Carrying On: The Experience of Premature Menopause

¶ … Carrying on: The experience of premature menopause in women with early stage breast cancer," concerning its rigor as a grounded theory study, its contribution to nursing and its usefulness in practice. A summary of the research and important findings are presented in the conclusion.

Description and Summarize of Key Research Components:

The title of the journal article under consideration is "Carrying on: The experience of premature menopause in women with early stage breast cancer," by T.M. Knobf (2002), appearing in Nursing Research, volume 51, issue 1, pages 9-17.

In her abstract, the researcher includes the background of the problem, the objectives of the study, the methods used and the results obtained, as well as conclusions and key words.

Introduction. The introduction is used to expand on the background initially presented in the abstract, including an overview of the prevalence of breast cancer in the United States and the treatments used for the disease. The researcher also uses the introduction to emphasize the importance of these types of studies based on the paucity of relevant and timely studies in this area. What is known, Knobf reports, is that premature menopause caused by chemotherapy has been shown to exacerbate the distress associated with physical symptoms as well as diminished sexual functioning compared to other breast cancer survivors. According to Ballard (2003), premature menopause affects about one percent of American women and is defined as cessation of menstruation before age 40 years (although it can take place far earlier), and while the specific causes of the condition remain unknown, it takes place when the ovaries do not respond to stimulation by the pituitary gland.

In addition, such chronic physical problems can increase psychological distress levels among these women as well. Although more research is needed in this area, Knobf points out that it has already been established that such menopausal symptoms are part of a larger constellation of symptoms experienced by women who undergo adjuvant treatment therapy for their breast cancer; however, there remains a need for a complete symptom experience for these women. Moreover, the researcher emphasizes midlife women's menopausal transition involves a number of biophysical and biosocial factors that highlight the need to better understand this transition from the larger context of how women's lives tend to shape the menopausal experience.

Methods. Qualitative researchers have a number of methodologies available to them besides grounded theory, including the historical methodology, ethnography, phenomenology, hermeneutics, field-based case study, and action research (Burton & Steane, 2004). Based on the lack of knowledge about the issue under investigation, Knobf maintains that a qualitative inquiry with grounded theory using a purposive sample of 27 women with early stage breast cancer who received adjuvant chemotherapy as part of their treatment regimen was the methodology best suited to achieve the study's goals. According to Neuman (2003), grounded theory is "a social theory that is rooted in observations of specific, concrete details. The purpose of grounded theory is to build a theory that is faithful to the evidence" (p. 536). This definition of grounded theory is congruent with the researcher's stated which "was to develop a substantive theory that would describe and explain women's responses to chemotherapy-induced premature menopause within the context of breast cancer" (p. 9). Likewise, Denscombe advises that purposive sampling allows researchers to "home in on people and events which there are good grounds for believing will be critical for the research. The researcher can concentrate of instances which will display a wide variety to illuminate the research question at hand" (p. 16).

Results. The overarching finding that emerged from this study was that women who receive adjuvant chemotherapy to treat their early stage breast cancer feel vulnerable. While these results may appear intuitive and unsurprising, Knobf qualifies this by explaining how vulnerability could adversely affect the other aspects of the treatment process. In this regard, Knobf reports that, "Vulnerability related to existential concerns from a cancer diagnosis, physical and psychological responses to chemotherapy side effects, alterations in self-concept, threatened sense of control over one's body and health, uncertainty, unpredictability of symptoms and unknown" (p. 11). The "Carrying On" element of the study's title refers to the various stages that women tend to experience as they progressively respond to these vulnerabilities in their lives to achieve acceptance and balance.

Discussion of the Research Report. Taken together, the researcher does a credible job of interpreting the results of the series of interviews with early stage breast cancer who received adjuvant chemotherapy to describe and explain their responses the premature menopause that resulted within the larger context of breast cancer. For this purpose, the researcher presents several verbatim excerpts from her interviews to illustrate various points which are then interpolated with the larger findings that emerged from the study. For example, following an excerpt the recounted one woman's experiences with healthcare providers who did not query her concerning her condition failed to recognize her premature menopausal symptoms. Based on these findings and several illustrative examples that follow, Knobf writes, "Women who were symptomatic and sought assistance in managing menopausal symptoms were more upset by the lack of talking and lack of definitive information from oncologists. Some women felt a lack of sensitivity by physicians to listen to their concerns" (p. 12).

Discussion Concerning the Strengths and Limitations of the Key Research Components

One of the major strengths of this study is its seminal nature. Although the incidence of women who suffer from breast cancer and menopause simultaneously is relatively low, the powerful combination of these two major life events creates what Knobf describes as "a complex experience for young midlife women" (p. 14) that remains seriously understudied. The same major strength of the study, though, also relates its limitations because of the relatively rarity of the combination of conditions and the availability of women for participation in this type of research. Indeed, the fact that the researcher succeeded in locating and enlisting 27 women who satisfied the criteria for participation in the study is noteworthy. In sum, Knobf describes how the study's participants "learned to live with an experience that was out of the mainstream of medical practice" (p. 14).

Suggestions for Improvement on the Methodology and Presentation of the Research Report.

Suggestions for the Methodology. Although a phenomenological approach could have been used to better understand the lived experiences of the subjects, this methodology does not contribute to the development of theory (Neuman, 2003). Therefore, the grounded theory methodology selected by Knopf appears to be spot-on appropriate for the purposes of this study. According to Denscombe (2003), "The grounded theory approach has become a popular choice of methodology . . . because it has come to provide a well recognized, authoritative approach that does not necessarily involve statistical analysis, quantitative data or the quest for representative samples" (p. 109).