title: Exploring the first days of adjustment to cancer: a modification of acclimating to breast cancer theory.
abstract: BACKGROUND
  Psychological adjustment may not be achieved by some women even years after breast cancer diagnosis. Although level of adjustment to diagnosis in the earliest (pretreatment) period is associated with future adjustment, limited research has explored this early period. Greater knowledge of women's thoughts and behaviors as adjustment is initiated is needed to target interventions for women at risk for future adjustment problems.
  
  
  OBJECTIVE
  This study was intended to expand what is known about the pretreatment experiences, thought processes, and behaviors of women diagnosed with breast cancer and further define concepts and increase the scope of Acclimating to Breast Cancer, a grounded theory of adjustment in the pretreatment period.
  
  
  METHODS
  Forty-five semistructured interviews were conducted with 26 women prior to and again within 30 days after breast cancer surgery. Women were 39 to 81 years old with stage 0 to stage II disease and primarily varied from the original sample geographically and on length of, and care coordination during, the pretreatment period. A multidisciplinary team performed directed content analysis, comparing new data to the original theory.
  
  
  RESULTS
  Although generally consistent with the original theory, findings contributed to renaming 1 and adding 2 theory categories plus expanding 7 of 8 existing categories. Additional personal and situational influences on the process were identified.
  
  
  CONCLUSIONS
  The grounded theory of Acclimating to Breast Cancer was modified with new data from women currently experiencing the pretreatment period following diagnosis.
  
  
  CONCLUSIONS
  This theory modification provides a framework to guide needed assessment, psychoeducation, and research aimed at supporting psychological adjustment during the pretreatment period.
authors.affiliation: School of Nursing, University at Buffalo, the State University of New York, Buffalo, NY 14214, USA. rmlally@buffalo.edu
authors.forename: Robin M
authors.initials: RM
authors.lastname: Lally
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Hydeman
authors.forename: Kathleen
authors.initials: K
authors.lastname: Schwert
authors.forename: Heather
authors.initials: H
authors.lastname: Henderson
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Edge
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000523:psychology* / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011582:Psychological Theory; D036301:Qualitative Research; D013997:Time Factors