title: Struggling with paradoxes: the process of spiritual development in women with cancer.
abstract: OBJECTIVE
  To examine the process of spiritual development in women diagnosed with cancer within five years of initial treatment.
  
  
  METHODS
  Exploratory, qualitative.
  
  
  METHODS
  Outpatients in the mid-central and southwestern United States.
  
  
  METHODS
  10 Caucasian women, ages 45-70, who completed initial treatment, were not undergoing treatment for recurrence, and were within five years of diagnosis for breast or ovarian cancer or non-Hodgkin's lymphoma.
  
  
  METHODS
  Data collected during two semistructured interviews, coded and analyzed using grounded theory techniques. Frame of reference--symbolic interactionism.
  
  
  METHODS
  Developmental processes of spirituality; responses to diagnosis, treatment, and survival of cancer.
  
  
  RESULTS
  Diagnosis of cancer threatened the meaning of the women's lives, resulting in a sense of disintegration. This problem was resolved through the basic social psychological process of Struggling With Paradoxes, a three-phase process of Deciphering the Meaning of Cancer for Me, Recognizing Human Limitations, and Learning to Live with Uncertainty. In phase I, the paradoxes focused on the possibility of death, distress, vulnerability, and maintaining connection. In phase II, the paradoxes involved confronting death, asking difficult questions, and letting go of ultimate control of their lives. In phase III, the paradoxes centered on uncertainty, redefining meaning, and identifying spiritual growth. Reintegration occurred over time, although when threatened by the possibility of recurrence, disintegration resurfaced for a time.
  
  
  CONCLUSIONS
  Findings emphasize not only the importance of spirituality, but also that spiritual experience is individualized and developmental in nature. Spiritual growth occurs over time following the diagnosis of cancer and is not necessarily related to age.
  
  
  CONCLUSIONS
  Spiritual concerns may be painful for patients to address; spiritual caregiving requires an acknowledgment of need by the woman with cancer and a caring, sensitive caregiver. Nurses should be aware of the phases of spiritual development so that interventions can be designed to address individual needs that may vary over time.
authors.affiliation: Department of Nursing, Towson University, Towson, MD, USA. mhalstead@towson.edu
authors.forename: M T
authors.initials: MT
authors.lastname: Halstead
authors.forename: M
authors.initials: M
authors.lastname: Hull
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D001293:Attitude to Death; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D003220:Conflict, Psychological; D005239:Fear; D005260:Female; D006694:Holistic Health; D006803:Human Development; D006801:Humans; D007389:Internal-External Control; D008016:Life Change Events; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D008875:Middle Aged; D008960:Models, Psychological; D015404:Nursing Methodology Research; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D012648:Self Care / Q000379:methods / Q000523:psychology; D029181:Spirituality; D013315:Stress, Psychological / Q000517:prevention & control / Q000523:psychology; D011795:Surveys and Questionnaires; D014930:Women / Q000523:psychology*