Adjustment Patterns of Chinese Women Surviving Breast Cancer

Background and Purpose: Adjustment after trauma and loss has long been a topic of interest to researchers and practitioners. In psycho-oncology, most studies have focused on identifying negative adjustment; relatively few address the potentials for positive growth experienced by cancer survivors. Research on patients' subjective experiences is also very limited, particularly in the Chinese context. The purpose of this study is to understand the impact of breast cancer on Chinese women's lives and their adjustment experiences, both positive and negative. Factors identified with positive adjustment are reported.

Method: Taking a constructivist grounded theory approach (Charmaz, 2003), theoretical sampling was used to recruit twenty-six Chinese women aged 25 to 69. An innovative method integrating an in-depth interview with drawing an autobiographical timeline (Leung & Chan, 2008) was used in data collection. It generated data in the form of narratives and sketches of autobiographical timelines which showed subjective perception of well-being over patients' lifespan. Line-by-line coding was conducted with the transcripts of these interviews, using qualitative analysis software NUDIST Nvivo. By constant comparison analysis, conceptual categories were constructed and patterns identified from the codes (Charmaz, 2003; Strauss & Corbin, 1990). Analysis was conducted for the timeline sketches, to detect patterns after the cancer episode.

Results: Findings reveal four patterns of adjustment for this group of Chinese women: (1) resilience, (2) transformation, (3) recovery, and (4) succumbing. The timelines of the resilience group did not dip after the cancer diagnosis, suggesting the women were not adversely affected by the illness in their subjective perception. All other groups represented the cancer episode as a dip in their timelines, indicating perceived negative impact. Each group had differing subsequent adjustment patterns. The transformation group had timelines that rebounded to a higher level, indicating better subjective well-being than before cancer. The recovery group had timelines that returned to about the same level. The succumbing group showed timelines that followed a continual downward slope after initial diagnosis. However, positive change was found in the succumbing group over time, showing a change in adjustment over the illness trajectory. Analysis of narratives shows that meaning reconstruction plays a key role in adjustment. It also suggests that cultural beliefs, personal disposition for optimism, prior experience of coping with crises, presence of social support, and a model of resilience are variables that may contribute to positive adjustment.

Conclusions and Implications: This study suggests that, beyond recovery, transformation and resilience are possible after cancer. It expands our understanding of the range of experiences that Chinese women with breast cancer may have. It suggests the importance of offering optimal psychosocial services for people, services that require identifying and ameliorating negative symptoms as well as reinforcing positive strengths and personal growth. This study also offers insights for further research on resilience and transformation responses and the variables associated with these adjustment patterns.