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Qualitative Exploration of Healthcare Relationships Following Delayed Diagnosis of Ovarian Cancer and Subsequent Participation in Supportive-Expressive Group Therapy

Lauren M. Walker

John W. Robinson

self-help groups, ovarian neoplasms
ONF 2009, 36(6), E310-E316. DOI: 10.1188/09.ONF.E310-E316

Purpose/Objectives: To explore the role of supportive-expressive group therapy (SEGT) in facilitating the development and quality of healthcare relationships in patients with ovarian cancer.

Research Approach: Qualitative, grounded theory, and comparative approach.

Setting: Tertiary care cancer center.

Sample: 6 patients with advanced ovarian cancer and 3 healthcare professionals.

Methodologic Approach: Patients participated in semistructured interviews that examined the nature of their healthcare relationships, diagnoses, and SEGT experience. The primary gynecologic oncologist and two nurses responsible for the care of the patients also were interviewed. Analysis of this qualitative study employed a grounded theory technique.

Main Research Variables: Patients' and healthcare professionals' perceptions of healthcare relationships.

Findings: Patients' negative diagnostic experiences were found to influence the quality of relationships with healthcare providers. However, the process appears to benefit from patient participation in SEGT. Patients perceived that SEGT helped facilitate communication between patients and professionals. Patients also indicated that SEGT led them to participate more actively in the treatment process. Professionals viewed patient participation in SEGT as a positive outlet for emotional expression, a source of psychological healing, and a tool that facilitated communication, collaboration, and understanding of medical treatment.

Conclusions: Participation in SEGT can advance communication and collaboration in medical care and provide opportunity and resources for psychological healing.

Interpretation: SEGT provides a vehicle to enhance the quality of life of patients with ovarian cancer by breaking down the common feeling of isolation, addressing women's frustration and resentment regarding delayed diagnosis, and enhancing relationships with healthcare providers to promote collaborative care in this patient population.

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    American Cancer Society. (2008). Detailed guide: Ovarian cancer, what are the key statistics about ovarian cancer? Retrieved April 28, 2008, from
    Anderson, M., & Urban, N. (1997). Physician gender and screening: Do patient differences account for differences in mammography use? Women and Health, 26(1), 29-39.
    Bell, R., Kravitz, R., Thom, D., Krupat, E., & Azari, R. (2002). Unmet expectations for care and the physician-patient relationship. Journal of General Internal Medicine, 17(11), 817-824.
    Bischoff, T. (2006). "Don't upset the ladies!" A qualitative analysis of the experience of supportive-expressive group therapy for ovarian cancer patients. Unpublished thesis, University of Calgary, Canada.
    Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. Thousand Oaks, CA: Sage.
    Edwards, A., Hailey, S., & Maxwell, M. (2004). Psychological interventions for women with metastatic breast cancer. Cochrane Database of Systematic Reviews, 3(2), CD004253.
    Evans, J., Ziebland, S., & McPherson, A. (2007). Minimizing delays in ovarian cancer diagnosis: An expansion of Andersen's model of "total patient delay." Family Practice, 24(1), 48-55.
    Fobair, P., Koopman, C., DiMiceli, S., O'Hanlan, K., Butler, L., Classen, C., et al. (2002). Psychosocial intervention for lesbians with primary breast cancer. Psycho-Oncology, 1(5), 427-438.
    Goff, B., Mandel, L., Muntz, H., & Melancon, C. (2000). Ovarian carcinoma diagnosis: Results of a national ovarian cancer survey. Cancer, 89(10), 2068-2075.
    Goodwin, P., Leszcz, M., Ennis, M., Koopmans, J., Vincent, L., Guther, H., et al. (2001). The effect of group psychosocial support on survival in metastatic breast cancer. New England Journal of Medicine, 345(24), 1719-1726.
    Guest, G., Bunce, A., & Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18(1), 59-82.
    Hitch, P.J., Fielding, R.G., & Llewelyn, S.P. (1994). Effectiveness of self-help and support groups for cancer patients: A review. Psychology and Health, 9(6), 437-448.
    Johns Hopkins Medical Institute. (2008). Ovarian cancer: What every woman should know. Retrieved April 28, 2008, from
    Kissane, D., Grabsch, B., Clarke, D., Christie, G., Clifton, D., Gold, S., et al. (2004). Supportive-expressive group therapy: The transformation of existential ambivalence into creative living while enhancing adherence to anticancer therapies. Psycho-Oncology, 13(11), 755-768.
    Kissane, D.W., Grabsch, B., Clarke, D.M., Smith, G.C., Love, A.W., Bloch, S., et al. (2007). Supportive-expressive group therapy for women with metastatic breast cancer: Survival and psychosocial outcome from a randomized controlled trial. Psycho-Oncology, 16(11), 1050-1052.
    Koldjeski, D., Kirkpatrick, M., Swanson, M., Everett, L., & Brown, S. (2003). Ovarian cancer: Early symptom patterns. Oncology Nursing Forum, 30(6), 927-932.
    Koldjeski, D., Kirkpatrick, M., Swanson, M., Everett, L., & Brown, S. (2005). An ovarian cancer diagnosis-seeking process: Unraveling the diagnostic delay problem. Oncology Nursing Forum, 32(5), 1036-1042.
    Mohr, D., Boudewyn, D., Goodkin, D., Bostrom, A., & Epstein, L. (2001). Comparative outcomes for individual cognitive-behavior therapy, supportive-expressive group psychotherapy, and sertraline for the treatment of depression in multiple sclerosis. Journal of Consulting and Clinical Psychology, 69(9), 942-949.
    Shaw, B., Han, J.Y., Hawkins, R., Stewart, J., McTavish, F., & Gustafson, D. (2007). Doctor-patient relationship as motivation and outcome: Examining uses of an interactive cancer communication system. International Journal of Medical Informatics, 76(4), 274-282.
    Shenolikar, R., Blakrishnan, R., & Hall, M. (2004). How patient-physician encounters in critical medical situations affect trust: Results of a national survey. BioMed Central Health Services Research, 4(1), 24.
    Smith, L., Morris, C., Yasmeen, S., Parikh-Patel, A., Cress, R., & Romano, P. (2005). Ovarian cancer: Can we make the clinical diagnosis earlier? Cancer, 104(7), 1398-1407.
    Spiegel, D., Butler, L.D., Giese-Davis, J., Koopman, C., Miller, E., DiMiceli, S., et al. (2007). Supportive-expressive group therapy and survival in patients with metastatic breast cancer: A randomized clinical intervention trial. Cancer, 110(5), 1130-1138.
    Spiegel, D., & Spira, J. (1991). Supportive-expressive group therapy: A treatment manual of psychosocial intervention for women with recurrent breast cancer. Stanford, CA: Psychosocial Treatment Laboratory, Stanford University School of Medicine.
    Strauss, A., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory (2nd ed.). Thousand Oaks, CA: Sage Publications.
    Street, R., Gordon, H., Ward, M., Krupat, E., & Kravitz, R. (2005). Patient participation in medical consultations: Why some patients are more involved than others. Medical Care, 43(10), 960-969.
    Wikborn, C., Pettersson, F., Silfversward, C., & Moberg, P. (1993). Symptoms and diagnostic difficulties in ovarian epithelial cancer. International Journal of Gynecology and Obstetrics, 42(3), 261-264.