Elsevier

Social Science & Medicine

Volume 172, January 2017, Pages 107-114
Social Science & Medicine

Cancer patients' experiences with nature: Normalizing dichotomous realities

https://doi.org/10.1016/j.socscimed.2016.10.024Get rights and content

Highlights

  • A grounded theory is presented that explores nature's role for cancer patients.

  • Nature experiences provide opportunities for normalizing cancer related life changes.

  • Nature experiences bolster ability to deal with shifting realities creatively.

  • Nature provides an unthreatening context for playing with inner and outer reality.

  • Nature engagement presents additional forms of supportive care in oncology.

Abstract

Aims

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.

Methods

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.

Results

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.

Conclusions

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.

Section snippets

The cancer care context

People affected by cancer can experience physical, psychosocial and mobility adjustments impacting their wellbeing and quality of life (Korszun et al., 2014), which may result in patients and carers having unmet needs (Sanson-Fisher et al., 2000). Given these immediate and ongoing challenges, numerous psychosocial care interventions are being created with the aim to alleviate cancer patient and carer strain, which have been broadly categorized as educational techniques, behavioral training,

Design and data collection

The qualitative research design used a grounded theory approach following the procedures recommended by Corbin and Strauss (2008) to generate a theoretical outline of the process underlying cancer patients' use of nature. Data collection comprised semi-structured interviews conducted either face-to-face in the hospital setting or over the phone. The semi-structured interview schedule posed open-ended questions about patients' own definition of nature, nature preferences, experiences, usages,

Participant demographics and description of nature interactions

Twenty cancer patients (9 female, mean age = 53 years, SD = 17) with mixed diagnoses participated in a single semi-structured interview (mean duration = 54 min). All were Australian born except two were born in Sri Lanka. Eleven were currently undergoing treatment, 5 were inpatients, 15 were outpatients, 8 underwent face-to-face interviews and 12 underwent phone interviews. One consented participant was withdrawn after attempts failed to make contact for scheduling the interview. Table 1

Discussion

The wide range of cancer patients’ experiences with nature shown in the five typologies (Table 2) and the theoretical analysis bear some reflection on the richness and subtleties of cancer patients' inner lives and struggle to maintain or in some cases shift everyday perspectives while also relocating themselves into a newly forming normality, a new-normal. It reflects their challenges to maneuver the unfolding cancer scenarios and move forward in their lives.

Many aspects of participants'

Conflict of interest

The Authors declare that there is no conflict of interest.

Funding

The first author (SB) was supported by a PhD scholarship grant from The University of Melbourne during the study period.

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