title: Cancer patients' experiences with nature: Normalizing dichotomous realities.
abstract: To explore cancer patients' subjective experiences with nature in order to examine the relevance of nature-based care opportunities in cancer care contexts. The rationale was to describe the underlying mechanisms of this interaction and produce translatable knowledge.
  
  
  
  Qualitative research design informed by grounded theory. Sampling was initially convenience and then theoretical. Competent adults with any cancer diagnosis were eligible to participate in a semi-structured interview exploring views about the role of nature in their lives. Audio-recorded and transcribed interviews were analyzed using inductive, cyclic, and constant comparative analysis.
  
  
  
  Twenty cancer patients (9 female) reported detailed description about their experiences with nature from which a typology of five common nature interactions emerged. A theory model was generated constituting a core category and two inter-related themes explaining a normalization process in which patients negotiate their shifting realities (Core Category). Nature functioned as a support structure and nurtured patients' inner and outer capacities to respond and connect more effectively (Theme A). Once enabled and comforted, patients could engage survival and reconstructive maneuvers and explore the consequences of cancer (Theme B). A dynamic relationship was evident between moving away while, simultaneously, advancing towards the cancer reality in order to accept a shifting normality. From a place of comfort and safety, patients felt supported to deal differently and more creatively with the threat and demands of cancer diagnosis, treatment and outlook.
  
  
  
  New understanding about nature's role in cancer patients' lives calls attention to recognizing additional forms of psychosocial care that encourage patients' own coping and creative processes to deal with their strain and, in some cases, reconstruct everyday lives. Further research is required to determine how nature opportunities can be feasibly delivered in the cancer care setting.
authors.affiliation: Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Parkville, Australia; Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia. Electronic address: sarah.blaschke@petermac.org.
authors.forename: Sarah
authors.initials: S
authors.lastname: Blaschke
authors.affiliation: Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Parkville, Australia; Department of Medicine, St Vincent's Hospital, The University of Melbourne, Parkville, Australia; Palliative Care Service, Cabrini Health, Melbourne, Australia. Electronic address: COCallaghan@cabrini.com.au.
authors.forename: Clare C
authors.initials: CC
authors.lastname: O'Callaghan
authors.affiliation: Department of Psychology, Faculty of Health Sciences, Swinburne University of Technology, Melbourne, Australia; Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Parkville, Australia; Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia. Electronic address: pschofield@swin.edu.au.
authors.forename: Penelope
authors.initials: P
authors.lastname: Schofield
authors.affiliation: Department of Social Work, Umeå University, Sweden. Electronic address: par.salander@umu.se.
authors.forename: Pär
authors.initials: P
authors.lastname: Salander
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D005260:Female; D066296:Grounded Theory; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D019368:Nature; D009369:Neoplasms / Q000523:psychology*; D036301:Qualitative Research
keywords: Attachment theory; Cancer; Grounded theory; Nature; Normalization; Supportive care