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CHAPTER 30 Carolyn L. Wiener; Marylin J. Dodd 599

inductively to reveal the core social-psychological
process around which the theory is explicated: tolerat- Major Assumptions
ing the uncertainty of living with cancer. Dimensions Personis the focus of this middle-range theory. Middle
of the uncertainty, management processes, and conse- range theories address one or more of the paradigm
quences were further explicated revealing the internal concepts (nursing, person, health, and environment),
consistency of the theoretical perspective of illness therefore some are not explicitly addressed; however,
trajectory. the following discussion of theoretical assumptions
When considering the use of adapted grounded sheds some light on a theoretical interpretation of
theory methods to analyze preexisting empirical these concepts. Wiener and Dodd’s Theory of Illness
evidence, several insights support the integrity of Trajectory explicates major assumptions that reflect its
this work. First, Wiener was well prepared to ad- derivation within a sociological perspective (Wiener &
vance new applications of the method from training Dodd, 1993). Closer examination of each assumption
and experience as a grounded theorist. The method- reveals several related basic premises undergirding the
ological credibility of this researcher supports her theory.
extension of a traditional research method into a The Theory of Illness Trajectory encompasses not
new application within her disciplinary perspective only the physical components of the disease, but the
(sociology). Further support is from the size of the “total organization of work done over the course of
data set: 100 patients and families were interviewed the disease” (Wiener & Dodd, 1993, p. 20). An illness
3 times each, for a total of 300 interviews, a very trajectory is theoretically distinct from the course of
large data set for a qualitative inquiry. Oberst pointed an illness. In this theory, the illness trajectory is not
out that given this volume of data, some semblance limited to the person who suffers the illness. Rather,
of theoretical sampling (within the full data set) the total organization involves the person with the
would likely be permitted by the researchers (Oberst, illness, the family, and health care professionals who
1993). But the sheer size of the data set does not tell render care.
the whole story. Also, notice the use of the term work. “The varied
Sampling patients who had a relatively wide range players in the organization have different types of
of types of cancers (ranging from gynecological can- work; however, the patient is the ‘central worker’ in
cers to lung cancer) and both patients undergoing the illness trajectory” (Wiener & Dodd, 1993, p. 20).
initial chemotherapeutic treatment and those receiv- This statement reaffirms an earlier assertion in illness
ing treatment for recurrence contributed significantly trajectory literature (Fagerhaugh, Strauss, Suczek,
to variation in the data set. These sampling strategies et al., 1987; Strauss, Corbin, Fagerhaugh, Glaser, et al.,
ultimately contributed to establishing an appropriate 1984). The work of living with an illness produces
sample, especially for revealing a trajectory perspec- certain consequences that permeate the lives of the
tive of change over time. Finally, despite the struc- people involved. In turn, consequences and reciprocal
tured format of the interview, it is important to note consequences ripple throughout the organization,
that the patients and families dialogued about the enmeshing the total organization with the central
previous month’s events in a form of “brainstorming” worker (i.e., the patient) through the trajectory of
(Wiener & Dodd, 1993, p. 18). This technique allowed living with the illness. The relationship among the
the subjects to introduce almost any topic that was of workers in the trajectory is an attribute that “affects
concern to them (regardless of the subsequent struc- both the management of that course of illness, as well
ture of the interview). The audiotaping and verbatim as the fate of the person who is ill” (Wiener & Dodd,
transcription of these dialogues contributed to the 1993, p. 20).
variation and appropriateness of the resultant data
set. Therefore, it may be concluded that empirical
evidence culled through the interviews conducted in Theoretical Assertions
the larger study provide adequate and appropriate The context for the work and the social relationships
data for a secondary analysis using expertly adapted affecting the work of living with illness in the Theory
grounded theory methods. of Illness Trajectory is based in the seminal work of