Greenbaum, Clare and Salifu, Yakubu and Preston, Nancy (2026) "When the Spine Speaks First" : A Constructivist Grounded Theory of People's Experiences of Discovering a Newly Diagnosed Advanced Cancer through Metastatic Spinal Cord Compression. PhD thesis, Lancaster University.
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Abstract
Background: Spinal cord compression can occur when cancer compresses the spinal cord, causing pain, limb weakness, or paralysis. For some, it is the first sign of a new advanced cancer. People facing this condition experience sudden physical decline alongside the emotional impact of a serious diagnosis. The need for timely, person-centred care increases, yet the experiences of this group remain under-researched. Aims: To understand how people experience the sudden discovery of a newly diagnosed advanced cancer through spinal cord compression. Methods: A constructivist grounded theory approach was used. Twelve participants were recruited through purposive and theoretical sampling. Semistructured interviews were conducted. Data were analysed using initial, focused, and theoretical coding. Constant comparison, memo-writing, and theoretical sensitivity were central to the analytical process, allowing for iterative interpretation and conceptual development grounded in the participants lived realities. A delayed literature review was conducted in line with constructivist grounded theory methodology to refine the emerging theory. Findings: Participants experienced spinal cord compression alongside a new diagnosis of cancer as a deeply disruptive and transitional event, triggering complex changes in physical function and emotional well-being. Three core categories were constructed: (1) “Making sense of bodily changes and disruption to normal life,” (2) “Focusing on living life for longer,” and (3) “Emotional consequences of a dual diagnosis.” An overarching concept of liminality, a transitional space between the loss of former health and an uncertain future, framed the experience. The synthesis identified four supporting constructs: (1) “Emotional impact of a dual diagnosis,” (2) “Competing priorities: immediate vs the future,” (3) “Adjusting to a new functional reality,” and (4) “The perception and processing of information about diagnosis and prognosis.” These findings informed the final theory titled “When the spine speaks first.” Conclusion: Through this study, the resulting theory provides new insights to guide timely, compassionate, and person-centred clinical responses during this critical diagnostic moment.