Lived Experience of Adult Female Cancer Survivors to Discover Common Protective Resilience Factors to Cope with Cancer Experience and to Identify Potential Barriers to Resilience.

Objectives: Primary objective - Phase I: The primary objective of this study was as follows: (1) To identify common protective resilient factors that enabled the adult female cancer survivors to cope with the cancer experience. (2) To identify potential barriers to the resilience of adult female cancer survivors. Secondary objective - Phase II: The secondary objective of this study was to develop and validate a resilience tool for cancer survivorship.

Material and methods: A mixed approach using sequential exploratory design was used in the study. A qualitative approach using phenomenology design was used in the first phase followed by a quantitative approach in the second phase. In the first phase, in-depth interviews were conducted until data saturation with 14 female breast cancer survivors chosen by purposive and maximum variation sampling methods based on inclusion criteria. The researcher used Colaizzi's data analysis framework to analyse the transcripts. Findings were configured as protective resilience factors and barriers to resilience. Based on the analysis of the qualitative phase, the researcher developed a 35-item resilience tool for cancer survivorship. Content validity, criterion validity and reliability of the newly developed instrument were assessed.

Results: In the qualitative phase, the mean age of the participants was 57.07 years and the mean age at diagnosis was 55.5 years. The majority 11 (78.57%) of them were homemakers. All 14 (100%) of them had undergone surgery. The majority 11 (78.57%) of them had all three modes of therapy, that is, surgery, chemotherapy and radiation therapy. The categories of themes identified are presented under two main headings, that is, protective resilience factors and barriers to resilience. The theme categories identified under protective resilience factors were personal, social, spiritual, physical, economic and psychological factors. The barriers to resilience identified were lack of awareness, medical/biological barriers, social, financial and psychological barriers. The developed resilience tool had a content validity index of 0.98, a criterion validity of 0.67, internal consistency of 0.88 and stability of 0.99 at a 95% confidence interval. Principle component analysis (PCA) was used to validate the domains. PCA of protective resilience factors (Q1-Q23) and barriers to resilience (Q24-Q35) had Eigenvalues of 7.65 and 4.49, respectively. The resilience tool for cancer survivorship was found to have good construct validity.

Conclusion: The present study has identified the protective resilience factors and barriers to resilience among adult female cancer survivors. The developed resilience tool for cancer survivorship was found to have good validity and reliability. It will be useful for nurses and all other healthcare professionals to assess the resilience needs of cancer survivors and to provide need-based quality cancer care.