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Twivy E, Griffiths H, Knight MTD. Evaluating end of treatment care of young people with cancer. Clin Child Psychol Psychiatry 2024; 29:661-673. [PMID: 37773596 PMCID: PMC10945980 DOI: 10.1177/13591045231204073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
BACKGROUND Existing literature implies there may be gaps in post-treatment support for young people with cancer. This service evaluation explored the needs and experiences of young people when ending cancer treatment in a UK children's hospital to inform service provisions. METHODS Semi-structured interviews were conducted with nine young people, aged 13-18 years, who had finished active cancer treatment and were receiving follow-up care. The data was analysed using thematic analysis. RESULTS Four main themes were developed: being in the dark (i.e. limited awareness of what happens when treatment ends); separation from the hospital (i.e. the loss of valued support from staff); consequences of cancer (i.e. managing ongoing psychological and physical effects); and getting back to normal life (i.e. shifting from hospital to everyday life). CONCLUSIONS Recommendations for improving clinical practice were made. Greater preparedness for ending treatment could be achieved by clearly setting out ongoing care arrangements, providing resource packs, having opportunities to mark the end of treatment, and offering peer support. To identify specific post-treatment needs, there should be an end of treatment multidisciplinary review and space for young people to share how they are feeling in follow-up medical appointments.
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Affiliation(s)
- Eve Twivy
- Oxford Institute of Clinical Psychology Training and Research, Oxford Health NHS Foundation Trust, University of Oxford, UK
| | - Helen Griffiths
- Oxford Children’s Hospital, Oxford University Hospitals NHS Foundation Trust, UK
| | - Matthew TD Knight
- Oxford Institute of Clinical Psychology Training and Research, Oxford Health NHS Foundation Trust, University of Oxford, UK
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Bristowe K, Timmins L, Pitman A, Braybrook D, Marshall S, Johnson K, King M, Roach A, Yi D, Almack K, Day E, Clift P, Rose R, Harding R. Between loss and restoration: The role of liminality in advancing theories of grief and bereavement. Soc Sci Med 2024; 344:116616. [PMID: 38310729 DOI: 10.1016/j.socscimed.2024.116616] [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: 09/30/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 02/06/2024]
Abstract
A recent national survey of bereaved partners found high levels of complicated grief and psychological distress, with evidence that loneliness and isolation may contribute to these outcomes. However, the mechanisms of action for this have not been explored. To advance grief theory this paper reports analysis of the survey free-text data to examine the relationship between social support and emotional responses to bereavement. Individuals bereaved of a civil partner or spouse 6-10 months previously were identified through death registration data. 569/1945 (29 %) completed surveys were received. Of those, 311 participants (55 %) provided responses to two free-text questions which asked about their 'feelings since the death of their partner or spouse', and 'about the support around' them. Data were analysed using corpus-assisted discourse analysis and the discourse dynamics approach for figurative language. Participants described diverse emotional responses to the bereavement (e.g. sadness, anger, denial, acceptance), and the value of formal and informal bereavement support. Although many of the experiences described are accounted for in existing grief theory, some participants described a liminal experience not recognised within these theories. They felt trapped, unable to engage with loss or restoration, and unable to move forward as their planned future no longer existed. They sought out 'communitas' (solidarity in experiences), but often found support from their social networks had diminished. Metaphors were used to describe this liminality, with partner grief expressed as a dark agentic force, a monster, an abyss, and as water. The findings of this study offer original insights into experiences and trajectories of bereavement, and our understandings of prolonged or complicated grief. A novel model 'Between Loss and Restoration' is presented to include these experiences. Recognition of the place for liminality within the spectrum of grief experiences could enhance grief literacy and improve formal and informal bereavement support provision.
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Affiliation(s)
- Katherine Bristowe
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK.
| | - Liadh Timmins
- Department of Psychology, Swansea University, Singleton Park, Sketty, Swansea, SA2 8PP, Wales, UK.
| | - Alexandra Pitman
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK; Camden and Islington NHS Foundation Trust, St. Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK.
| | - Debbie Braybrook
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK.
| | - Steve Marshall
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK; King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
| | - Katherine Johnson
- Social and Global Studies Centre, Royal Melbourne Institute of Technology, 124 La Trobe Street, Melbourne, Victoria, 3000, Australia.
| | - Michael King
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Anna Roach
- Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Deokhee Yi
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK.
| | - Kathryn Almack
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK.
| | | | - Paul Clift
- Patient and Public Involvement Representative, UK.
| | - Ruth Rose
- Patient and Public Involvement Representative, UK.
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK.
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Cho E, Akard TF. Perspectives From Adolescent and Young Adult Cancer Survivors for a Planned Nurse-Patient Dyadic Storytelling Intervention. J Holist Nurs 2024; 42:49-63. [PMID: 37475533 DOI: 10.1177/08980101231189392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Purpose: This qualitative study aimed to explore the perspectives of adolescents and young adults (AYA) on a planned nurse-patient dyadic storytelling intervention. Background: Cancer is a highly distressful event for AYA. AYA with cancer experience multidimensional suffering while dealing with their developmental transition from adolescence to young adulthood. Their unique needs require appropriate, well-tailored psychosocial support. Nurses can provide such support through storytelling approaches. METHOD AYA cancer survivors participated in cross-sectional qualitative interviews to provide feedback on the nurse-patient storytelling intervention model. ANALYSIS Qualitative content analysis was used to interpret and categorize the data. FINDINGS Barriers and facilitators of the intervention emerged. Themes related to barriers included (a) the disadvantages of an online program, (b) the limitations of the in-person program, (c) interacting with nurses, (d) sharing personal stories with others, and (e) the timing of the program. Themes regarding facilitators included (a) benefits to AYA with cancer, (b) benefits to nurses, (c) benefits of online/in-person programs, and (d) willingness to participate. Conclusions: AYA with cancer may benefit from the nurse-patient dyadic storytelling intervention. Developing innovative methods to optimize and customize interventions based on preferences is essential. Future research should involve nurse feedback and tailored approaches for AYA with cancer.
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Affiliation(s)
- Eunji Cho
- Connell School of Nursing, Boston College, Boston, MA, USA
| | - Terrah Foster Akard
- School of Nursing, Vanderbilt University, Nashville, TN, USA
- School of Medicine, Vanderbilt University, Nashville, TN, USA
- Graduate School, Vanderbilt University, Nashville, TN, USA
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Phan J, Laurence V, Marec-Berard P, Cordero C, Riberon C, Flahault C. The Place of Sick Peers in Adolescents and Young Adults with Cancer: Advantage, Disadvantage, and What Makes Barriers to the Encounter. J Adolesc Young Adult Oncol 2023; 12:879-889. [PMID: 36999900 DOI: 10.1089/jayao.2022.0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Purpose: The appreciation of peer support can vary from one country to another due to the cultural and relational differences. This study explores what perceptions French adolescents and young adults (AYAs) in post-treatment for cancer have of the place of sick peers during their treatment and what can make barriers to meet them. Methods: A semistructured interview has been proposed 6 months after the end of cancer treatments. A thematic analysis has been conducted to highlight the major themes and subthemes identified through the participants' discourses. Results: Twelve AYAs (mean age 23 y.o., standard deviation = 2.8; min = 19; max = 26) from two French cancer centers were interviewed. Five major themes were identified, but only two were presented in this article: the place of peers and the impact of coronavirus disease 2019 (COVID-19) epidemic on AYA facilities. AYA peers with cancer major theme demonstrated that meeting sick peers has benefits (e.g., identification, understanding, support, feeling of normalcy) but also has disadvantages (e.g., negative emotional influence). The benefits of peer-to-peer meetings seem to outweigh the disadvantages. Nevertheless, AYAs can face social barriers to this kind of relationship (e.g., fatigue, need to focus on oneself, confrontation to cancer and negative events, feeling of unnatural meeting). Finally, patients' encounters and the normal functioning of AYA facilities have been hampered by the COVID-19 pandemic. Conclusion: Even if AYA services systematically suggest a meeting with other sick peers, it is important to reiterate this proposal since the needs can evolve over time. It can also be interesting to propose places of life outside the hospital to make the encounters more comfortable and natural for AYAs. Clinical Trial Registration number: NCT03964116.
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Affiliation(s)
- Jeff Phan
- Psychopathology and Health Processes Laboratory, Paris Cité University, Boulogne Billancourt, France
- Adolescents and Young Adults Unit, Curie Institute, Paris, France
| | - Valérie Laurence
- Psychopathology and Health Processes Laboratory, Paris Cité University, Boulogne Billancourt, France
- Adolescents and Young Adults Unit, Medical Oncology and SIREDO (Care, Innovation and Research for Children, Adolescents, and Young Adults with Cancer) Departments, Curie Institute, Paris, France
| | - Perrine Marec-Berard
- Pediatrics and Adolescents and Young Adults Oncology Department, Institute of Hematology and Pediatric Oncology, Lyon, France
| | - Camille Cordero
- Adolescents and Young Adults Unit, Medical Oncology and SIREDO (Care, Innovation and Research for Children, Adolescents, and Young Adults with Cancer) Departments, Curie Institute, Paris, France
| | - Christèle Riberon
- Pediatrics and Adolescents and Young Adults Oncology Department, Institute of Hematology and Pediatric Oncology, Lyon, France
| | - Cécile Flahault
- Psychopathology and Health Processes Laboratory, Paris Cité University, Boulogne Billancourt, France
- Psycho-Oncology Unit, Gustave Roussy Hospital, Villejuif, France
- Functional Unit of Psychology and Liaison Psychiatry and Emergency, Adult and Elderly Psychiatry Service, George Pompidou European Hospital, Paris, France
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Liminality and insecurity: A qualitative study of young adults’ vulnerabilities during the first 12 months of the COVID-19 pandemic in Australia. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 3:100260. [PMID: 37013150 PMCID: PMC10050194 DOI: 10.1016/j.ssmqr.2023.100260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 02/19/2023] [Accepted: 03/23/2023] [Indexed: 03/31/2023]
Abstract
COVID-19 has disrupted the normative social order, particularly for young adults. Their deteriorating mental health over 2020 has been associated with the economic and social conditions during the COVID-19 lockdowns. We conducted 19 semi-structured interviews with young adults aged 8 and 29 most of whom lived in Victoria, Australia. The interviews explored participants' experiences and responses to COVID-19, covering areas such disrupted everyday practices and future plans, impacts on their physical and mental health, and interactions community and services. Young adults were concerned about loss of social connectedness, their mental health and the complex interplay of issues such as employment, income, education and housing. They developed routines to protect their physical and mental health while in lockdown and some made the most of opportunities. However, the pandemic may have had a profound effect by disrupting some young adults’ plans for the future, thus contributing to a sense of ontological insecurity.
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Phan J, Vander Haegen M, Karsenti L, Laurence V, Marec-Berard P, Cordero C, Thisse A, Riberon C, Flahault C. Psychological Adjustment, Adaptation, and Perception of Social Support in French Adolescents and Young Adults After the Diagnosis of Cancer. J Adolesc Young Adult Oncol 2022. [PMID: 36067271 DOI: 10.1089/jayao.2022.0034] [Citation(s) in RCA: 1] [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
Purpose: The third Cancer Plan (2014-2019) has helped with the recognition of adolescents and young adults (AYAs) with cancer's medical and psychosocial specificities and has enabled the creation of dedicated structures in France. Methods: The study involved 43 AYA patients (Nmen = 21; Nwomen = 22) between 15 and 27 years old (Mage = 19.9), diagnosed with all types of cancer, and were recruited in two French cancer centers. Online questionnaires were filled in 2 months after the beginning of treatment. AYAs completed measures of depressive and anxiety symptoms, perceived social support, and coping strategies. Results: Results demonstrated moderate depressive symptoms (M = 10.7, standard deviation [SD] = 7.0) and suggested a good satisfaction (M = 30, SD = 9.5) and a mild availability (M = 27, SD = 10.3) of the social support. Spearman's correlations demonstrated that coping strategies are related to depressive symptoms, for which acceptance (p < 0.01) of the disease played a key role in their psychological adjustment. Perceived social support subscales were positively correlated with the use of distraction as a coping strategy (p < 0.05). Kruskal-Wallis test demonstrated the preferential use of instrumental (p < 0.05) and emotional support (p < 0.01), denial (p < 0.01), and self-blame (p < 0.01) for women and the use of acceptance (p < 0.05) and humor (p < 0.05) for men; and there were no significant differences between patients hospitalized in the two cancer center facilities. Conclusion: Finally, a better understanding of the psychological adjustment and processes among French AYAs with cancer will help families and processionals to better adjust AYA-specific needs at the beginning of cancer treatment. ClinicalTrials.gov.: NCT03964116.
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Affiliation(s)
- Jeff Phan
- Psychopathology and Health Processes Laboratory, UR 4057, Paris Cité University, Boulogne Billancourt, France.,Adolescents and Young Adults Unit, Curie Institute, Paris, France
| | - Marie Vander Haegen
- Psychopathology and Health Processes Laboratory, UR 4057, Paris Cité University, Boulogne Billancourt, France.,Unit of Research: Health and Society Interfaculty, Liège University, Liège, Belgium.,Haute École Léonard de Vinci, Brussels, Belgium
| | - Lucille Karsenti
- Psychopathology and Health Processes Laboratory, UR 4057, Paris Cité University, Boulogne Billancourt, France.,Adolescents and Young Adults Unit, Curie Institute, Paris, France.,Psycho-Oncology Unit, Gustave Roussy Hospital, Villejuif, France
| | - Valérie Laurence
- Psychopathology and Health Processes Laboratory, UR 4057, Paris Cité University, Boulogne Billancourt, France.,Adolescents and Young Adults Unit, Medical Oncology and SIREDO (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer) Departments, Curie Institute, Paris, France
| | - Perrine Marec-Berard
- Pediatrics and Adolescents and Young Adults Oncology Department, Institute of Hematology and Pediatric Oncology, Lyon, France
| | - Camille Cordero
- Adolescents and Young Adults Unit, Medical Oncology and SIREDO (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer) Departments, Curie Institute, Paris, France
| | - Audrey Thisse
- Pediatrics and Adolescents and Young Adults Oncology Department, Institute of Hematology and Pediatric Oncology, Lyon, France
| | - Christèle Riberon
- Pediatrics and Adolescents and Young Adults Oncology Department, Institute of Hematology and Pediatric Oncology, Lyon, France
| | - Cécile Flahault
- Psychopathology and Health Processes Laboratory, UR 4057, Paris Cité University, Boulogne Billancourt, France.,Psycho-Oncology Unit, Gustave Roussy Hospital, Villejuif, France.,Functional Unit of Psychology and Liaison Psychiatry and Emergency, Adult and Elderly Psychiatry Service, George Pompidou European Hospital, Paris, France
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Cho E, Baker-Ward LE, Smith SK, Barfield RC, Docherty SL. Human Flourishing in Adolescents with Cancer: Experiences of Pediatric Oncology Health Care Professionals. J Pediatr Nurs 2021; 59:10-18. [PMID: 33406441 DOI: 10.1016/j.pedn.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE This study explores human flourishing (HF) in adolescents with cancer (AC) as witnessed by their health care providers, and it develops a list of critical attributes associated with HF to describe the positive outcomes witnessed. DESIGN AND METHODS Our study used a qualitative descriptive design incorporating data from an open-ended electronic survey and semi-structured individual interviews with 17 pediatric oncology health care providers. RESULTS We found 3 major themes (positive forward motion, connectedness, and self-character) representing 11 critical attributes of human flourishing in AC: (1) initiative and enterprise, (2) positivity and evocativeness, (3) tranquility and maturity, (4) perseverance and tenacity, (5) compassion and empathy, (6) social engagement and connection, (7) wisdom and translation into life, (8) supportive background, (9) self-awareness and self-agency, (10) transcendence and full potential, and (11) meaning-making. CONCLUSIONS Understanding the concept of HF as it applies to the needs of AC is a step toward establishing it as a comprehensive health care goal and toward developing care provider guidelines for its promotion. PRACTICE IMPLICATIONS Given the attributes of HF in AC, nurses can consider HF as an ultimate nursing care outcome and should focus on goals of care beyond disease treatment and symptoms mitigation when providing care for this population. Holistic, individualized assessment, timely care during each phase of treatment, and developmentally tailored intervention should be provided.
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Affiliation(s)
- Eunji Cho
- Duke University School of Nursing, Durham, NC, United States of America.
| | - Lynne E Baker-Ward
- Department of Psychology, North Carolina State University, Raleigh, NC, United States of America
| | - Sophia K Smith
- Duke University School of Nursing, Durham, NC, United States of America
| | - Raymond C Barfield
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States of America; Duke University Divinity School, Durham, NC, United States of America
| | - Sharron L Docherty
- Duke University School of Nursing, Durham, NC, United States of America; Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States of America
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Contingent hope theory: The developmental exploration of hope and identity reconciliation among young adults with advanced cancers. Palliat Support Care 2020; 19:437-446. [PMID: 32729458 PMCID: PMC7856215 DOI: 10.1017/s1478951520000656] [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: 11/06/2022]
Abstract
OBJECTIVE The diagnosis of an advanced cancer in young adulthood can bring one's life to an abrupt halt, calling attention to the present moment and creating anguish about an uncertain future. There is seldom time or physical stamina to focus on forward-thinking, social roles, relationships, or dreams. As a result, young adults (YAs) with advanced cancer frequently encounter existential distress, despair, and question the purpose of their life. We sought to investigate the meaning and function of hope throughout YAs' disease trajectory; to discern the psychosocial processes YAs employ to engage hope; and to develop a substantive theory of hope of YAs diagnosed with advanced cancer. METHOD Thirteen YAs (ages 23-38) diagnosed with a stage III or IV cancer were recruited throughout the eastern and southeastern United States. Participants completed one semi-structured interview in-person, by phone, or Skype, that incorporated an original timeline instrument assessing fluctuations in hope and an online socio-demographic survey. Glaser's grounded theory methodology informed constant comparative methods of data collection, analysis, and interpretation. RESULTS Findings from this study informed the development of the novel contingent hope theoretical framework, which describes the pattern of psychosocial behaviors YAs with advanced cancer employ to reconcile identities and strive for a life of meaning. The ability to cultivate the necessary agency and pathways to reconcile identities became contingent on the YAs' participation in each of the psychosocial processes of the contingent hope theoretical framework: navigating uncertainty, feeling broken, disorienting grief, finding bearings, and identity reconciliation. SIGNIFICANCE OF RESULTS Study findings portray the influential role of hope in motivating YAs with advanced cancer through disorienting grief toward an integrated sense of self that marries cherished aspects of multiple identities. The contingent hope theoretical framework details psychosocial behaviors to inform assessments and interventions fostering hope and identity reconciliation.
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Dauphin S, Van Wolputte S, Jansen L, De Burghgraeve T, Buntinx F, van den Akker M. Using Liminality and Subjunctivity to Better Understand How Patients With Cancer Experience Uncertainty Throughout Their Illness Trajectory. QUALITATIVE HEALTH RESEARCH 2020; 30:356-365. [PMID: 31617448 DOI: 10.1177/1049732319880542] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Uncertainty is a central theme in the illness experiences of older cancer patients throughout their illness trajectory. Mishel's popular theory on uncertainty during illness approaches uncertainty as an outcome and is characterized by the patient's inability to find meaning in illness events. This study used the concepts of liminality and subjunctivity to explore uncertainty throughout the illness trajectory of cancer patients. We interviewed 18 older (age range = 57-92 years) patients with breast cancer or gastro-intestinal cancer 3 to 4 years post diagnosis. Our analysis is based on the QUAGOL guide that draws on elements of grounded theory such as constant comparison. We found that liminality and subjunctivity provide a useful frame for understanding uncertainty with a specific focus on its productive potential and meaning making. Health care professionals should be open to acquiring a complete picture of patients' diverse and dynamic experiences of uncertainty in the different stages of their illness trajectory.
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Affiliation(s)
| | | | | | | | - Frank Buntinx
- KU Leuven, Leuven, Belgium
- Maastricht University, Maastricht, The Netherlands
| | - Marjan van den Akker
- KU Leuven, Leuven, Belgium
- Maastricht University, Maastricht, The Netherlands
- Johann Wolfgang Goethe University, Frankfurt am Main, Germany
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