"Living in the moment" among cancer survivors who report life-transforming change.

Background: Some cancer survivors say that while coping with their illness they have had what they identify as a highly beneficial, personal, life-transforming change (LTC; a self-subscribed condition among participants in this study, not a researcher-defined construct). Previously we found that the content of LTC was highly individual; but certain features of the LTC process were quite uniform. For example, LTC was driven by a very rational desire to remain genuinely functional as a person in the midst of highly stressful circumstances. Our purpose is to further understand LTC by analysis of participants' critique of questionnaire items on positive subjective outcomes.

Methods: We obtained a set of 67 positive psychosocial questionnaire items from the Psychosocial Impact of Illness (PII) item bank development team of the National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information Systems (PROMIS) initiative. The PII items are sourced from a variety of instruments, representing more than one theory of personal growth. This enabled a grounded theory approach, allowing a theory of LTC to emerge from the data. Each of nine cancer survivors participated in a single, two-part session: an hour-long semi-structured qualitative interview regarding their LTC (previously reported), then individually critiquing the 67 items in terms of relevance and importance to their self-reported LTC experience (their critique is analyzed in this article). The PII items were grouped into 20 researcher-defined conceptual themes and average scores for each theme were computed and compared.

Results: The theme "living in the moment" (LITM; sometimes referred to as "Being in the moment" in other literature) scored significantly higher than other themes. Qualitative interview transcripts revealed that participants spontaneously used LITM as a coping tactic that reduced worries to manageable levels. These participants noticed subsequently that LITM also produced unexpected substantial benefits in many aspects of their lives unrelated to cancer. This experience motivated increased use of LITM that led to LTC beyond coping with cancer.

Conclusions: LITM can be a practical, effective coping tactic to manage worries and promote adaptation to the challenges of a life-threatening illness. Participant interviews indicated the motivation for LITM is not traumatic experience, but seems to be conservation of their own personal resources for coping with increased stresses. Hobfoll's conservation of resources model appears to be more consistent with LITM among our participants than Tedeshi's posttraumatic growth (PTG) model. Several PII items that represent LITM have unfortunately been removed from the current PROMIS PII item bank, indicating a need for improved of item selection criteria. Further research is needed first to identify or develop assessment items that more effectively capture the precursors and phases of LITM, and then develop interventions that facilitate LITM and LTC for patients.