1. Emotional Resistance Building: A grounded theory of how family members of loved ones undergoing chemotherapy deal with fear of emotional collapse
Dr Bridie McCarthy
Supervisor: Dr Tom Andrews
Co-supervisor: Professor Josephine Hegarty

2. Outline of Presentation
Background to study
Research methodology
The emergent substantive theory

3. Background Interest in family members Clinical experience
Teaching experience
Personal experience
Chemotherapy units
Colo-rectal cancer
Literature on communication

4. Aim of Study
To explore family members’ experiences when their loved ones were undergoing chemotherapy treatment for colo-rectal cancer.

5. Methodology Grounded theory (classical)
Data collection – Interviews (n=35)
Analysis:
Constant comparative analysis
Field notes and memoing
Ethical approval

6. Core Category Main concern: Fear of emotional collapse Core category:
“Emotional Resistance Building” (ERB)

7. PHASES OF ERB
Phase Figuring out Emotional reflecting Information seeking Advanced planning Emotional shielding
Phase Uncertainty adjustment Pragmatic adjusting Reality adjusting Reconciliatory adjusting
Phase Getting on with it Burden relieving Emotional releasing Emotional holding

8. Phase 1: Figuring out Emotional reflecting Time taking
Explanation seeking
Comparison making
I couldn't believe it. I had to take time to think, was it real or just a bad dream. How could it be real, she is too young.

9. Phase 1 – continued Information seeking Attending medical appointments
Active listening/questioning
Establishing trust in HCPs
I never knew he was so lonely until he told the doctor why he couldn’t sleep at night. I was just thinking it was depression and at him to pick himself up. It was a real wake-up call for me

10. We are in this together and we will get through it together
Phase 1: Continued
Advance planning
Action planning
Disclosing the diagnosis
Re-normalising
We are in this together and we will get through it together

11. Phase 1 continued Emotional shielding Emotional hiding Physical hiding
Emotional containing
It was terrible at the start. I didn’t leave the house, I just didn’t want to meet or see anyone. I just wanted to be by myself and have a good cry

12. Phase 2: Getting on with it
Burden relieving
Responsibility taking
Openly communicating
Illness fighting
We have to fight this. We are getting the best treatment and I believe my wife will come through this We are both very positive and I have to believe it. We have small children, my wife is not even 40 yet and we have our whole lives ahead of us.

13. Phase 2 continued Emotional releasing Externalising emotional displays
Externalised burden sharing
Spiritualised burden sharing
God has spared me my husband for which I am most grateful. Now if He will save him for me and my family I will do whatever it takes , anything he wants me to do to save my husband, I will do it

14. Phase 2: Continued Emotional holding Emotional postponing
Maintaining hope
Illness detachment
No matter how bad the news I would never cry in front of my partner or HCPs. I would hold back until I get to the first loo or until I got home

15. Phase 3: Uncertainty adjustment
Pragmatic adjusting
Planning
Negotiating support
Illness disclosure
I work shift hours so I had to arrange my dad’s chemo around times that suited me. If I couldn’t do that I really don’t know how we’d manage

16. Phase 3 – continued Reality adjusting Getting through each day
Letting go
Confidence layering
My wife got so sick with the chemo that I had to do everything. It was hard going at the beginning with young children as well, but I just took one day at a time

17. Phase 3: Continued Reconciliatory adjusting Valuing time Balancing
Accommodating disruption
You never know from day to day or week to week what is gong to happen. Even if they will have the chemo. So you have to be ready for setbacks

18. Conclusion
Policies and reports highlight the need to include and support family members (FMs) of patients with cancer (WHO 2006 & DoH&C 2012).
That nurses should have an awareness of the emotional impact of cancer on FMs (DoH&C 2012).
This explanatory theory highlights the many concerns that FMs experience and how they process them to avoid emotional collapse.
Future - Need to intervene at an earlier stage, to reassure, support and guide FMs during this process

19. Thank you for listening
Bridie