Repair of the Threatened Feminine Identity

Experience of Women With Cervical Cancer Undergoing Fertility Preservation Surgery

Hiroko Komatsu, PhD, RN; Kaori Yagasaki, MSN, RN; Rie Shoda, RN; Younghui Chung, RN; Takashi Iwata, PhD, MD; Juri Sugiyama, MD; Takuma Fujii, PhD, MD


Cancer Nurs. 2014;37(1):75-82. 

In This Article


Research Design

The conceptual orientation of the present study drew upon symbolic interactionism because the study focused on the concept of a woman. According to symbolic interactionism,[12] the individual (woman) acts based on the meaning of the object (fertility preservation) for her. This meaning is created through interactions with the self, others, and external events. There are 2 types of others: "significant others" or those who are close to the woman such as her family, whereas "generalized others" include such things as social norms.[13]

To understand the behaviors of women with cervical cancer undergoing fertility preservation surgery, we used a qualitative design based on interviews with women who underwent radical trachelectomy. More specifically, we used Grounded Theory methodology[14] with a conceptual orientation of symbolic interactionism.

Participants and Settings

Participants were purposively recruited from a list of outpatients who had undergone radical trachelectomy between 2006 and 2010 in the Department of Obstetrics and Gynecology of Keio University Hospital in Tokyo, Japan. The participants were women who were diagnosed with cervical cancer, underwent radical trachelectomy, were followed up at an outpatient clinic, and who were encouraged to attempt conception after 6 months without cancer recurrence. We excluded women with anxiety and depression confirmed by a physician or nurse; this was to avoid the risk of an in-depth interview about the self and decision making possibly negatively affecting their psychological conditions. We did not have any restriction on marital status (married or single with/without partners), experience of fertility treatment, or childbirth.

The gynecologist explained the study and the nature of the study to women at their follow-up visit and asked if they wished to participate in the study. After the gynecologist obtained verbal consent for the study from those who agreed to participate, the nurse explained the details and voluntary nature of the study and obtained written informed consent.

We used theoretical sampling, and had several meetings with the gynecologists and nurses to confirm theoretical saturation of data after the 13th interview, but obtained interview data for 3 more women. A total of 16 women were interviewed, but 1 woman was excluded from the analysis because her husband attended the interview. We collected patient demographic and clinical information, including age, year of operation, and experience of pregnancy/childbirth from medical charts.

Of the 15 women included in the analysis, 6 were married at the time of the surgery (Table 1). Of the 9 women who were single at the time of the surgery, 2 got married after surgery, 2 were engaged during the study period, and 3 had partners. The mean age of the participants at the time of the surgery was 31.6 years (range, 25–38 years). Only 1 woman had a child before the surgery.

Data Collection

The study took place between August 2011 and July 2012. Two nurses who each had more than 5 years of experience in clinical practice and who had training in interviewing conducted the in-depth interviews using a semistructured interview guide at the outpatient clinic or in the ward of the Department of Obstetrics and Gynecology of Keio University Hospital (Table 2). The duration of the interviews ranged from 30 to 45 minutes. The facilitator recorded field notes from each interview. All interviews were conducted in Japanese, audiotaped, and transcribed verbatim. The researcher translated the themes and quotations to English after the induction of themes and extraction of quotations to support the themes.


The data were analyzed according to Grounded Theory[14] and Grounded Theory as Methods.[15] Open coding was achieved by deconstructing each interview sentence by sentence to generate the initial concepts. Subcategories were derived from axial coding, and relating these subcategories led to categories. A core category was derived by relating all categories and subcategories.


The rigor of the study was confirmed by credibility, dependability, confirmability, and transferability.[16] For credibility, the analytical process and results of the study were shown to the gynecologists and nurses for confirmation. Themes were discussed, and consensus was reached. For dependability, 2 of the nurse researchers (H.K. and K.Y.) reviewed the data to approve the codes and themes identified. Furthermore, we discussed the interpretation and modifiability of data with the gynecologists and nurses, as well as theoretical saturation after the analyses of the 3rd, 5th, and 13th study participants. For confirmability, the procedure was interactive following the Grounded Theory approach,[14] and the emergent categories were confirmed. Tranferability was reviewed and confirmed by the gynecologists and nurses who provided care.

Ethical Considerations

This study was approved by the internal review board of Keio University (no. 2011-042). All participants were informed of the voluntary nature of the study and their right to withdraw from the study at any point.