title: Confronting the unexpected: temporal, situational, and attributive dimensions of distressing symptom experience for breast cancer survivors.
abstract: OBJECTIVE
  To describe women's unexpected and distressing symptom experiences after breast cancer treatment.
  
  
  METHODS
  Qualitative and descriptive.
  
  
  METHODS
  Depending upon their preference, participants were interviewed in their homes or in a private office space in a nearby library.
  
  
  METHODS
  Purposive sample of 13 women 1-18 years after breast cancer treatment.
  
  
  METHODS
  Secondary analysis of phenomenologic data (constant comparative method).
  
  
  METHODS
  Breast cancer symptom distress, ongoing symptoms, and unexpected experiences.
  
  
  RESULTS
  Women described experiences of unexpected and distressing symptoms in the years following breast cancer treatment. Symptoms included pain, loss of energy, impaired limb movement, cognitive disturbance, changed sexual experience, and lymphedema. Four central themes were derived: living with lingering symptoms, confronting unexpected situations, losing precancer being, and feeling like a has-been. Distress intensified when women expected symptoms to disappear but symptoms persisted instead. Increased distress also was associated with sudden and unexpected situations or when symptoms elicited feelings of loss about precancer being and feelings of being a has been. Findings suggest that symptom distress has temporal, situational, and attributive dimensions.
  
  
  CONCLUSIONS
  Breast cancer survivors' perceptions of ongoing and unexpected symptoms have important influences on quality of life. Understanding temporal, situational, and attributive dimensions of symptom distress empowers nurses and healthcare professionals to help breast cancer survivors prepare for subsequent ongoing or unexpected experiences in the years after breast cancer treatment.
  
  
  CONCLUSIONS
  Follow-up care for breast cancer survivors should foster dialogue about ways that symptoms might emerge and that unexpected situations might occur. Prospective studies are needed to examine symptom distress in terms of temporal, situational, and attributive dimensions and explore the relationship between symptom distress and psychological distress after breast cancer treatment.
authors.affiliation: College of Nursing, New York University, New York City, USA. mtr3@nyu.edu
authors.forename: Mary
authors.initials: M
authors.lastname: Rosedale
authors.forename: Mei R
authors.initials: MR
authors.lastname: Fu
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000150:complications* / Q000628:therapy; D003863:Depression / Q000209:etiology; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D007389:Internal-External Control; D008016:Life Change Events; D008875:Middle Aged; D015404:Nursing Methodology Research; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology; D012649:Self Concept; D013315:Stress, Psychological / Q000209:etiology / Q000517:prevention & control / Q000523:psychology*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D035501:Uncertainty; D014481:United States