title: Interconnection: A qualitative analysis of adjusting to living with renal cell carcinoma.
abstract: ABSTRACTObjective:Adjusting to cancer is an ongoing process, yet few studies explore this adjustment from a qualitative perspective. The aim of our qualitative study was to understand how patients construct their experience of adjusting to living with cancer.
  
  
  
  Qualitative analysis was conducted of written narratives collected from four separate writing sessions as part of a larger expressive writing clinical trial with renal cell carcinoma patients. Thematic analysis and constant comparison were employed to code the primary patterns in the data into themes until thematic saturation was reached at 37 participants. A social constructivist perspective informed data interpretation.
  
  
  
  Interconnection described the overarching theme underlying the process of adjusting to cancer and involved four interrelated themes: (1) discontinuity-feelings of disconnection and loss following diagnosis; (2) reorientation-to the reality of cancer psychologically and physically; (3) rebuilding-struggling through existential distress to reconnect; and (4) expansion-finding meaning in interconnections with others. Participants related a dialectical movement in which disruption and loss catalyzed an ongoing process of finding meaning.
  
  
  
  Our findings suggest that adjusting to living with cancer is an ongoing, iterative, nonlinear process. The dynamic interactions between the different themes in this process describe the transformation of meaning as participants move through and revisit prior themes in response to fluctuating symptoms and medical news. It is important that clinicians recognize the dynamic and ongoing process of adjusting to cancer to support patients in addressing their unmet psychosocial needs throughout the changing illness trajectory.
authors.affiliation: Department of Palliative, Rehabilitation, and Integrative Medicine,The University of Texas MD Anderson Cancer Center,Houston,Texas.
authors.forename: Isabel
authors.initials: I
authors.lastname: Leal
authors.affiliation: Department of Palliative, Rehabilitation, and Integrative Medicine,The University of Texas MD Anderson Cancer Center,Houston,Texas.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Milbury
authors.affiliation: School of Nursing at the University of Texas Health Science Center,Houston,Texas.
authors.forename: Joan
authors.initials: J
authors.lastname: Engebretson
authors.affiliation: Department of Urology, Division of Surgery,The University of Texas MD Anderson Cancer Center,Houston,Texas.
authors.forename: Surena
authors.initials: S
authors.lastname: Matin
authors.affiliation: Department of Genitourinary Medical Oncology, Division of Cancer Medicine,The University of Texas MD Anderson Cancer Center,Houston,Texas.
authors.forename: Eric
authors.initials: E
authors.lastname: Jonasch
authors.affiliation: Department of Genitourinary Medical Oncology, Division of Cancer Medicine,The University of Texas MD Anderson Cancer Center,Houston,Texas.
authors.forename: Nizar
authors.initials: N
authors.lastname: Tannir
authors.affiliation: Department of Urology, Division of Surgery,The University of Texas MD Anderson Cancer Center,Houston,Texas.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
authors.affiliation: Department of Palliative, Rehabilitation, and Integrative Medicine,The University of Texas MD Anderson Cancer Center,Houston,Texas.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Cohen
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology*; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology; D014956:Writing
keywords: Adjustment; Expressive writing; Kidney cancer; Meaning-making; Qualitative