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Walsh CA, Currin-McCulloch J, Faris NR, Nguyen TST, Al Achkar M. "Living with Loss": A qualitative exploration of existential fears among people with advanced lung cancer in online lung cancer support groups. Palliat Support Care 2024:1-6. [PMID: 38420708 DOI: 10.1017/s147895152400004x] [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: 03/02/2024]
Abstract
OBJECTIVES With targeted therapies, people are surviving longer with advanced lung cancer and engaging in online lung cancer support communities. While these groups provide a sense of community, witnessing the death of peers can lead to emotional distress. This qualitative study aims to (1) explore the experience of witnessing death in online cancer support groups; (2) identify factors that contribute to the emotional struggles of witnessing the death of peers; and (3) identify strategies/options for dealing with losses in the cancer community. METHODS We conducted a cross-sectional analysis of qualitative interviews exploring existential concerns with participants (n = 25) from oncogene-specific online lung cancer support groups. The principal investigator conducted study interviews between August 2018 and March 2019 where participants were asked about their cancer experiences and existential concerns. We used thematic analysis and NVIVO 11 software to examine and store the de-identified interview data. RESULTS Participants indicated that they had often witnessed their peers die and felt the pain of the loss. Factors that played a part in their struggle with witnessing others' death included the closeness of the relationship with the person, the age of the person who died, seeing oneself in the experience of the other dying, disparities in care, and losing touch in the final stages. Participants used varied coping strategies such as celebrating the life of the individual who died, engaging in advocacy efforts, not focusing on the loss, participating in therapy, and bringing self-preserving thoughts. SIGNIFICANCE OF RESULTS Our study highlights the importance of addressing existential fears in online lung cancer support groups and incorporating conversations about death in spaces that deal with cancer.
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Affiliation(s)
- Casey A Walsh
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Nicholas R Faris
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Thu Suong Thi Nguyen
- School of Education, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, WA, USA
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Bandieri E, Borelli E, Bigi S, Mucciarini C, Gilioli F, Ferrari U, Eliardo S, Luppi M, Potenza L. Positive Psychological Well-Being in Early Palliative Care: A Narrative Review of the Roles of Hope, Gratitude, and Death Acceptance. Curr Oncol 2024; 31:672-684. [PMID: 38392043 PMCID: PMC10888238 DOI: 10.3390/curroncol31020049] [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: 12/19/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
In the advanced cancer setting, low psychological functioning is a common symptom and its deleterious impact on health outcomes is well established. Yet, the beneficial role of positive psychological well-being (PPWB) on several clinical conditions has been demonstrated. Early palliative care (EPC) is a recent value-based model consisting of the early integration of palliative care into standard care for solid tumors and hematologic malignancies. While the late palliative care primary offers short-term interventions, predominantly pharmacological in nature and limited to physical symptom reduction, EPC has the potential to act over a longer term, enabling specific interventions aimed at promoting PPWB. This narrative review examines nine English studies retrieved from MEDLINE/PubMed, published up to October 2023, focusing on EPC and three dimensions of PPWB: hope, gratitude, and death acceptance. These dimensions consistently emerge in our clinical experience within the EPC setting for advanced cancer patients and appear to contribute to its clinical efficacy. The choice of a narrative review reflects the novelty of the topic, the limited existing research, and the need to incorporate a variety of methodological approaches for a comprehensive exploration.
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Affiliation(s)
- Elena Bandieri
- Oncology and Palliative Care Units, Civil Hospital Carpi, Unità Sanitaria Locale (USL), 41012 Carpi, Italy; (E.B.); (C.M.); (F.G.); (U.F.); (S.E.)
| | - Eleonora Borelli
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy; (M.L.); (L.P.)
| | - Sarah Bigi
- Department of Linguistic Sciences and Foreign Literatures, Catholic University of the Sacred Heart, 20123 Milan, Italy;
| | - Claudia Mucciarini
- Oncology and Palliative Care Units, Civil Hospital Carpi, Unità Sanitaria Locale (USL), 41012 Carpi, Italy; (E.B.); (C.M.); (F.G.); (U.F.); (S.E.)
| | - Fabio Gilioli
- Oncology and Palliative Care Units, Civil Hospital Carpi, Unità Sanitaria Locale (USL), 41012 Carpi, Italy; (E.B.); (C.M.); (F.G.); (U.F.); (S.E.)
| | - Umberto Ferrari
- Oncology and Palliative Care Units, Civil Hospital Carpi, Unità Sanitaria Locale (USL), 41012 Carpi, Italy; (E.B.); (C.M.); (F.G.); (U.F.); (S.E.)
| | - Sonia Eliardo
- Oncology and Palliative Care Units, Civil Hospital Carpi, Unità Sanitaria Locale (USL), 41012 Carpi, Italy; (E.B.); (C.M.); (F.G.); (U.F.); (S.E.)
| | - Mario Luppi
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy; (M.L.); (L.P.)
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena, 41124 Modena, Italy
| | - Leonardo Potenza
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy; (M.L.); (L.P.)
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena, 41124 Modena, Italy
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Chen J, Xu W, Cai X, Chen C. Nursing model based on Snyder's hope theory in emergency care of patients with acute myocardial infarction. Am J Transl Res 2023; 15:4770-4778. [PMID: 37560221 PMCID: PMC10408511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/29/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE To investigate the effect of Snyder's hope theory in emergency care for patients with acute myocardial infarction (AMI). METHODS This retrospective study included 200 AMI patients admitted to Rugao People's Hospital from January 2019 to December 2021. The patients were divided into a conventional group (routine care, n=100) and an intervention group (care based on Snyder's Hope theory, n=100) according to differences in nursing approach. Baseline data of the two groups were collected. The psychological state was evaluated using the self-rating anxiety scale (SAS) and self-rating depression scale (SDS). Self-care ability was assessed using the exercise of self-care agency (ESCA) scale. The myocardial enzyme indexes including cardiac troponin T (cTnT) and myocardial creatine kinase isoenzyme (CK-MB), as well as electrocardiogram index (Tp-Te/QT) were compared between the two groups. Complications of the two groups were recorded, and the risk factors for complications in the intervention group were examined. RESULTS After nursing, the SAS and SDS scores in the intervention group were lower than those in the conventional group (P < 0.05). The ESCA scores in all dimensions were higher in the intervention group than those of the conventional group (P < 0.05). The cTnT and CK-MB decreased in both groups, but the decreases in the intervention group were greater than those of the conventional group (P < 0.05). The Tp-Te/QT in the intervention group (0.25±0.04) was lower than that in the conventional group (0.32±0.06, P < 0.05). The incidence of complications in the intervention group was 9.00%, lower than 21.00% in the conventional group (P < 0.05). Multivariate logistic regression analysis showed that cTnT, CK-MB, and Tp-Te/QT were influencing factors for complications in the intervention group (P < 0.05). CONCLUSION The effect of nursing based on Snyder's hope theory in emergency care fof AMI patients is promising because it can improve the psychological state of patients and reduce the incidence of complications.
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Affiliation(s)
| | | | - Xun Cai
- Emergency Department, Rugao People’s HospitalRugao 226500, Jiangsu, China
| | - Chunyan Chen
- Emergency Department, Rugao People’s HospitalRugao 226500, Jiangsu, China
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Abdelaal M, Avery J, Chow R, Saleem N, Fazelzad R, Mosher P, Hannon B, Zimmermann C, Al-Awamer A. Palliative care for adolescents and young adults with advanced illness: A scoping review. Palliat Med 2023; 37:88-107. [PMID: 36352490 PMCID: PMC9841827 DOI: 10.1177/02692163221136160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Age-related complex medical conditions have been commonly reported among adolescents and young adults with advanced life-limiting illness. There is increasing interest in exploring their palliative care needs and end-of-life experiences. AIM This scoping review aimed to explore the available literature about providing palliative and end-of-life care to adolescents and young adults with advanced life-limiting illnesses. DESIGN Scoping review. This review was registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/SPTD7). DATA SOURCES Electronic databases (MEDLINEALL, Embase, Emcare, Cochrane Central Register of Controlled Trial CENTRAL, Scopus, PsycINFO, Cochrane Database of Systematic Reviews), Google Scholar and reference lists were searched up to October 2021. We included studies reporting on adolescents and/or young adults with advanced life-limiting illnesses. There were no limitations concerning location, type of illness or study design. RESULTS We identified 51 studies published between 2002 and 2021. Most studies were published in the United States (n = 34, 67%), and nine studies (18%) reported exclusively on patients with non-malignant illnesses. Two thirds of the identified studies were case reports and retrospective chart reviews (n = 33). Three main topics were identified: Physical symptom burden (n = 26, 51%), Psychological and social needs (n = 33, 65%), and end-of-life care (n = 30, 59%). Twenty-six studies (51%) were focused only on one topic, and the age range used to identify adolescents and young adults varied based on the study location. CONCLUSION The findings of this review shed light on the different palliative care experiences and knowledge gaps related to adolescents and young adults as an underserved and vulnerable patient population. Further research needs to be dedicated toward palliative care programs tailored for adolescents and young adults.
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Affiliation(s)
- Mohamed Abdelaal
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jonathan Avery
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Ronald Chow
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nasreen Saleem
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rouhi Fazelzad
- UHN Library and Information Services, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Pamela Mosher
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Child and Adolescent Psychiatry, Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ahmed Al-Awamer
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Burgers VWG, van den Bent MJ, Dirven L, Lalisang RI, Tromp JM, Compter A, Kouwenhoven M, Bos MEMM, de Langen A, Reuvers MJP, Franssen SA, Frissen SAMM, Harthoorn NCGL, Dickhout A, Noordhoek MJ, van der Graaf WTA, Husson O. "Finding my way in a maze while the clock is ticking": The daily life challenges of adolescents and young adults with an uncertain or poor cancer prognosis. Front Oncol 2022; 12:994934. [PMID: 36457502 PMCID: PMC9706234 DOI: 10.3389/fonc.2022.994934] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/12/2022] [Indexed: 10/03/2023] Open
Abstract
INTRODUCTION Increasingly more adolescent and young adult (AYA, aged 18-39 years) patients with an uncertain and/or poor cancer prognosis (UPCP) are gaining life-years because of novel treatments or refinement of established therapies, and sometimes even face the prospect of long-term disease control. This study aims to examine the challenges of AYAs with a UPCP in daily life to inform the development of AYA care programs. METHODS Semi-structured in-depth interviews were conducted among AYAs with a UPCP. Since we expected differences in experiences between three AYA subgroups, we interviewed patients of these subgroups (1): traditional survivors (2), low-grade glioma survivors, and (3) new survivors. Interviews were analyzed using elements of grounded theory. AYA patients were actively involved as research partners. RESULTS In total 46 AYAs with UPCP participated and shared their challenges in daily life. They were on average 33.4 years old (age range 23-44) and most of them were women (63%). The most common tumor types were low-grade gliomas (16), sarcomas (7), breast cancers (6), and lung cancers (6). We identified five primary themes: (1) feeling inferior to previous self and others (e.g. feeling useless, who wants me in a relationship), (2) feeling of being alone (e.g. lonely thoughts, nobody really gets me), (3) ongoing confrontation (e.g. it is always there, own decline), (4) grief about life (e.g. grief about life I did not get, grief about old life), and (5) loss of control over the future (e.g. not able to make future plans, waiting for growth). Although all of the challenges were identified in the three AYA subgroups, the perceived intensity of the challenges differed slightly between the subgroups. DISCUSSION AYAs living with a UPCP experience challenges associated to their sense of altered identity, their position in the social network, and the future uncertainties. This study highlights the importance to recognize and acknowledge the unique challenges of this group. To provide age-specific care, it is important to embed acceptance and commitment therapy and AYA peer support within the healthcare system and other care programs to support AYAs to live well with their disease.
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Affiliation(s)
- Vivian W. G. Burgers
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | | | - Linda Dirven
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, Netherlands
| | - Roy I. Lalisang
- Division Medical Oncology, Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
- GROW-School of Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jacqueline M. Tromp
- Department of Medical Oncology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Annette Compter
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Mathilde Kouwenhoven
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam University Medical Centers (UMC), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Monique E. M. M. Bos
- Department of Medical Oncology, Erasmus Medical Center (MC) Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Adrianus de Langen
- Department of Thoracic Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Milou J. P. Reuvers
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | | | | | | | - Annemiek Dickhout
- Division Medical Oncology, Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
- GROW-School of Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
- Adolescent and Young Adult (AYA) Research Partner, Amsterdam, Netherlands
| | | | - Winette T. A. van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
- Department of Medical Oncology, Erasmus Medical Center (MC) Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Olga Husson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
- Department of Surgical Oncology, Erasmus Medical Center (MC) Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
- Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom
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Croker A, Fisher K, Hungerford P, Gourlay J, May J, Lees S, Chapman J. Developing a meta-understanding of 'human aspects' of providing palliative care. Palliat Care Soc Pract 2022; 16:26323524221083679. [PMID: 35281714 PMCID: PMC8915236 DOI: 10.1177/26323524221083679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/01/2022] [Indexed: 01/03/2023] Open
Abstract
Objectives: Our intention was to develop a meta-understanding of the ‘human aspects’ of providing palliative care. Integral to developing this meta-understanding was recognising the individuality of people, their varied involvements, situations, understandings, and responses, and the difficulty in stepping back to get a whole view of this while being in the midst of providing palliative care. We intended for this meta-understanding to inform reflections and sense-making conversations related to people’s changing situations and diverse needs. Methods: Using collaborative inquiry, this qualitative research was undertaken ‘with’ clinicians rather than ‘on’ them. Our team (n = 7) was composed of palliative care clinicians and researchers from a co-located rural health service and university. We explored our personal perceptions and experiences through a series of 12 meetings over 8 months. In addition, through five focus groups, we acccessed perceptions and experiences of 13 purposively sampled participants with a range of roles as carers and/or healthcare providers. Data were dialogically and iteratively interpreted. Findings: Our meta-understanding of ‘human aspects’ of providing palliative care, represented diagrammatically in a model, is composed of ATTRIBUTES OF HUMANITY and ACTIONS OF CARING. ATTRIBUTES OF HUMANITY are death’s inevitability, suffering’s variability, compassion’s dynamic nature, and hope’s precariousness. ACTIONS OF CARING include recognising and responding, aligning expectations, valuing relationships, and using resources wisely. The meta-understanding is a framework to keep multiple complex concepts ‘in view’ as they interrelate with each other. Significance of findings: Our meta-understanding, highlighting ‘human aspects’ of providing palliative care, has scope to embrace complexity, uncertainty, and the interrelatedness of people in the midst of resourcing, requiring, and engaging in palliative care. Questions are posed for this purpose. The non-linear diagrammatic representation of ATTRIBUTES OF HUMANITY and ACTIONS OF CARING facilitates multiple ways of engaging and revisiting palliative care situations or navigating changes within and across them.
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Affiliation(s)
- Anne Croker
- Department of Rural Health (UONDRH), The University of Newcastle, 114 - 148 Johnston Street, Tamworth, NSW 2340, Australia
| | - Karin Fisher
- Department of Rural Health (UONDRH), The University of Newcastle, Tamworth, NSW, Australia
| | | | - Jonathan Gourlay
- Hunter New England Local Health District, Tamworth, NSW, Australia
| | - Jennifer May
- Department of Rural Health (UONDRH), The University of Newcastle, Tamworth, NSW, Australia
| | - Shannon Lees
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Zhang A, Ji Q, Zhang K, Cao Q, Chen Y, Chen J, DuVall A. Solution-focused brief therapy for adolescent and young adult cancer patients in China: a pilot randomized controlled trial. J Psychosoc Oncol 2021; 40:816-833. [PMID: 34232115 DOI: 10.1080/07347332.2021.1931627] [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: 01/04/2023]
Abstract
OBJECTIVE This pilot clinical trial investigated solution-focused brief therapy (SFBT) for psychological distress among adolescent and young adult (AYA) patients with cancer in China. METHODS Fifty Chinese AYA patients diagnosed with cancer were randomized into the treatment group (SFBT) and control group (active control). Psychological distress was measured by the brief symptom inventory and hope was measured by the Herth-Hope-Index. Treatment effects were analyzed using analysis-of-covariance and between-group small-sample-size corrected Hedges' g. RESULTS The results indicated that SFBT resulted in a significant reduction in the psychological distress and improvement in hope of AYA patients with cancer. Analyses of the 4-week posttreatment score suggest the short-term sustainability of SFBT for psychological distress among AYAs diagnosed with cancer. CONCLUSIONS AND IMPLICATIONS This study has demonstrated that SFBT's impact is statistically significant and clinically meaningful. The inclusion of positive emotions, i.e., hope, as part of the investigation also highlighted the significance of promoting positive emotions among AYA patients with cancer.
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Affiliation(s)
- Anao Zhang
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Qingying Ji
- Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kan Zhang
- Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qing Cao
- Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuting Chen
- Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jingzhi Chen
- Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Adam DuVall
- Department of Medicine, University of Chicago, Chicago, IL, USA
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