Whys and wherefores: adult patient perspectives of the meaning of cancer.

Theory and empirical evidence suggest that the search for meaning is a significant part of the cancer experience. Yet differences exist in how the construct "search for meaning" is conceptualized. In this article, the meaning of cancer is discussed using four approaches: (1) casual explanations, (2) selective incidence, (3) responsibility, and (4) significance. Research describing these approaches to the process of searching for meaning among persons with cancer is reviewed. Several studies have investigated cancer patients' casual explanations: the most frequently cited causes include God's will, heredity, chance, life-style and personal factors, and environment. Whereas no studies have focused explicitly on the phenomenon of selective incidence (eg, asking "why me?"), a few investigations have begun to explore cancer patients' attributions of responsibility. These investigations have identified projections of responsibility/blame for cancer such as chance, God, others, or the environment. Research describing the significance, which is usually positive, that persons with cancer ascribe to their illness is also reviewed. Such meanings for cancer identified include reprioritization of goals, changed lifestyles and values, increased appreciation for nature and others, and spiritual development. Responses to the need for meaning vary; indeed, some persons with cancer do not perceive that they "search for meaning." The nursing implications of these various responses to meaning making are presented.