’ to attach to. Study II explored the women’s ideas about what motivated and discouraged their return to work. The results illustrate that the meaning of work fluctuates over time and that the processes of returning to work are conditioned by the patients’ individual life situations. Returning to work was regarded as an important part of the healing process because of how it generated and structured the women’s everyday lives. Returning to work meant demonstrating well-being and normalcy after breast cancer. Study III examined how life was lived and valued during and after treatment for breast cancer compared to pre-cancer life. The analysis showed that being afflicted with breast cancer was evaluated from a context of the women’s former everyday lives and stressed that how the women experienced breast cancer was a matter of personal circumstances. Study IV focused on how the women experienced and dealt with their altered bodies. The results showed that the women followed three different body-mind trajectories that depended to a significant extent on the severity of side effects and bodily alterations that resulted from their treatments.

Being afflicted by breast cancer implies vulnerability and losses, but it can also involve benefits and provide new perspectives on life. How the overall breast cancer experience is valued seems to be very much a matter of circumstances in everyday life. This thesis highlights circumstances that focus in particular on contacts with health care, the body, the work situation, and the family situation. 

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2013. , 90 p.
Series
Studier i socialt arbete vid Umeå universitet : avhandlings- och skriftserie, ISSN 0283-300X ; 80
Keyword [en]
breast cancer, psycho-oncology, oncology, everyday life, patient perspective, gender, sick leave, work, side effects, attachment, 'critical incidents'
Keyword [sv]
bröstcancer, psykosocial onkologi, onkologi, vardagsliv, patientperspektiv, genus, sjukskrivning, arbete, biverkningar, anknytning, 'critical incidents'
National Category
Social Work
Identifiers
URN: urn:nbn:se:umu:diva-82968ISBN: 978-91-7459-757-8 (print)OAI: oai:DiVA.org:umu-82968DiVA: diva2:664212
Public defence
2013-12-06, Samhällsvetarhuset, Hörsal B, Umeå universitet, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Funder
Swedish Cancer Society
Available from: 2013-11-15 Created: 2013-11-14 Last updated: 2013-11-14Bibliographically approved
List of papers
1. Admission into a helping plan: a watershed between positive and negative experiences in breast cancer
Open this publication in new window or tab >>Admission into a helping plan: a watershed between positive and negative experiences in breast cancer
2010 (English)In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 19, no 8, 806-813 p.Article in journal (Refereed) Published
Abstract [en]

Cancer patients are in an exposed situation that raises certain psychosocial needs in contact with health care. Previous studies have mainly investigated these needs by assessments on predefined categories.Objective: The purpose of the present study is, from the patients' perspective, to identify breast cancer patients' psychosocial needs, and to synthesise them in a model reflecting the core of these needs.Methods: Seventy-one patients treated with radition therapy were consecutively included and repeatedly interviewed about their experiences of health care. 'Critical incidents' where identified from the interviews and analysed due to the similarities-differences technique in grounded theory.Results: Four categories of needs where detected: 'access', 'information', 'treatment', and 'how approached'. These categories and their properties merged into a core category - 'admission into a helping plan'. These findings are well understood in terms of attachment theory. In times of immanent danger and stress people strive to fina a 'safe haven' to attach to. Cancer patients' 'safe haven' can be described as 'a helping plan'. It is not the result of a separate patient-caregiver relationship but is created by a pattern of individual experiences from all kind of contacts with the health-care system as a whole.Conclusions: The presented model of patients needs as converging into 'admission into a helping plan' may serve as an easily comprehendible model for caregivers, guiding them to contribute to the patient's feeling of security and trust, and thus to the patient's own 'hoope work'.

Place, publisher, year, edition, pages
Wiley, 2010
Keyword
breast cancer, psycho-oncology, patient perspective, attachment theory, critical incident
National Category
Social Work
Research subject
Psychology
Identifiers
urn:nbn:se:umu:diva-26065 (URN)10.1002/pon.1619 (DOI)000280897400002 ()19771573 (PubMedID)
Available from: 2009-09-22 Created: 2009-09-22 Last updated: 2017-12-13Bibliographically approved
2. Meaning of work and the returning process after breast cancer: a longitudinal study of 56 women
Open this publication in new window or tab >>Meaning of work and the returning process after breast cancer: a longitudinal study of 56 women
2013 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, ISSN 0283-9318, Vol. 27, no 2, 267-274 p.Article in journal (Refereed) Published
Abstract [en]

Background: An increasing number of women survive breast cancer and a majority return to work. However, findings based on mean values may conceal individual processes that need to be better understood to discuss meaningful rehabilitation.

Aim: The purpose of this paper is to describe the sick-leave pattern of a group of Swedish women with primary breast cancer but foremost to explore their ideas about what motivates and discourages their return to work.

Method: Fifty-six women were repeatedly interviewed over a period of 18 to 24 months. Interview sections that clearly illustrated the women’s experiences and ideas about work were categorized using the comparative similarities-differences technique.

Findings: The average length of sick leave was 410 days (range 0-942). Six months after the first day of sick leave, 29% worked at least their previous service grade. At 12 months, 55%, and at 18 months 57% did so. Those treated with chemotherapy had in average more than twice as large sick leave as those who did not. Three categories emerged. ‘Motives for not returning to work’ consists of four sub-categories: ‘I’m still too fragile to return to work’; ‘My workplace is a discouraging place’; ‘I took an opportunity to pause’ and ‘I’ve lost the taste for work’. ‘Motives for returning’ consists of two sub-categories: ‘Work generates and structures my everyday life’ and ‘I miss my workplace’. Finally, ‘Transition in work approach’ reflects a changed approach to work.

Conclusion: The meaning of work varies over time, but first and foremost work was regarded as an important part of the healing process as it restores the disruption of everyday life. Guidelines cannot be reduced to a linear relationship with biomedical variables but the individual context of everyday life must be considered.

Place, publisher, year, edition, pages
HOBOKEN, NJ, USA: Wiley-Blackwell, 2013
Keyword
Activity, breast cancer, chemotherapy, everyday life, guidelines, sick leave, work working life
National Category
Social Sciences
Research subject
Psychology
Identifiers
urn:nbn:se:umu:diva-54647 (URN)10.1111/j.1471-6712.2012.01026.x (DOI)
Available from: 2012-05-03 Created: 2012-05-03 Last updated: 2017-12-07Bibliographically approved
3. The impact of breast cancer on living an everyday life 4.5-5 years post-diagnosis: a qualitative prospective study of 39 women
Open this publication in new window or tab >>The impact of breast cancer on living an everyday life 4.5-5 years post-diagnosis: a qualitative prospective study of 39 women
2011 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 50, no 3, 399-407 p.Article in journal (Refereed) Published
Abstract [en]

Background. The survival of women with breast cancer has improved. There are many studies available describing different aspects of how the illness and its treatment affect the women. Usually these studies are cross-sectional and focus on assessments of a sample of women at a single point in time during post-treatment. These studies are important but of limited value if we are interested in understanding more about breast cancer in a life context. The present study is a contribution.

Methods. A consecutive sample of 39 women was followed up by means of repeated thematic interviews about how they lived their lives, from the end of radiation therapy to a point four years later, i.e. 4.5–5 years post diagnosis.

Results. Four different groups of women emerged. Largely, the first group evaluated the cancer initiated transformation of their lives in a positive way. The breast cancer helped them depart from a career treadmill or to positive interpersonal experiences. In the second group the cancer and its treatment seemed to pass without marked traces. The cancer made a difference for the third group, but both in positive and negative ways. A different life perspective or improved relationships were weighted against troublesome side effects from treatment. Finally, in the fourth group a bodily decline due to side effects and other health problems was predominant and this obstructed their chances of living a good life.

Discussion. The narratives showed that being diseased by breast cancer has different impacts depending on how the woman lives her life – it is very much a matter of transition in a life context. The results are furthermore discussed in relation to adaptation and coping theory.

Place, publisher, year, edition, pages
Informa Plc., 2011
National Category
Gender Studies Social Work
Identifiers
urn:nbn:se:umu:diva-38974 (URN)10.3109/0284186X.2010.547216 (DOI)
Available from: 2011-01-13 Created: 2011-01-13 Last updated: 2017-12-11Bibliographically approved
4. Breast cancer experience through the body: A consecutive, six-year longitudinal study of 24 women
Open this publication in new window or tab >>Breast cancer experience through the body: A consecutive, six-year longitudinal study of 24 women
(English)Manuscript (preprint) (Other academic)
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-82953 (URN)
Available from: 2013-11-14 Created: 2013-11-14 Last updated: 2014-01-14Bibliographically approved

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