title: The importance of relationships in the experience of cancer: a re-working of the policy ideal of the whole-systems approach.
abstract: OBJECTIVE
  This paper outlines the importance of interpersonal familial relationships in how people experience cancer.
  
  
  METHODS
  This paper draws on data from a longitudinal, qualitative study which aimed to explore the experiences of people with cancer within the first year following diagnosis. The sample included fifteen men with colorectal cancer, 3 women with colorectal cancer, twelve women with breast cancer, nine women with gynaecological cancer, six women with lung cancer, eleven men with lung cancer and ten men with prostate cancer. Four people died during the course of the study and ten people chose to withdraw.
  
  
  RESULTS
  Close interpersonal relationships were clearly core mediating features in how the illness was experienced; for example, presenting for symptom investigation was often the result of ongoing interaction and debate between partners. We use the idea of the 'joint ownership of cancer' to elucidate the role of relationships in experiencing and understanding the disease. We propose a re-working of the notion of a whole-systems approach to include not just partnership working within health and social care agencies, but centralising the patient's interpersonal relationships as critical in each aspect of their experience of cancer.
  
  
  CONCLUSIONS
  The findings are discussed in terms of the need for service delivery and research to be mindful of the relational aspects and implications of illness. Nurses can play a key role in how this is operationalised in supporting people affected by cancer in the context of their relationships.
authors.affiliation: Cancer Care Research Centre, University of Stirling, Stirling FK9 4LA, UK. n.a.illingworth@stir.ac.uk
authors.forename: Nicola
authors.initials: N
authors.lastname: Illingworth
authors.forename: Liz
authors.initials: L
authors.lastname: Forbat
authors.forename: Gill
authors.initials: G
authors.lastname: Hubbard
authors.forename: Nora
authors.initials: N
authors.lastname: Kearney
mesh_terms: D000223:Adaptation, Psychological; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000451:nursing / Q000523:psychology / Q000628:therapy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000451:nursing / Q000523:psychology / Q000628:therapy; D005195:Family Relations; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008175:Lung Neoplasms / Q000175:diagnosis / Q000451:nursing / Q000523:psychology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis / Q000451:nursing* / Q000523:psychology* / Q000628:therapy; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000451:nursing / Q000523:psychology / Q000628:therapy; D012657:Self-Help Groups; D012737:Sex Factors; D018434:Sickness Impact Profile; D012944:Social Support