Negotiating With Myself: A Grounded Theory Study of How Women With Sporadic Unilateral Early-Stage Breast Cancer Choose Contralateral Prophylactic Mastectomy

Author

Nancy Ellen Roecklein, The Graduate Center, City University of New YorkFollow

Date of Degree

6-2023

Document Type

Dissertation

Degree Name

Ph.D.

Program

Nursing

Advisor

Steven L. Bauman

Committee Members

Christine Anne Ganzer

Juan Battle

Subject Categories

Other Nursing

Keywords

contralateral prophylactic mastectomy, decision making, sensemaking, wellness, intrapersonal dialoguing, grounded theory

Abstract

This research aimed to investigate the main concern facing women with a diagnosis of sporadic unilateral early-stage breast cancer who made the choice for contralateral prophylactic mastectomy, the surgical removal of the unaffected healthy female breast. The scholarly literature in this area has primarily attempted to understand this surgical phenomenon within the breast cancer treatment paradigm. As such, there has been a focus primarily on shared decision making processes and oncologic outcomes. Given this bias, most studies devalued the choice for CPM and, in some instances, devalued the individual women making that choice, thus revealing a gap in understanding of woman’s direct engagement in the choice process. A grounded approach was deemed necessary in order to gain a better understanding of “what is really happening” in this substantive area. The study included the experience of 28 individuals, representing all regions of the United States. This study found that the choice for CPM may be more problematic due to competing messages related to patient empowerment and engagement, healthcare citizen duties, breast cancer narratives, postfeminist makeover culture, and objective breast cancer outcome measures. The spoken word echoed factors well-known in the extant literature. However, the unspoken word brought to light the emergent core variable of negotiating with myself (NWM). NWM is an intrapersonal sensemaking process that women undertake when choosing CPM. NWM was recognizable as a separate and distinct choice process that occurred prior to, and concurrent with, the shareddecision making process for breast cancer treatment of the affected breast. The desire to be done with the cancer experience, defined in wellness terms, emerged as the main concern. This study provided a new and original conceptualization for how women choose CPM thus providing an inflection point for future research in this substantive area. The findings of this study provide a basis for relevant predictions, explanations, interpretations, and applications in the substantive area and may serve as a basis for developing health policy and expanded nursing roles to meet the needs of women faced with the first diagnosis of early-stage breast cancer.

Recommended Citation

Roecklein, Nancy Ellen, "Negotiating With Myself: A Grounded Theory Study of How Women With Sporadic Unilateral Early-Stage Breast Cancer Choose Contralateral Prophylactic Mastectomy" (2023). CUNY Academic Works.
https://academicworks.cuny.edu/gc_etds/5395