federal nursing services award: Enlisted women with breast cancer: Balancing demands and expectations, The

Military Medicine, Jul 2003 by Wilmoth, Margaret Chamberlain

Diagnosis with breast cancer is not an automatic cause for discharge from the military. Therefore, it is important to know how this disease impacts enlisted women in the military. This study describes how enlisted women manage diagnosis and treatment within the context of their military careers. Grounded theory guided the study methodology. Audiotaped semistructured interviews were conducted three times over 9 months to learn how treatment impacted work demands. Data saturation was attained after 46 interviews were conducted. Participants had to balance demands and expectations among the Military Career and Military Medical Subsystems and their Social Support Subsystem. Support from the chain of command was critical in women's ability to balance demands and expectations of career, family, and illness. Military nurses are in a unique position to create strategies that will assist enlisted women in coping with breast cancer.

Introduction

Women on active duty in the military who are diagnosed with breast cancer can generally continue their careers if the cancer responds to therapy or if treatment side effects are manageable.1 Although diagnosis does not automatically end careers, it can alter career progression, impact physical and psychological readiness, and restrict overseas assignments. This study describes how enlisted women managed their breast cancer diagnosis treatment within the context of their military careers.

The American Cancer Society estimates that there will be 203,500 new breast cancer cases diagnosed in 2002(2) and approximately 265 of these cases will occur in enlisted women on active duty. Current breast cancer survival rates indicate that 97% of Caucasian women and 89% of African American women diagnosed with localized disease 5 years ago are alive today3. These data suggest that women will return to their premorbid lifestyles, including full-time employment. Thus, it is important to understand the processes women use in managing diagnosis, treatment, careers, and families to guide development of appropriate military policies and nursing interventions.

The literature lacks descriptions of how women in technical career fields manage breast cancer treatments in conjunction with their family and work demands. Therefore, this study examined breast cancer treatments and work from the perspective of enlisted women in the military. The specific aim of this study was to describe processes used by enlisted women in managing their lives during and immediately after cancer treatment.

Literature Review

Demands of illness present Stressors that may tax an individual's usual coping resources. These demands may vary depending on the context within which the illness is experienced.4 It is difficult to generalize findings from previous work on demands of illness from civilian breast cancer survivors to those in the military. First, the average length of time since diagnosis for women in previous reports was 5 years (SD = 4.9).5-8 These retrospective interviews may not provide the reader with an accurate depiction of processes used to manage the disease and on the demands that treatment placed on them since memory bias may distort past attitudes or perceptions.9 Furthermore, the majority of civilian subjects in (X = 42 years old) previous studies were married with children,6 were primarily Caucasian with 2 years of college education8 with only 54% employed outside the home. Army (only service for which these data were available) demographics indicate that the median age for enlisted personnel is 26 years (B. Loo, personal communication). Caucasian women in the military comprise only 54% of the enlisted female force and nearly one-quarter of Army enlisted personnel have had some college level education in addition to required military education. It is conceivable that the demands breast cancer treatment places on these younger, employed, and more culturally diverse women differs from those in civilian populations. Finally, enlistment on active duty in the military requires frequent and long separations from the nuclear family in conjunction with the stress of noncombat- or combat-related assignments.

Berry10 described the process of men returning to white collar jobs following treatment for genitourinary cancer. Mobilizing social support within the workplace emerged as the most salient concept influencing this process. Another study concluded that having control over hours during treatment assisted in maintaining premorbid work performance.11 Little is known about the degree of flexibility within military work environments to meet treatment demands. Knowledge of issues that hinder or facilitate a service member's ability to continue working during treatment for breast cancer has implications for continuous unit readiness.

Methods

Grounded Theory method was used in this study since little was known about the phenomenon under study.12 Grounded Theory is a qualitative method that prescribes the use of a systematic set of procedures to inductively develop a theory grounded in the experience of those who live it.12 Simultaneous collection, analysis, and interpretation of subjective data about a phenomena obtained from knowledgeable informants characterize this method. Data collection ceases when saturation is obtained through no new categories being identified.12 Procedures to protect human subjects were followed as prescribed by the university's and each military medical installation or facility's Institutional Review Board.