Toward a Grounded Theory of Prostate Cancer Treatment Decision Making: From Pilot Study to Model Development

2.50
Hdl Handle:
http://hdl.handle.net/10755/165646
Category:
Abstract
Type:
Presentation
Title:
Toward a Grounded Theory of Prostate Cancer Treatment Decision Making: From Pilot Study to Model Development
Author(s):
O'Rourke, M.
Author Details:
M. O�Rourke, University of North Carolina, Winston-Salem, North Carolina, USA
Abstract:
Purpose: (1) To examine the process by which newly diagnosed prostate cancer patients and their wives make decisions regarding prostate cancer treatment selection; (2) to examine influential factors in the decision making process; (3) to track the ongoing decisions made by couples following completion of initial therapy. The goal of this program of research was to develop a grounded theory of decision making regarding cancer treatment selection. Significance: Within the USA more than 100,000 men are diagnosed with prostate cancer annually. Given that there is no consensus in the scientific community as to which, if any, treatment modality is superior, prostate cancer remains a model of ambiguity and uncertainty. Understanding now men and their partners proceed through the decision making process provides essential information that must precede the development of interventions to enhance decision making. Methods/Framework: A family systems framework guided the conception of both the initial focus group pilot study and the larger longitudinal study. Sample selection, data sources and collection procedures, analysis, and presentation of the longitudinal study data were also guided by the grounded theory approach. Eighteen couples (aged 49 – 78) were recruited from community urology practices within western North Carolina. Couples were interviewed conjointly and individually on 3 occasions: within 6 weeks of diagnosis, and again at 3 and 12 months post treatment (n = 162 interviews). Interviews were recorded and transcribed verbatim, then analyzed by constant comparison content analysis techniques. An audit trail included tapes, transcripts and field notes. All methodologic and analytic decisions were documented. Member checks were performed. Graduate level nursing theory students participated in labeling key concepts and developing the current model structure. Findings have been shared and validated with couples participating in local prostate cancer support groups. Findings: Preliminary model development based on data from initial focus groups and data from the larger longitudinal study are presented. Antecedent variables include symptom appraisal, environmental factors (including cohort factors and issues of social power/dominance and paternalism within relationships between couples and physicians), personal and vicarious cancer experiences, and marital relationships. Decisional consequences included reaffirmation of the initial decision, reconstructing the initial decision to cope with alternations in treatment plans and the resulting cognitive dissonance experienced, and remodeling of future plans. The decision process is more accurately depicted by a circular/iterative vs. linear model. The model captures the ongoing decisions made by couples up to and beyond one year post initial treatment. Implications for Nursing Practice & Research: Both the process of model development and the preliminary model itself will be discussed. The model requires further refinement, but will provide the basis for future research as it is tested and reduced and revised. The confirmed model will require validation across other cancer diagnoses and may serve as the basis for the development of specific multi-disciplinary interventions to facilitate couple based treatment decision making. Construction of the initial model has served to identify practice recommendations such as including specifically identified concerns during initial counseling beyond the presentation of factual information, and the optimal timing of educational interventions to deal with treatment related incontinence and impotence.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2001
Conference Name:
26th Annual Oncology Nursing Society Congress
Conference Host:
Oncology Nursing Society
Conference Location:
San Diego, California, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleToward a Grounded Theory of Prostate Cancer Treatment Decision Making: From Pilot Study to Model Developmenten_GB
dc.contributor.authorO'Rourke, M.en_US
dc.author.detailsM. O�Rourke, University of North Carolina, Winston-Salem, North Carolina, USAen_US
dc.identifier.urihttp://hdl.handle.net/10755/165646-
dc.description.abstractPurpose: (1) To examine the process by which newly diagnosed prostate cancer patients and their wives make decisions regarding prostate cancer treatment selection; (2) to examine influential factors in the decision making process; (3) to track the ongoing decisions made by couples following completion of initial therapy. The goal of this program of research was to develop a grounded theory of decision making regarding cancer treatment selection. Significance: Within the USA more than 100,000 men are diagnosed with prostate cancer annually. Given that there is no consensus in the scientific community as to which, if any, treatment modality is superior, prostate cancer remains a model of ambiguity and uncertainty. Understanding now men and their partners proceed through the decision making process provides essential information that must precede the development of interventions to enhance decision making. Methods/Framework: A family systems framework guided the conception of both the initial focus group pilot study and the larger longitudinal study. Sample selection, data sources and collection procedures, analysis, and presentation of the longitudinal study data were also guided by the grounded theory approach. Eighteen couples (aged 49 – 78) were recruited from community urology practices within western North Carolina. Couples were interviewed conjointly and individually on 3 occasions: within 6 weeks of diagnosis, and again at 3 and 12 months post treatment (n = 162 interviews). Interviews were recorded and transcribed verbatim, then analyzed by constant comparison content analysis techniques. An audit trail included tapes, transcripts and field notes. All methodologic and analytic decisions were documented. Member checks were performed. Graduate level nursing theory students participated in labeling key concepts and developing the current model structure. Findings have been shared and validated with couples participating in local prostate cancer support groups. Findings: Preliminary model development based on data from initial focus groups and data from the larger longitudinal study are presented. Antecedent variables include symptom appraisal, environmental factors (including cohort factors and issues of social power/dominance and paternalism within relationships between couples and physicians), personal and vicarious cancer experiences, and marital relationships. Decisional consequences included reaffirmation of the initial decision, reconstructing the initial decision to cope with alternations in treatment plans and the resulting cognitive dissonance experienced, and remodeling of future plans. The decision process is more accurately depicted by a circular/iterative vs. linear model. The model captures the ongoing decisions made by couples up to and beyond one year post initial treatment. Implications for Nursing Practice & Research: Both the process of model development and the preliminary model itself will be discussed. The model requires further refinement, but will provide the basis for future research as it is tested and reduced and revised. The confirmed model will require validation across other cancer diagnoses and may serve as the basis for the development of specific multi-disciplinary interventions to facilitate couple based treatment decision making. Construction of the initial model has served to identify practice recommendations such as including specifically identified concerns during initial counseling beyond the presentation of factual information, and the optimal timing of educational interventions to deal with treatment related incontinence and impotence.en_GB
dc.date.available2011-10-27T12:22:25Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T12:22:25Z-
dc.conference.date2001en_US
dc.conference.name26th Annual Oncology Nursing Society Congressen_US
dc.conference.hostOncology Nursing Societyen_US
dc.conference.locationSan Diego, California, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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