Although the term ‘cancer survivorship’ first appeared in the literature over 20 years ago, and is now commonly used by professionals and public alike, it apparently has no agreed definition. The concept analysis undertaken by Doyle (2008) and published in this issue of JAN (pp. 499–509) is, therefore, a landmark publication.

A concept analysis concentrates on identifying and describing the ‘attributes’ of the concept under scrutiny. Five attributes of the concept of cancer survivorship were identified by Doyle, and her paper provides a masterly summarization of how these were drawn from the literature. The five attributes (numbers added) are pulled together to form an overall definition (p. 502 and Figure 2 on p. 506):

The concept of cancer survivorship is a dynamic, emerging concept pertinent to all cancer care and may be defined as: (1)a process beginning at diagnosis; (2)involving uncertainty; (3)it is a life-changing experience; (4)a duality of positive and negative aspects and (5)unique to the individual but with universality.

Doyle’s quest to provide a definition of cancer survivorship was primarily to give direction and cohesion to future research. In her discussion she identifies some issues and areas in need of enquiry, and in her conclusion she says that the opportunity is there ‘for nurses to take a leadership role in the future of cancer care by influencing theory, research and practice around the dynamic concept of survivorship’ (p. 507).

But first, I suggest, this discussion needs to be opened up beyond the confines of professional debate. The concept of cancer survivorship was introduced in the first place to give empowerment to people with cancer. We need to know what they want to have researched and, indeed, we first need to know whether they see the concept of cancer survivorship to be helpful and empowering.

Does everyone who is diagnosed with cancer want to be called a survivor (and forever) or, at least, to be cared for by professionals who are insistent that ‘survivorship’ is the only applicable model? Survival rates go on improving, but the outlook is still bleak in the case of some cancers; and, within groups, the odds are not equal for all individuals and so, not surprisingly, some may indeed see themselves as ‘victims’. And many people, whether sooner or later, progress from ‘living with cancer’ to ‘dying from cancer’. Does the concept of cancer survivorship accommodate all of these groups and stages and contingencies?

The method of concept analysis that Doyle particularly chose to use in her work is one that values the lay perspective. A small number of autobiographical texts were included in her selection of literature but, as she herself acknowledges (p. 506), this provided only limited input. Web-based material would also need to be included to obtain a contemporary lay perspective.

Seeking to obtain a lay perspective on Doyle’s definition of cancer survivorship, before the version presented in this JAN paper is firmly adopted, would be the ideal next step in this ‘evolutionary concept analysis’. Taking that extra step would demonstrate a true commitment to ‘patient empowerment’.


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