Taking Care of Second Cancer Risk

Krista L. Wilkins, PhD, RN; Roberta L. Woodgate, PhD

Disclosures

Cancer Nurs. 2012;35(1):55-62. 

In This Article

Methods

An interpretive, descriptive, qualitative research design was used to detail cancer survivors' perspectives. According to Thorne,[21] interpretive description departs from traditional qualitative descriptive approaches in that it encourages the researcher to construct a description of a phenomenon and then move beyond the initial description, through interpretation, toward developing a comprehensive understanding of human health and illness experiences. Hence, adopting an interpretive descriptive approach was appropriate to capture knowledge related to cancer survivors' experiences with taking care of second cancer risk.

Participants

Consistent with the interpretive description approach, participant recruitment focused on individuals living the experience under study by the strategy of purposive sampling.[21] Recruitment efforts were directed at selecting individuals with a cancer diagnosis who were included in the provincial cancer registry and met the following criteria: (1) 5 or more years from the initial cancer diagnosis, (2) at least 19 years of age at the time of the interview, (2) resided within the region in which interviews were being conducted, and (4) able to speak and understand English. Individuals with a diagnosis of a premalignant or benign first cancer or a second cancer were excluded from the study.

For the interview sample to be representative of the cancer survivor population in an Atlantic Canadian province, all cancer survivors who met the inclusion criteria (n = 100) were invited to participate in the study. Letters of invitation were distributed by the administrators of the provincial cancer registry and hospitalbased cancer pediatric patient database. Fifty-six cancer survivors responded to the letter of invitation, with 26 cancer survivors yielding no interest and 30 cancer survivors expressing an interest in the study. Reasons cited for lack of interest in the study by the 26 cancer survivors included being too busy to participate, feeling uncomfortable talking about second cancer risk, a desire to forget they had cancer, and believing they did not qualify as "cancer survivors" because they never had cancer. Of the 30 cancer survivors who were interested in learning more about the study, the researchers were unable to contact 3 cancer survivors, and 5 cancer survivors did not qualify for the study. All eligible cancer survivors who were contacted (n = 22) agreed to participate in the study.

The interview sample was composed of 16 women and 6 men. Participants ranged in age from 19 to 87 years, with a mean age of 50 years. All participants were white. Participants predominately lived in urban areas. On average, cancer survivors were 40 years of age at the time of the cancer diagnosis (range, 2–78 years). Participants had a cancer history of lymphoma or leukemia (n = 6), breast cancer (n = 4), colon cancer (n = 3), melanoma (n = 3), male or female genital cancer (n = 3), and other cancers (n = 3). All participants had no evidence of disease at the time of the interview. Seven of the cancer survivors had undergone surgery, 2 received chemotherapy, and 13 received a combination of surgery, radiation therapy, and/or chemotherapy. Time elapsed since the cancer diagnosis ranged from 5 to 18 years, with an average of 11 years.

Procedure

Permission to carry out this study was granted by the local university and hospital-based ethical review committees. Informed consent was obtained from all participants. Each participant took part in digitally recorded semistructured interviews with the first author of this article. A total of 23 interviews were conducted, with 1 participant interviewed twice because the first interview ended prematurely due to child care concerns. Data were collected until redundancy occurred and the researchers found no new data emerging.

An interview guide with open-ended questions was used to elicit what really matters most to cancer survivors about how they modified their second cancer risk (see Table 1 for sample questions). The authors developed the interview guide from key themes identified in a review of the literature on second cancer risk and their experience in caring for cancer patients. Interviews lasted anywhere from 30 minutes to 2 hours. Most interviews took place in the participants' homes. Field notes were made after each interview that included observations arising during the interviews. All interviews and field notes were transcribed verbatim.

Analysis

Data analysis occurred concurrently with data collection using the constant comparative method.[22] This data analysis method was used because it produces a description of a phenomenon and interpretation of data through the development of themes.[21] Critical to the development of themes was an iterative coding process that involved comparing and contrasting data within and between individuals, comparing data to emerging codes and creating new codes. In keeping with interpretive description, the researchers asked repeatedly: "What is happening here?" and "What am I learning about this?" throughout the analysis process.[21] A variety of strategies were used to enhance the rigor of the research process, including achieving data saturation, member checking of transcripts, peer review and debriefing, using direct quotes, and maintaining an audit trail of contextual information, methodological information, analytical decisions, and personal reflections.[23]

processing....