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Farthing P, Bally J, Rennie DC. Perceptions Related to Death in Adolescents and Their Parents During the Management of Type 1 Diabetes: A Thematic Analysis. J Pediatr Health Care 2024; 38:586-594. [PMID: 38661590 DOI: 10.1016/j.pedhc.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Type 1 diabetes (T1D) is associated with an increased risk of premature death compared to those without T1D, yet perceptions of dying have not been well studied. The purpose of this secondary analysis of existing data was to explore the fears of adolescents with T1D and their parents related to the possibility of death due to T1D. METHOD A reflexive thematic analysis was used to examine data from interviews conducted with adolescents with T1D and their parents who participated in a primary grounded theory study of interdependence in T1D management. FINDINGS Three themes were generated from the data including: (1) Facing the Reality of Death, (2) Fearing Highs and Lows, and (3) Finding a Way through Fears. Participants indicated they see death as a consequence of failing to optimally manage T1D. CONCLUSION Additional investigation is needed to explore the fear of death in adolescents with T1D and any fear their parents may have of their adolescents' mortality.
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Affiliation(s)
- Pamela Farthing
- Pamela Farthing, Saskatchewan Polytechnic, School of Nursing, Saskatoon, Canada..
| | - Jill Bally
- Jill Bally, Associate Professor, College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - Donna C Rennie
- Donna C. Rennie, Professor Emeritus, College of Nursing, University of Saskatchewan, Saskatoon, Canada
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2
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Wilharm C, Pralong A, Weiss M, Hallek M, Voltz R, Tuchscherer A, Simon ST. Facing life-threat during youth: a qualitative study on challenges, coping, and needs among adolescents and young adults with cancer. Support Care Cancer 2024; 32:179. [PMID: 38383874 PMCID: PMC10881674 DOI: 10.1007/s00520-024-08370-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/11/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE While the unique situation of adolescents and young adults with cancer (AYAs) has become the focus of research and clinical practice, little is known about how they deal with the threat to life at a curative stage. The aim of this study was to obtain insight into the challenges, coping strategies, and needs of AYAs regarding the life-threatening nature of their diseases. METHODS Face-to-face in-depth interviews were conducted with patients who were 18-39 years old at diagnosis. The interviews took place 2-5 years after their diagnosis. Patients who were still undergoing treatment or who were suspected of recurrence were excluded. Interviews were transcribed verbatim and analyzed using qualitative content analysis. RESULTS Fifteen patients (mean age 27.33 years, nine females) were interviewed in a large comprehensive cancer center in Germany. Before diagnosis, AYAs had not faced their own mortality and had little experience with cancer. The sudden confrontation with a life-threatening disease and therapy, as well as experiencing the death of other AYAs, challenged them. Fear, particularly regarding recurrence and death, and the loss of trust in their own bodies were the major emotions that continued to limit them even after the end of treatment. For mothers, concern of leaving their young children alone was paramount. Coping strategies frequently mentioned were hope, avoidance, self-soothing, and valuing the experience as a chance. Health care professionals were expected to be reassuring, motivating, and open and to provide honest information based on individual and current needs. CONCLUSION AYAs appear to cope with life-threats similarly to older patients but have additional unique challenges, including inexperience with life-threatening diseases and responsibility for young children. More research is needed in this area, although it is already evident that AYAs need honest and reassuring communication regarding the life-threat during any curable phases of their disease. Trial registration number DRKS00030277; September 27, 2022 (German Clinical Trials Register).
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Affiliation(s)
- Carolin Wilharm
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Anne Pralong
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Mara Weiss
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital, Center for Integrated Oncology Cologne Aachen Bonn Cologne Duesseldorf (ABCD), University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
- Faculty of Medicine and University Hospital, Center for Integrated Oncology Cologne Aachen Bonn Cologne Duesseldorf (ABCD), University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
- Faculty of Medicine and University Hospital, Center for Health Services Research (ZVFK), University of Cologne, Cologne, Germany
| | - Armin Tuchscherer
- Department I of Internal Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital, Center for Integrated Oncology Cologne Aachen Bonn Cologne Duesseldorf (ABCD), University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Steffen T Simon
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany.
- Faculty of Medicine and University Hospital, Center for Integrated Oncology Cologne Aachen Bonn Cologne Duesseldorf (ABCD), University of Cologne, Kerpener Street 62, 50937, Cologne, Germany.
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Liu Q, Ho KY, Lam KKW, Lam W, Cheng EHL, Ching SSY, Belay GM, Wong FKY. Adaptation and psychometric evaluation of the Chinese version of the functional assessment of chronic illness therapy spiritual well-being scale among Chinese childhood cancer patients in China. Front Psychol 2022; 13:1065854. [PMID: 36544451 PMCID: PMC9760963 DOI: 10.3389/fpsyg.2022.1065854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
Background Spiritual well-being is a strength for childhood cancer patients to cope with cancer. The availability of a valid and reliable instrument for assessing spiritual well-being is crucial. This study translated and adapted the Functional Assessment of Chronic Illness Therapy Spiritual Well-being scale (FACIT-Sp) for Chinese childhood cancer patients and examined the psychometric properties and factor structure in this population. Methods This was a methodological study. The FACIT-Sp was translated into Chinese. Adaptation was based on our qualitative study. For psychometric evaluation, a convenience sample of 412 were recruited based on the suggested sample size for the exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Childhood cancer patients were included if they aged 8-17 years, with parental consent to participate, able to communicate that they were being treated for cancer, and able to communicate and read Chinese. Participants answered the Chinese version of the adapted FACIT-Sp, the Center for Epidemiology Studies Depression Scale for Children (CES-DC), and the Pediatric Quality of Life Inventory 3.0 Cancer Module (PedsQL). Content validity, convergent validity, internal consistency and test-retest reliability were examined. Both EFA and CFA assessed the structural validity of the adapted FACIT-Sp. Results The content validity index values for items ranged 0.8-1.0 and that for the scale was 0.84, indicating appropriate content validity. The scale had good internal consistency, with a Cronbach's alpha of 0.815. The FACIT-Sp scores positively correlated with the CES-DC scores, and negatively correlated with PedsQL scores, suggesting that the Chinese version of the adapted FACIT-Sp had reasonable convergent validity. EFA yielded a four-factor (meaning, peace, faith, and connection with others) model. The CFA results revealed that the four-factor model achieved a better fit than the original three-factor model (Chi-Square Mean/Degree of Freedom = 2.240 vs. 3.557, Comparative Fit Index = 0.953 vs. 0.916, Goodness of Fit Index = 0.909 vs. 0.884, Root Mean Square Error of Approximation = 0.078 vs. 0.112). Conclusion The Chinese version of the adapted FACIT-Sp is a reliable and valid instrument for assessing spiritual well-being among Chinese childhood cancer patients. This instrument can be applied in clinical settings for routine assessment.
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Olesen AMR, Boisen KA, Missel M. How Adolescents and Young Adults with Cancer Experience an Age-Appropriate Intervention When Undergoing Treatment in Adult Surgery Clinics: A Qualitative Study. J Adolesc Young Adult Oncol 2022; 12:177-184. [PMID: 35759421 DOI: 10.1089/jayao.2022.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Despite growing international attention, few interventions specifically target adolescents and young adults (AYAs) with cancer even though appropriate interventions may improve care delivery during cancer treatment. The study's purpose was to explore how AYAs with cancer experience an age-appropriate intervention when undergoing treatment in adult surgery clinics. Methods: Twenty AYAs with cancer, aged 18-29 years, from five surgery clinics at Copenhagen University Hospital Rigshospitalet participated in an intervention consisting of three main components: care provided by trained youth coordinator nurses (YCNs) to the greatest extent possible; a 1-hour one-on-one conversation with a YCN during hospitalization; and a postdischarge phone call. Semistructured interviews were used to collect data, which were analyzed in a stepwise process based on inductive content analysis. Results: Three themes were identified: a beacon in the dark; from patient to person; and the caring check-up. Participants felt safe and experienced a sense of presence and a caring environment in a significant and trusting relationship with YCNs, which encouraged them to share thoughts, feelings, and needs they previously had kept silent about. The one-on-one conversations helped them begin reflecting and in emotional processing and the postdischarge phone call was perceived as a caring check-up. Conclusions: The study shows how an age-appropriate intervention was experienced overall as meaningful for the participants hospitalized in adult surgery clinics, but more research is required to further examine the significance and effect of interventions that target AYAs with cancer.
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Affiliation(s)
- Anne Marie Roholm Olesen
- Department of Cardiothoracic Surgery, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kirsten A Boisen
- Department of Paediatrics and Adolescent Medicine, Centre of Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Malene Missel
- Department of Cardiothoracic Surgery, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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5
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Phan J, Laurence V, Marec-Berard P, Cordero C, Riberon C, Flahault C. La confrontation au deuil d’un pair chez une AJA atteinte de cancer. Une analyse phénoménologique interprétative. PSYCHO-ONCOLOGIE 2022. [DOI: 10.3166/pson-2022-0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectif : Les adolescents et jeunes adultes (AJA) atteints de cancer faisant face à la perte d’un autre AJA malade peuvent être confrontés à une « triple tâche » : le processus d’adolescence, l’ajustement psychologique au cancer et la mort d’un pair malade. L’objectif de l’étude a été d’explorer les processus sous-jacents à la perte d’un pair malade chez les AJA atteints de cancer.
Matériel et méthodes : Un entretien unique a été soumis à une Analyse phénoménologique interprétative (IPA), conçu pour comprendre le système de significations attaché à un phénomène subjectif et intime tel que le deuil.
Résultats : L’IPA a fait émerger six thèmes majeurs : le parcours de vie ; le parcours de soins ; les représentations du cancer, de soi et du monde ; l’ajustement psychologique au cancer ; les relations interpersonnelles ainsi que la perte d’un pair AJA malade. Le récit interprétatif montre la place centrale du processus d’identification aux pairs malades, notamment au défunt, dans la mise en sens du cancer et du deuil. Cette expérience du deuil d’un pair comporte des aspects négatifs (e.g., perspective de sa propre mort, perte de repère, peur de la rechute) et positifs (e.g., sentiment de continuité avec le défunt, changement de perception de soi et du monde).
Conclusion : L’étude montre l’importance de considérer ces processus dans l’accompagnement des AJA atteints de cancer confrontés à la mort d’un pair malade et de proposer des interventions adaptées à cette tranche d’âge.
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Comas Carbonell E, Mateo-Ortega D, Busquets-Alibés E. The psychological experience of pediatric oncology patients facing life-threatening situations: A systematic review with narrative synthesis. Palliat Support Care 2021; 19:733-743. [PMID: 33750507 DOI: 10.1017/s1478951521000031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this systematic review is to describe the elements of the psychological experience of pediatric oncology patients facing life-threatening situations and the corresponding care needs. METHODS The study design is a systematic review following the PRISMA standard of qualitative, quantitative, and mixed-methods research. The review was conducted using multiple databases, including Scopus, Web of Science, PubMed, and PsycINFO. The risk of bias of the articles was evaluated with the "Critical Appraisal Skills Programme." RESULTS A total of 21 articles met inclusion criteria. The analysis of the evidence revealed that the psychological experience involves changes in relationships, thoughts about death, emotional changes, physical symptoms, spiritual changes, and feelings of uncertainty. SIGNIFICANCE OF RESULTS The care needs identified are maintaining normality, controlling physical and psychological symptoms, and that maintaining hope is an important aspect for children. Whether or not the children want to talk about death is another important aspect that needs to be reflected upon, and it would be appropriate to consider, on an individual level, involving patients in the discussion on the diagnosis and treatment of the illness. Future research should be conducted from the children's perspective since most existing research is from the perspective of the family members or health professionals. Furthermore, it is recommended to take into account qualitative approaches that provide more detailed information on the patients' subjectivity.
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Affiliation(s)
| | - Dolors Mateo-Ortega
- Palliative Care Unit, Consorci Sanitari de Terrassa, Barcelona, Spain
- Research Group on Stress and Health, Faculty of Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Chair in Palliative Care, University of Vic - Central University of Catalonia, Barcelona, Spain
| | - Ester Busquets-Alibés
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVic-UCC), Barcelona, Spain
- Chair in Bioethics Fundació Grífols, University of Vic - Central University of Catalonia, , Barcelona, Spain
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Jackson Levin N, Zhang A, Reyes-Gastelum D, Chen DW, Hamilton AS, Zebrack B, Haymart MR. Change in worry over time among Hispanic women with thyroid cancer. J Cancer Surviv 2021; 16:844-852. [PMID: 34633638 DOI: 10.1007/s11764-021-01078-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study is to assess change in worry over time in Hispanic women with thyroid cancer. METHODS Worry about recurrence, quality of life, family at risk, death, and harm from treatments was assessed in 273 Hispanic women with thyroid cancer diagnosed in 2014-2015. Subjects were recruited from Surveillance, Epidemiology, and End Results (SEER) Los Angeles. Participants were surveyed at two points in time (time 1: 2017-2018 and time 2: 2019). Multivariable logistic regression was used to determine correlates with high worry (somewhat, quite a bit, very much) versus low worry (not at all, a little) at time 2. RESULTS For the five worry items, 20.1-39.6% had high worry at both time 1 and time 2. An additional 7.6-13.4% had low worry at time 1 that became high worry at time 2. In multivariable logistic regression controlling for age, recurrence status, education level, and number of complications or side effects symptoms, younger age (20-39) as compared to older (40-79) was associated with high worry about thyroid cancer recurrence (OR 2.16, 95% CI 1.12-4.17). History of recurrent or persistent disease was associated with high worry about harms from treatment (OR 2.94, 95% CI 1.29-6.67). Greater number of complications or side effects of symptoms was associated with more worry across all five items. CONCLUSIONS Some Hispanic women with thyroid cancer have persistently high worry, with young adult Hispanic women vulnerable to worry about recurrence. IMPLICATIONS FOR CANCER SURVIVORS Hispanic women with thyroid cancer may benefit from targeted psychosocial support during survivorship, with interventions informed by patient and cancer characteristics.
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Affiliation(s)
- Nina Jackson Levin
- School of Social Work and Department of Anthropology, University of Michigan, 1080 S. University Ave, Room B660, Ann Arbor, MI, 48109, USA
| | - Anao Zhang
- School of Social Work, University of Michigan, 1080 S. University, Room 3704, Ann Arbor, MI, 48109, USA
| | - David Reyes-Gastelum
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Bldg. 16, 400S-20, MI, 48109, Ann Arbor, USA
| | - Debbie W Chen
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Domino's Farms (Lobby C, Suite 1300), 24 Frank Lloyd Wright Drive, PO Box 451, Ann Arbor, MI, 48106, USA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto St., SSB318E, MC9239, Los Angeles, CA, 90089-9239, USA
| | - Bradley Zebrack
- School of Social Work, University of Michigan, 1080 S. University, Room 2778, Ann Arbor, MI, 48109, USA
| | - Megan R Haymart
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Bldg 16, Rm 408E, Ann Arbor, MI, 48109, USA.
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Ciobanu E, Preston N. Hearing the voices of children diagnosed with a life-threatening or life-limiting illness and their parents' accounts in a palliative care setting: A qualitative study. Palliat Med 2021; 35:886-892. [PMID: 33765880 DOI: 10.1177/02692163211000238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Exploring children's experiences of a life-threatening or life-limiting diagnosis is essential in offering appropriate care for them. There have been few studies examining these and they are often from the parent's perspective. Even if adults are frequently unwilling to share information with children, they become aware of their diagnosis and prognosis. The theory of awareness contexts provided a theoretical framework through which it can be understood what children knew about their condition. AIM To advance the understanding of the experiences of children with a life-threatening or life-limiting condition. DESIGN A qualitative study using dyadic interviews and thematic analysis. SETTING/PARTICIPANTS Ten children between 14 to 17 years old with a life-threatening or life-limiting illness who were supported by a palliative care service in Romania. Interviews were also undertaken with their mothers. RESULTS Interview data demonstrated that there was a gap in the child's experience and understanding of their condition compared to their parents. The data produced six major themes: awareness of the illness, death and dying, the spiritual response to illness, the emotional response to illness, striving for normality and independence and coping strategies. The study showed that children can read subtle cues or they may talk with other children to learn about their illness when information is not openly available to them. CONCLUSIONS Children in the study often know more about their condition than their parents realised. Using this understanding, healthcare professionals can advise parents and children about how to communicate with one another which would enable the children to give voice to their thoughts, emotions and experiences.
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Affiliation(s)
- Estera Ciobanu
- Emanuel Hospice Foundation, Bihor, Oradea, Romania.,Emanuel University of Oradea, Bihor, Oradea, Romania
| | - Nancy Preston
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Olesen AMR, Missel M, Boisen KA. The Needs and Care Experiences of Adolescents and Young Adults Treated for Cancer in Adult Surgery Clinics: A Qualitative Study. J Adolesc Young Adult Oncol 2021; 11:48-55. [PMID: 33844956 DOI: 10.1089/jayao.2021.0010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Adolescents and young adults (AYAs) with cancer hospitalized in adult surgery clinics are an overlooked group of patients. They are a minority hospitalized among elderly surgical patients, and the surroundings and care are designed with older patients in mind. A growing body of research focuses on AYAs' experiences of cancer care. However, studies exploring care experiences in terms of in-patient surgery treatment are still needed. Hence, the purpose of the study was to explore the needs and care experiences of AYAs, 15-29 years of age, treated for cancer in adult surgery clinics. Methods: This qualitative study was based on semistructured interviews with 15 AYAs with cancer from seven surgery clinics at Rigshospitalet, Copenhagen University Hospital, Denmark. Data were analyzed and interpreted using inductive content analysis. The Danish Data Protection Agency approved the study (project no.: 05617). Results: Three themes were identified: (1) being the black sheep - experiences of being young in an adult environment, (2) the significant nurse - experiences of the essential relationship between AYAs and the nurses, and (3) the wounded body - experiences of how the physically changed body affects the mind. Conclusions: Our findings showed that the psychosocial needs of AYAs with cancer hospitalized in adult surgery clinics were not being adequately met. Initiatives are needed to improve the psychological and social well-being of this vulnerable patient group, while hospitalized for treatment in surgery clinics.
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Affiliation(s)
- Anne Marie Roholm Olesen
- Department of Cardiothoracic Surgery, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Malene Missel
- Department of Cardiothoracic Surgery, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirsten A Boisen
- Department of Pediatrics and Adolescent Medicine, Center of Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Telles CM. A scoping review of literature: What has been studied about adolescents and young adults (AYAs) with cancer? Cancer Treat Res Commun 2021; 27:100316. [PMID: 33545568 DOI: 10.1016/j.ctarc.2021.100316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To map, organize and analyze the articles published in the last five years about AYAs with cancer. METHODS CAPES database and Google Scholar were searched to identify relevant studies from 2015 to February 2020. Eligible articles included empirical or theoretical research, quantitative and/or qualitative studies, targeted AYAs with cancer, addressed different topics related to AYAs such as unmet needs, hospital challenges, interventions or tools based on evidence, as well as political and socioeconomic aspects. RESULTS Of the 161 articles analyzed, 74 (46%) discussed the health system, including hospital dynamics, treatment and interventions during treatment; 63 (39.1%) discussed aspects or interventions that influence the quality of life and mental health of AYAs with cancer; 14 (8.7%) discussed issues related to sexual health; and 10 (6.2%) addressed social, economic and demographic problems of AYAs with cancer. Three types of purposes have been identified in the articles: 118 (73.3%) investigated variables in areas related to AYAs with cancer, aiming to increase the understanding of the phenomenon and the needs of AYAs; 18 (11.2%) intervened on the needs of AYAs with cancer through pilot studies or evidence-based interventions; and 22 (13.7%) aimed to evaluate an intervention previously performed or to evaluate an intervention based on evidence. CONCLUSION There is still much to be researched within the last two categories. In the last three years, these categories have been growing gradually and on a small scale.
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Affiliation(s)
- Camila M Telles
- Graduating in Psychology - Senior year, Positivo University - Curitiba, Paraná, Brazil (Student); Teen Cancer America - Los Angeles, California, the United States of America (Intern Pro Cancer).
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Sharma A, Loades ME, Baker L, Jordan A, James V. Parental experiences of adolescent cancer-related distress: A qualitative study. Eur J Cancer Care (Engl) 2021; 30:e13417. [PMID: 33512062 DOI: 10.1111/ecc.13417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 12/21/2020] [Accepted: 01/11/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Adolescents' cancer-related distress is more complex, severe, and long-lasting than that of children and adults. Parents adopt an active role in supporting their adolescent, reporting that adolescent cancer-related distress is the most problematic symptom parents experience. Research has predominantly focused on exploring adolescents' experiences of cancer-related distress, with little attention to how their parents experience their adolescent's cancer-related distress. Therefore, we aimed to explore parents' experiences of distress within the context of parenting an adolescent with cancer-related distress during or immediately subsequent to active treatment. METHODS A total of 21 semi-structured interviews were conducted face-to-face or via telephone, with parents of adolescents aged 12-18 years from south-west England. Inductive reflexive thematic analysis was used to analyse the data. RESULTS Three themes were generated: "The contagion of distress", "Navigating breaking point" and "Developmental disruption". Parental distress transcended from adolescent cancer-related distress, eliciting uncertainty and challenging parenting limits. Parental distress was perpetuated by feelings that their adolescent had missed out on "normal" adolescence during and just after active treatment. CONCLUSION Parental distress reflected the multi-faceted nature of their adolescent's cancer-related distress. Findings advocate the importance of providing a parental voice within adolescent oncology populations. Developing tailored interventions to address parental distress are suggested.
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Affiliation(s)
- Aditi Sharma
- Department of Psychology, University of Bath, Bath, UK
| | - Maria E Loades
- Department of Psychology, University of Bath, Bath, UK.,Bristol Medical School, University of Bristol, Bristol, UK
| | - Laura Baker
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Abbie Jordan
- Department of Psychology, University of Bath, Bath, UK.,Centre for Pain Research, University of Bath, Bath, UK
| | - Venessa James
- Department of Psychology, University of Bath, Bath, UK
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Shin H, Bartlett R, De Gagne JC. Integrative Literature Review on Psychological Distress and Coping Strategies Among Survivors of Adolescent Cancer. Oncol Nurs Forum 2020; 47:E131-E148. [PMID: 32830805 DOI: 10.1188/20.onf.e131-e148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Cancer survivors, particularly those diagnosed in adolescence, are faced with physical, mental, and emotional stressors associated with the disease and its treatment. These stressors add to the demand placed on survivors' already taxed coping skills. This article reviews the literature on psychological distress experienced by survivors diagnosed with cancer during adolescence and the coping strategies they employed. LITERATURE SEARCH Three electronic databases (CINAHL®, PsycINFO®, PubMed®) were searched, and 19 studies were selected. Garrard's matrix method guided this integrative review. DATA EVALUATION Gough's weight of evidence framework was used to evaluate each study. SYNTHESIS Analysis revealed important findings about the types of coping strategies used by adolescents during and after cancer treatment and the impact of each on levels of psychological distress. IMPLICATIONS FOR PRACTICE Healthcare providers, who regularly assess for negative thoughts and unmet needs among survivors, may identify symptoms of psychological distress, intervene early, and facilitate better outcomes for their patients. Patient-centered interventions aimed at coping with psychological distress are most helpful.
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McDonnell GA, Pope AW, Ford JS. Associations Among Perceived Parent and Peer Support, Self-Esteem, and Cancer-Related Worry in Adolescent and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2020; 10:209-216. [PMID: 32833557 DOI: 10.1089/jayao.2020.0111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Cancer-related worry is common among adolescent and young adult (AYA) cancer survivors, and is associated with adverse psychosocial outcomes. Thus, it is crucial to identify possible modifiable covariates of cancer-related worry to aid in developing targeted interventions. This study aimed to explore the cross-sectional associations between cancer-related worry and potential covariates (i.e., perceived parental support, perceived peer support, self-esteem). Methods: One hundred fifty-two survivors between the ages of 15 and 25 who had been diagnosed with cancer between the ages of 14 and 21 completed the Inventory of Parent and Peer Attachment, the Rosenberg Self-Esteem Scale, the Self-Perception Profile for Adolescents, and a measure of cancer-related worry. Relationships among variables were assessed through structural equation modeling. Results: The model showed good fit [χ2(13) = 13.26, p = 0.43; comparative fit index = 0.997; root mean square error of approximation = 0.01 (90% confidence interval = 0.00-0.08); standardized root mean square residual = 0.04]; however, not all associations were in expected directions. Higher perceived parent and peer support were each significantly associated with lower self-esteem, which, in turn, was significantly associated with higher cancer-related worry. There was no direct association between support variables and cancer-related worry. Conclusion: These findings, which contradict existing theory about self-esteem development in healthy AYAs and prior research about the association between support and self-esteem in children and adolescents with cancer, suggest complex, and likely reciprocal, relationships among perceived support, cancer-related worry, and self-esteem in AYA cancer survivors. Support interventions involving peers with cancer and cognitive behavioral interventions targeting parent and peer relationships, self-esteem, and cancer-related worry may be beneficial in fostering AYA cancer survivors' psychosocial development.
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Affiliation(s)
- Glynnis A McDonnell
- Center for Healthcare Delivery Science, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Alice W Pope
- Department of Psychology, St. John's University, Queens, New York, USA
| | - Jennifer S Ford
- Department of Psychology, Hunter College and The Graduate Center, City University of New York, New York, NY, USA
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Nilsson S, Hård Af Segerstad Y, Olsson M. Worrying About Death: An Initial Analysis of Young Adult Cancer Patients' Needs. J Adolesc Young Adult Oncol 2020; 10:105-108. [PMID: 32552246 DOI: 10.1089/jayao.2020.0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Young adults (YAs) with cancer may have a need to develop strategies to cope with their worries about death. This brief report presents findings from a pilot study on YAs' needs with regard to such issues. An anonymous, web-based questionnaire was posted with a total of 83 cancer patients taking the questionnaire (71 females and 12 males). Almost half of the participants thought about death every day. Since most of the participants had ended their treatment, this would appear to show that matters related to death remain an important issue after the YAs' cancer treatment has ended. The results show a need for YAs to talk about death, either with professionals or with peers.
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Affiliation(s)
- Stefan Nilsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg Center for Person-Centered Care, University of Gothenburg, Gothenburg, Sweden
| | - Ylva Hård Af Segerstad
- Department of Applied IT, University of Gothenburg Center for Person-Centered Care, University of Gothenburg, Gothenburg, Sweden
| | - Maria Olsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg Center for Person-Centered Care, University of Gothenburg, Gothenburg, Sweden
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15
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Razban F, Mehdipour-Rabori R, Rayyani M, Mangolian Shahrbabaki P. Meeting death and embracing existential loneliness: A cancer patient's experience of being the sole author of his life. DEATH STUDIES 2020; 46:208-223. [PMID: 32048554 DOI: 10.1080/07481187.2020.1725932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Facing the truth of death in silence instead of fearing and denying it enables people to regain their freedom. This qualitative case study aimed to illuminate the meaning of a single person's experience of confronting death and living with cancer. The transcripts of unstructured interviews were analyzed using the hermeneutic phenomenological method. Data analysis led to extraction of four themes including "Confronting death, meeting nonbeing and longing for being", "Embracing existential loneliness, responsibility and freedom", "Taking over the mind, living mindfully, a meaningful life", and "Flourishing authentic self-love, moving in the path of caring and healing the self".
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Affiliation(s)
- Farideh Razban
- Nursing Research Center, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Roghayeh Mehdipour-Rabori
- Nursing Research Center, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Masoud Rayyani
- Nursing Research Center, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Parvin Mangolian Shahrbabaki
- Nursing Research Center, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
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16
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Pearce S, Whelan J, Kelly D, Gibson F. Renegotiation of identity in young adults with cancer: A longitudinal narrative study. Int J Nurs Stud 2019; 102:103465. [PMID: 31841739 DOI: 10.1016/j.ijnurstu.2019.103465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Despite increasing international awareness of the impact of cancer on young adults, to date there has been limited in-depth research to understand their experiences following a diagnosis using a qualitative and longitudinal perspective. OBJECTIVES To explore the impact of cancer on young adults' evolving sense of self and identity over one year from the time of diagnosis. In addition, to contribute further to an understanding of innovative research methods used to examine this experience. DESIGN This was a longitudinal narrative study using visual methods and a psychosocial lens. Narrative was used to re-present experiences over time. SETTING AND SAMPLE Recruitment was from a Principal Treatment Centre for Teenagers and Young Adults with Cancer and a Cancer Centre for Adults in the United Kingdom. Total population sampling was used over a six-month period, recruiting 18 young adults aged between 16 and 30, one to three months from a diagnosis of bone cancer, lymphoma or leukaemia. METHODS In depth, free association narrative interviews at three-time points over a year were undertaken. Photographs were used to help with story-telling. Extensive reflexive field notes, debriefing and the use of a psychosocial research group, also formed data sources. Forty interviews were conducted with 18 participants: eight took part in three interviews, six in two interviews and four in one interview. Analysis focused on the holistic 'case' of the individual temporally. In-depth, visual images were analysed from discussion in the narrative text. Through memoing, coding and comparison, themes were developed across all cases and a conceptual framework developed. RESULTS The conceptual framework illustrates the renegotiation of self over time through narrative. This was 'biographically' during young adult development and across 'cancer time'; through the core components of: the inner world, (psyche, emotion and coping); self as embodied; self as relating to others, and self as relating to place. Stories indicated that there was a constant inter- relationship over time between the renegotiation of identity and adaption of biography. CONCLUSIONS The focus in this paper is on 'the temporality of cancer' through the first year from diagnosis, and the juxtaposed process of managing biographical and developmental milestones. The importance of developing health care and research which enables narrative and the patient's voice has been highlighted. It emphasises the need for professionals to 'be with' and 'walk alongside' through the intensity of a biographically and identity changing illness. Using longitudinal narrative, visual & psychosocial methods to describe the impact of a diagnosis of cancer on young adults' sense of biography and identity.
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Affiliation(s)
- S Pearce
- School of Nursing and Midwifery, University of Plymouth, Room 204, 10 Portland Villas, Plymouth PL4 8AA, Devon, UK; Torbay and South Devon Clinical School, Torbay and South Devon NHS Foundation Trust, UK.
| | - J Whelan
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK.
| | - D Kelly
- School of Healthcare Sciences, Cardiff University, Cardiff, UK.
| | - F Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust and School of Health Science, University of Surrey, Guilford, Surrey, UK.
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17
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Hauken MA, Grue M, Dyregrov A. “It's been a life‐changing experience!” A qualitative study of young adult cancer survivors’ experiences of the coexistence of negative and positive outcomes after cancer treatment. Scand J Psychol 2019; 60:577-584. [DOI: 10.1111/sjop.12572] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 07/09/2019] [Indexed: 12/16/2022]
Affiliation(s)
- May A. Hauken
- Center for Crisis Psychology Faculty of Psychology University of Bergen Norway
| | - Marthe Grue
- Center for Crisis Psychology Faculty of Psychology University of Bergen Norway
| | - Atle Dyregrov
- Center for Crisis Psychology Faculty of Psychology University of Bergen Norway
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Greenblatt A, Saini M. Experiences of adolescents with cancer from diagnosis to post-treatment: a scoping review. SOCIAL WORK IN HEALTH CARE 2019; 58:776-795. [PMID: 31311459 DOI: 10.1080/00981389.2019.1640338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 05/19/2019] [Accepted: 06/27/2019] [Indexed: 06/10/2023]
Abstract
Adolescence is a turbulent time of transition. Facing a serious health issue such as cancer during this time can be challenging and confusing. This study presents a scoping review of 33 research articles including quantitative, qualitative, mixed method, and reviews focused on the experiences of adolescents throughout the cancer journey. Extracted themes across studies identified individual, interpersonal, and environmental aspects of adolescents' experiences in each stage of this trajectory. Implications for these findings are discussed including a need for early diagnosis and treatment of adolescent cancers and developmentally appropriate clinical supports.
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Affiliation(s)
- Andrea Greenblatt
- Factor-Inwentash School of Social Work, University of Toronto , Toronto , Ontario , Canada
| | - Michael Saini
- Factor-Inwentash School of Social Work, University of Toronto , Toronto , Ontario , Canada
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19
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McDonnell GA, Pope AW, Schuler TA, Ford JS. The relationship between cancer-related worry and posttraumatic growth in adolescent and young adult cancer survivors. Psychooncology 2018; 27:2155-2164. [PMID: 29843190 DOI: 10.1002/pon.4785] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 05/01/2018] [Accepted: 05/22/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To examine cancer-related worry in adolescent and young adult (AYA) cancer survivors and its relationship with posttraumatic growth over time, as the relationship between these constructs has not been assessed longitudinally in this population. METHODS A total of 153 AYA cancer survivors completed measures of cancer-related worry and posttraumatic growth 3 times across approximately 1 year. Descriptive statistics were calculated for cancer-related worry items, and mixed-effects modeling assessed the relationship between cancer-related worry and posttraumatic growth. RESULTS Most participants reported at least moderate cancer-related worry in at least 1 area at each assessment (88.2-93.9% across time points). Worry about future health was the most prevalent concern (65.4%-83.7% across time points). Cancer-related worry was positively related to posttraumatic growth in the mixed-effects model. However, post hoc analyses indicated that cancer-related worry and posttraumatic growth were modestly related; there was no evidence that either construct predicted the other over time. CONCLUSIONS Cancer-related worry appears to be a common psychosocial outcome in AYA cancer survivors. However, cancer-related worry appears to be only modestly related to the development of posttraumatic growth, implying that these may be independent constructs despite theoretical literature suggesting that posttraumatic growth may stem from posttraumatic distress. Thus, it is necessary to assess AYA survivors for cancer-related worry and posttraumatic growth, and develop interventions to target cancer-related worry and foster posttraumatic growth.
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Affiliation(s)
- Glynnis A McDonnell
- Department of Psychology, St. John's University, Jamaica, NY, USA.,Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alice W Pope
- Department of Psychology, St. John's University, Jamaica, NY, USA
| | - Tammy A Schuler
- Association for Behavioral and Cognitive Therapies, New York, NY, USA
| | - Jennifer S Ford
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Abstract
Background Total pain is a concept that approaches pain holistically: physically, psychologically, socially, and spiritually. Any individual may experience pain in each domain at a different level. This is the case report of an adolescent who suffered from total pain and how his healthcare team and peers helped to relieve it. Case presentation A 15-years-old Thai male was diagnosed with recurrent T-cell lymphoma and readmitted to hospital. He was admitted to an adult ward and suffered from pain due to his disease and from the fear of being alienated. As a result, he had an existential crisis. His parents felt unsure whether they or the patient should make the medical decisions and advance care plan. Conclusions This case report emphasises the importance of total pain assessment in the relief of total pain in an adolescent whose needs are different from both children and adults. It also highlights the role of medical decision-making in adolescents and the importance of the social support of peers in the alleviation of pain.
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21
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Beerbower E, Winters D, Kondrat D. Bio-psycho-social-spiritual needs of adolescents and young adults with life-threatening illnesses: Implications for social work practice. SOCIAL WORK IN HEALTH CARE 2018; 57:250-266. [PMID: 29377778 DOI: 10.1080/00981389.2018.1430091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This paper explores the biopsychosocial and spiritual needs of adolescents and young adults (AYA) with life-threatening or terminal illnesses. AYA are situated between childhood and adulthood (ages 15-25) and have distinct biopsychosocial and spiritual needs unique to their developmental stage. Having a life-threatening or terminal illness directly challenges normal AYA developmental tasks and identity formation. AYA experience more troubling physical symptoms during the dying process compared to other age groups, which leads to significant psychological distress and an increased need for pharmacological treatments. In general, AYA desire to be fully informed and involved in the health care decision-making process, leading to ethical dilemmas when the AYA is a minor and their wishes differ from the wishes of their legal guardian(s). Social workers are especially well-equipped to serve this population due to aligning professional standards and ability to advocate for holistic care within interdisciplinary teams. Additional research is needed to tailor holistic interventions to meet the needs of this population.
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Affiliation(s)
- Emily Beerbower
- a Indiana University School of Social Work , Indianapolis , IN , USA
| | - Drew Winters
- a Indiana University School of Social Work , Indianapolis , IN , USA
| | - David Kondrat
- a Indiana University School of Social Work , Indianapolis , IN , USA
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22
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Graugaard C, Sperling CD, Hølge-Hazelton B, Boisen KA, Petersen GS. Sexual and romantic challenges among young Danes diagnosed with cancer: Results from a cross-sectional nationwide questionnaire study. Psychooncology 2018. [DOI: 10.1002/pon.4700] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Christian Graugaard
- Center for Sexology Research, Department of Clinical Medicine; Aalborg University; Aalborg Denmark
| | | | - Bibi Hølge-Hazelton
- Research Support Unit; Zealand University Hospital; Roskilde Denmark
- Department of Regional Health Research; University of Southern Denmark; Odense Denmark
| | - Kirsten A. Boisen
- Center of Adolescent Medicine; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
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23
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King SDW, Fitchett G, Murphy PE, Rajaee G, Pargament KI, Loggers ET, Harrison DA, Johnson RH. Religious/Spiritual Struggle in Young Adult Hematopoietic Cell Transplant Survivors. J Adolesc Young Adult Oncol 2017; 7:210-216. [PMID: 29099640 DOI: 10.1089/jayao.2017.0069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This study describes the prevalence of religious and/or spiritual (R/S) struggle in long-term young adult (YA) survivors following hematopoietic cell transplantation (HCT) as well as existential concerns (EC), social support, and demographic, medical, and emotional correlates of R/S struggle. METHODS Data were collected as part of an annual survey of survivors of HCT aged 18-39 years at survey completion; age at HCT was 1-39 years. Study measures included measures of R/S struggle (defined as any non-zero response on the negative religious coping subscale from Brief RCOPE), quality of life (QOL), and depression. Factors associated with R/S struggle were identified using multivariable logistic regression models. RESULTS Fifty-two of the 172 respondents (30%), who ranged from less than a year to 33 years after HCT, had some R/S struggle. In bivariate analysis, depression was associated with R/S struggle. In a multivariable logistic regression model, individuals with greater EC were nearly five times more likely to report R/S struggle. R/S struggle was not associated with age at transplant, time since transplant, gender, race, R/S self-identification, or medical variables. CONCLUSION R/S struggle is common among YA HCT survivors, even many years after HCT. There is a strong correlation between EC and R/S struggle. Given the prevalence of R/S struggle and its associations with EC, survivors should be screened and referred to professionals with expertise in EC and R/S struggle as appropriate. Further study is needed to determine longitudinal trajectory, impact of struggle intensity, causal relationships, and effects of R/S struggle on health, mood, and QOL for YA HCT survivors.
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Affiliation(s)
- Stephen D W King
- 1 Chaplaincy, Child Life, & Clinical Patient Navigators, Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance , Seattle, Washington
| | - George Fitchett
- 2 Department of Religion, Health, and Human Values, Rush University Medical Center , Chicago, Illinois
| | - Patricia E Murphy
- 2 Department of Religion, Health, and Human Values, Rush University Medical Center , Chicago, Illinois
| | - Geila Rajaee
- 3 University of Michigan School of Public Health, Department of Health Behavior and Health Education, University of Michigan , Ann Arbor, Michigan
| | - Kenneth I Pargament
- 4 Department of Psychology, Bowling Green State University , Bowling Green, Ohio
| | - Elizabeth Trice Loggers
- 5 Division of Clinical Research, Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance , Seattle, Washington
| | - David A Harrison
- 6 Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle, Washington
| | - Rebecca H Johnson
- 7 Division of Pediatric Oncology, Department of Pediatrics, Mary Bridge Hospital/MultiCare Health System , Tacoma, Washington
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