As noted above, the planning of this study’s method involved two distinct but related steps: (a) The ability to allow the participants’ voices to be heard in relation to their experience of having believed they were cancer free and subsequently having advanced cancer recurrence, and; (b) to be able to develop a conceptual model describing the participants’ meaning of this experience. So while grounded theory, as Charmaz (2014) has pointed out, ‘has had a long history of raising and answering analytic “why?” questions in addition to “what?” and “how?”’ (p. 228), in this study my intent is to explore specifically the ‘what?’ and ‘how?’ questions, rather than moving into an exploration of analytic ‘why?’ questions. As such, by asking participants to voice what they are experiencing and then proceeding by constructing a conceptual model that reflects how the participants’ experiences interrelate and are shared, my study constructs a broader conceptual understanding that rests on the interrelationship between the categories of the experiences voiced by the participants.
Grounded theory is an approach to qualitative research that provides a framework for social research based on symbolic interactionism (Glaser &
Strauss, 1967). Symbolic interactionism provides a theoretical perspective
whereby people construct themselves, reality, and society through interactions (Altheide & Johnson, 2011). It is an active, dynamic process where people develop and modify meaning through constant comparative analysis and
theoretical sampling (Charmaz, 2014; McCann & Clark, 2003). By categorizing the experiences of the participants and then conceptualizing how these categories of experience interrelate, this study follows the inquiry model set up by grounded theory. Grounded theory seeks to provide a description of a situation that conceptualizes the participants’ perspective through the inductive organization of the data provided and co-construction by the researcher (Morse, 2001; Timmermans & Tavory, 2012). As noted by Charmaz (2012) the grounded theory method, ‘begins but does not end with inductive inquiry, it is a comparative, iterative, and interactive method’ (p. 2). This method provides a framework that allows both the methodology and methods of the research study to work together.
According to Glaser & Strauss (1967), traditional grounded theory’s goal is to understand the meaning behind human behaviour. Where ethnography is the observation of interactions, grounded theory methodology provides empirical insight as described directly by the participant (Charmaz, 2012; Timmermans & Tavory, 2012).
Grounded theory allows the researcher to consider a relationship between various categories to conceptualise the experience and provide a conceptual model related to the phenomenon (Burns & Grove, 2001; Charmaz, 2014)
2.5.1 Different perspectives of grounded theory.
Grounded theory has broadly developed into three approaches: traditional, evolved, and constructivist grounded theory (Mills et al., 2006). Traditional grounded theory was developed by Glaser & Strauss (1967). Strauss & Corbin
constructivist grounded theory (Charmaz, 2006; Glaser & Strauss, 1967; Mills et al., 2006; A. Strauss & Corbin, 1997). Table 3 provides a comparison of the three approaches to grounded theory and a description of the epistemology, ontology, sampling, and coding processes for each.
Table 3
Comparison of Grounded Theory Approaches Qualitative
research criteria
Glaser & Strauss (1967) (Traditional) Strauss (1987) / Strauss & Corbin (1990) (Evolved) Charmaz (2006, 2014) (Constructivist)
Epistemology Positivism Less-positivistic-
interpretivist Interpretivist
Ontology Objectivist Constructivist Constructivist
Sampling Theoretical
sampling Theoretical sampling Theoretical sampling
Sampling
method Interview and observations
Literature review to support emerging theory
Interview and observations
Limited literature review to enhance theoretical sensitivity Interview and observations Literature review related to newly developed conceptual model Coding
approach Constant comparative
method Inductive, verification Open-coding Core categories Theoretical memos Technical procedures- preconceived categories Constant comparative method Deductive, inductive, verification Open-coding Axial-coding-relate categories-sub- categories Selective- coding Hypothesis testing Theoretical memos Interpretative rendering co- constructed synthesis Constant comparative method Initial word by word, incident to incident Focused coding, sifts, sorts, synthesizes, and analyses Inductive, verification Theoretical memos There are methods used that are essential for a study to be called a grounded
inductively guide the research (Glaser, 1978, 1992; Glaser & Strauss, 1967). Strauss & Corbin (1997), however, maintain that the researcher applies deductive verification to create themes and categories that arise from patterns in the data. Using induction, deduction, and verification as part of the research process, the researcher continuously refines the categories based on each participant’s data (Glaser & Strauss, 1967; Heath & Cowley, 2003; A. Strauss & Corbin, 1990).
A. Strauss & Corbin (1997) propose that Glaser’s process may not allow new information to emerge. In contrast, Glaser argues that Strauss’s & Corbin’s use of guiding questions may force the data in a specific direction (Glaser, 2001). Table 3 provides a comparison of these methods with some detail into the coding components. An essential piece of this review was to clarify the epistemology and ontology of the approaches. This research aims to understand in depth the meaning of the experience of advanced cancer recurrence from the participant’s words and co-construction with the researcher. The interpretive process of conceptualisation used in the constructivist grounded theory (CGT) method as co-construction of the meaning provides a methodology that allows a verification of concepts through theoretical sampling and memoing that goes beyond the classic method of Glaser & Strauss (1967) or Strauss & Corbin (1997). Therefore, using classic Glasarian grounded theory (Glaser & Strauss, 1967) or Strauss & Corbin’s (1997) evolved grounded theory methods were not congruent because they did not allow the co-constructive element and flexible format to explore the conceptual development of the experience.
2.5.2 Constructivist grounded theory.
Charmaz (2006) further evolved grounded theory to allow more flexibility and synergy with other qualitative analysis methods. This Charmazian grounded theory approach is less mechanical and allows the researcher to become a participant in the construction process to describe a phenomenon (Charmaz, 2014, p. 13). Taking the epistemological understanding of knowledge within grounded theory, Charmaz (2006) delineates both a constructivist grounded theory and an objectivist grounded theory. A constructivist grounded theory approach ‘looks at the phenomena of study and sees both data and analysis as co-created from shared experiences and relationships’ (p. 130). In this, the researcher’s perspective is relevant to the final conceptual model (Charmaz, 2006; Mills et al., 2006). Constructivist grounded theory shares the necessary components of any grounded theory research including the following areas: theoretical sensitivity, theoretical sampling, constant comparative analysis, coding and categorizing the data, literature as a source of data, and memo writing, which is described in greater detail in Section 2.9. It also includes the co-construction process for the development of a conceptual model (Charmaz, 2014; McCann & Clark, 2003).
The objectivist grounded theory as described by Charmaz (2014) is focused on the positivist epistemology, which sees data as real but is not focused on the process of how those data are known. Therefore the conceptual model is discovered from data that are already in the world and the researcher provides the discovered model from a neutral perspective without the inclusion of social context (Charmaz, 2014).
Constructivist grounded theory (CGT) is particularly appropriate to examine the experience of advanced cancer recurrence in people with cancer who have perceived themselves as cancer free. By placing the researcher into the participant’s story, CGT permits the co-creation of a conceptual model within the context of the experience, while retaining the participant’s voice. The researcher’s ontological view of constructionism and epistemological stance on interpretivism logically leads to the constructivist grounded theory approach. This approach guides how knowledge in a growing area of research, such as the experience of advanced cancer recurrence within the changing context of new treatments that include immunotherapy and focused treatment options, becomes known. Through the use of in-depth interviews within CGT, insight is gained into the human experience being studied, which supports the generation of new knowledge (Crouch & McKenzie, 2006). The constructivist grounded theory method provides the conceptual model necessary to answer the research question. The newly developed conceptual model will allow others to understand the patient phenomena (Mills et al., 2006). These particular features illustrate why this method of qualitative research was selected for this research study.