The Process of Adapting to Altered Bowel Function in Patients With Rectal Cancer: A Grounded Theory Study

To develop a theoretical framework for understanding the adaptation process to altered bowel function in patients with rectal cancer.

This is a constructivist grounded theory study using theoretical sampling to select 24 patients who experienced low anterior resection syndrome, and were followed-up at a cancer centre in Northern Taiwan. Data were collected using interviews until theoretical saturation was reached. During the interview, field notes synchronously were written as a memo to capture what was seen, heard, felt, and thought. Data were analysed using iterated constant comparisons, initial coding, focused coding, and theoretical coding.

A substantive theory was developed that describes how participants adapted to altered bowel functioning. These categories encompassed experiences of altered bowel functioning, distress from altered bowel functioning, tolerance of distress fuels motivation for self-empowerment, dynamic self-regulation styles, and "living with" altered bowel functioning. From this process, a core category emerged: "The journey from painful struggles toward self-empowerment."

These findings could guide healthcare professionals to comprehensively evaluate patients' distress from altered bowel functioning, witness those who are motivated to govern their situation, and provide timely information and tailored resources to sustain the growth of compassionate self-care strategies that enable them to deal with, and live with, their altered bowel function. In future research, the findings could help researchers to develop a tool to comprehensively evaluate distress from altered bowel function and design a timely, ongoing, individual, and cost-effective protocol that guides patients on a healing pathway.