Formative research in the development of a care transition intervention in breast cancer survivors

Purpose: The purpose of this qualitative study was to evaluate breast cancer survivors' (BCS) responses to a self-management survivorship care transition intervention in the formative development of such an intervention. The experience of BCS is marked by uncertainty and anxiety about subsequent care, and a desire for more information about future care needs and late effects of treatment. Self-management strategies have demonstrated improved outcomes in chronic illness, and may address the unmet needs of breast cancer survivors.

Methods and sample: Five focus and discussion groups each were conducted at a single site in the Southeastern United States with a total of twenty breast cancer survivors. BCS were presented with a description of a survivorship transition intervention that encouraged self-management. Groups were led by a trained moderator using a semi-structured guide with 7 open-ended questions about their care transition experience and response to the proposed intervention. A theoretically-derived, concept-guided coding strategy was developed after review of transcripts. Iterative constant comparative methods were used to ensure that transcripts were reviewed exhaustively for emerging codes and relationships.

Key results: Three dominant themes emerged around readiness for self-management: 1) the breast cancer experience as a catalyst for self-management; 2) fear of recurrence as a catalyst for self-management; and 3) the impact of the meaning of breast cancer on individual readiness for self-management.

Conclusions: These findings contribute to further development of a conceptual model and interventions built on BCS self-management to improve the survivorship experience.