title: 'Admission into a helping plan': a watershed between positive and negative experiences in breast cancer.
abstract: Cancer patients are in an exposed situation that raises certain psychosocial needs in contact with health care. Previous studies have mainly investigated these needs by assessments on pre-defined categories.
  
  
  OBJECTIVE
  The purpose of the present study is, from the patients' perspective, to identify breast cancer patients' psychosocial needs, and to synthesise them in a model reflecting the core of these needs.
  
  
  METHODS
  Seventy-one patients treated with radiation therapy were consecutively included and repeatedly interviewed about their experiences of health care. 'Critical incidents' where identified from the interviews and analysed due to the similarities-differences technique in grounded theory.
  
  
  RESULTS
  Four categories of needs where detected: 'access', 'information', 'treatment' and 'how approached'. These categories and their properties merged into a core category--'admission into a helping plan'. These findings are well understood in terms of attachment theory. In times of imminent danger and stress people strive to find a 'safe haven' to attach to. Cancer patients' 'safe haven' can be described as 'a helping plan'. It is not the result of a separate patient-caregiver relationship but is created by a pattern of individual experiences from all kind of contacts with the health-care system as a whole.
  
  
  CONCLUSIONS
  The presented model of patients needs as converging into 'admission into a helping plan' may serve as an easily comprehendible model for caregivers, guiding them to contribute to the patient's feeling of security and trust, and thus to the patient's own 'hope work'.
authors.affiliation: Department of Social Work, Umeå University, Umeå, Sweden. Sara.Lilliehorn@socw.umu.se
authors.forename: Sara
authors.initials: S
authors.lastname: Lilliehorn
authors.forename: Katarina
authors.initials: K
authors.lastname: Hamberg
authors.forename: Anneli
authors.initials: A
authors.lastname: Kero
authors.forename: Pär
authors.initials: P
authors.lastname: Salander
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001943:Breast Neoplasms / Q000523:psychology* / Q000532:radiotherapy; D002983:Clinical Competence; D003266:Continuity of Patient Care; D003299:Cooperative Behavior; D003858:Dependency, Psychological; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006379:Helping Behavior; D006801:Humans; D033183:Interdisciplinary Communication; D007406:Interview, Psychological; D008016:Life Change Events; D008875:Middle Aged; D020380:Needs Assessment; D009769:Object Attachment; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D012803:Sick Role; D012944:Social Support