Bringing threat to the fore: participating in lifelong surveillance for genetic risk of cancer.
OBJECTIVE
To explain how patients with multiple endocrine neoplasia type 2a (MEN2a) and family members conceptualize participation in lifelong surveillance in genetic cancer care.


METHODS
Qualitative naturalistic inquiry.


METHODS
Northeastern United States. Data were collected during interviews in informants' homes.


METHODS
12 adult patients and 9 family members were recruited purposively through endocrinology clinics at two East Coast medical centers.


METHODS
A grounded theory design was used. Subjects completed a demographic questionnaire and were interviewed on two occasions. In-depth interviews were audiotaped. The core concept and process variables emerged through three levels of narrative content analysis, theoretical sampling, and constant comparison. The generated theory was presented to the participants for validation.


METHODS
The basic psychological issue associated with participation in lifelong surveillance and the psychosocial processes used by individuals to deal with the issues.


RESULTS
MEN2a patients and family members experience surveillance as a (Re)Minding of a threat to health. Once threat is brought to the fore, participants interpret the meaning and negotiate control of the impact of the diagnosis, related events, and consequences. Meaningful information from surveillance activities is incorporated into participants' self-image and daily lives through a process of (Re)Integration. The genetic nature of MEN2a did not emerge as a significant subcategory in relation to the core variable.


CONCLUSIONS
Finding meaning in the outcomes of surveillance events is a psychosocial process that is central to participation in lifelong surveillance. Genetic predisposition to cancer was a peripheral concern to subjects as they dealt with surveillance issues.


CONCLUSIONS
This investigation provides a model for the development of a grounded theory for understanding how people with other genetic cancer syndromes participate in lifelong surveillance.
Giarelli
Ellen
E
School of Nursing at the University of Pennsylvania, Philadelphia, PA, USA. giarelli@nursing.upenn.edu
D000310:Adrenal Gland Neoplasms / Q000175:diagnosis; D000328:Adult; D000368:Aged; D002116:Calcitonin / Q000097:blood; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018813:Multiple Endocrine Neoplasia Type 2a / Q000235:genetics / Q000451:nursing / Q000523:psychology*; D015399:Nursing Research; D010673:Pheochromocytoma / Q000175:diagnosis; D012306:Risk; D011795:Surveys and Questionnaires; D013964:Thyroid Neoplasms / Q000175:diagnosis
D002116:Calcitonin