Advertisement

Human Flourishing in Adolescents with Cancer: Experiences of Pediatric Oncology Health Care Professionals

Published:January 03, 2021DOI:https://doi.org/10.1016/j.pedn.2020.12.012

      Highlights

      • Adolescents with cancer require age-appropriate and comprehensive support.
      • Human flourishing means complete well-being.
      • Human flourishing can guide holistic care tailored to adolescents with cancer.
      • Nurses are well-positioned to promote human flourishing in this population.

      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.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      References

        • National League for Nursing
        Program Outcomes: Human Flourishing. National League for Nursing.
        (Retrieved June 18 from)
        • Teenage Cancer Trust
        Young People's Stories.
        (Retrieved Jan 23 from)
        • Alex'’s Lemonade Stand Foundation
        Childhood Cancer heroes. Retrieved Jan 23 from.
        • Arpawong T.E.
        • Oland A.
        • Milam J.E.
        • Ruccione K.
        • Meeske K.A.
        Post-traumatic growth among an ethnically diverse sample of adolescent and young adult cancer survivors.
        Psycho-oncology. 2013; 22 (2210p): 2235-2244
        • Baassiri M.J.
        • Mulrooney D.A.
        At the heart of adolescent and young adult cancer survivorship.
        Journal of Clinical Oncology. 2016; 34: 1570-1572
        • Burgess-Allen J.
        • Owen-Smith V.
        Using mind mapping techniques for rapid qualitative data analysis in public participation processes.
        Health Expectations. 2010; 13: 406-415https://doi.org/10.1111/j.1369-7625.2010.00594.x
        • Carver C.S.
        Resilience and thriving: Issues, models, and linkages.
        Journal of Social Issues. 1998; 54: 245-266
        • Christiansen H.L.
        • Bingen K.
        • Hoag J.A.
        • Karst J.S.
        • Velazquez-Martin B.
        • Barakat L.P.
        Providing children and adolescents opportunities for social interaction as a standard of Care in Pediatric Oncology.
        Pediatric Blood & Cancer. 2015; 62: S724-S749https://doi.org/10.1002/pbc.25774
        • Dell’Oro R.
        Introduction.
        in: Dell’Oro R. Taylor C. Health and human flourishing: Religion, medicine, and moral anthropology (pp. 1–12). Georgetown University Press, 2006
        • Diener E.
        • Wirtz D.
        • Tov W.
        • Kim-Prieto C.
        • Choi, D.-w., Oishi, S., & Biswas-Diener, R.
        New well-being measures: Short scales to assess flourishing and positive and negative feelings.
        Social Indicators Research. 2010; 97: 143-156https://doi.org/10.1007/s11205-009-9493-y
        • Docherty S.L.
        • Kayle M.
        • Maslow G.R.
        • Santacroce S.J.
        The adolescent and young adult with Cancer: A developmental life course perspective [article].
        Seminars in Oncology Nursing. 2015; 31: 186-196https://doi.org/10.1016/j.soncn.2015.05.006
        • Ferrari A.
        • Barr R.D.
        International evolution in AYA oncology: Current status and future expectations.
        Pediatric Blood & Cancer. 2017; 64https://doi.org/10.1002/pbc.26528
        • Fredrickson B.L.
        • Losada M.F.
        Positive affect and the complex dynamics of human flourishing.
        The American Psychologist. 2005; 60: 678-686https://doi.org/10.1037/0003-066x.60.7.678
        • Graneheim U.H.
        • Lundman B.
        Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness.
        Nurse Education Today. 2004; 24: 105-112https://doi.org/10.1016/j.nedt.2003.10.001
        • Gupta A.A.
        • Papadakos J.K.
        • Jones J.M.
        • Amin L.
        • Chang E.K.
        • Korenblum C.
        • Giuliani M.E.
        Reimagining care for adolescent and young adult cancer programs: Moving with the times.
        Cancer. 2016; 122: 1038-1046https://doi.org/10.1002/cncr.29834
        • Haase J.E.
        • Kintner E.K.
        • Monahan P.O.
        • Robb S.L.
        The resilience in illness model, part 1: Exploratory evaluation in adolescents and young adults with cancer.
        Cancer Nursing. 2014; 37: E1-E12
        • Hilton C.L.
        • Ratcliff K.
        • Collins D.M.
        • Flanagan J.
        • Hong I.
        Flourishing in children with autism spectrum disorders.
        Autism research : official journal of the International Society for Autism Research. 2019; 12: 952
        • Hsieh H.F.
        • Shannon S.E.
        Three approaches to qualitative content analysis.
        Qualitative Health Research. 2005; 15: 1277-1288https://doi.org/10.1177/1049732305276687
        • Husson O.
        • Zebrack B.J.
        Psychometric evaluation of an adolescent and young adult module of the impact of Cancer instrument.
        Journal of Adolescent and Young Adult Oncology. 2017; 6: 159-170https://doi.org/10.1089/jayao.2016.0038
        • Iles V.
        Dying is the Most grown-up thing we ever do: But do health care professionals prevent us from taking it seriously?.
        Health Care Analysis. 2016; 24: 105-118https://doi.org/10.1007/s10728-016-0317-3
        • Ishibashi A.
        • Okamura J.
        • Ueda R.
        • Sunami S.
        • Kobayashi R.
        • Ogawa J.
        Psychosocial strength enhancing resilience in adolescents and young adults with Cancer.
        Journal of Pediatric Oncology Nursing. 2015; 33: 45-54
        • Jones L.
        The healing relationship: Understanding the different methods of therapeutic communication is vital for nurses.
        Nursing Standard. 2009; 24: 64
        • Jootun D.
        • McGhee G.
        • Marland G.R.
        Reflexivity: Promoting rigour in qualitative research.
        Nursing Standard. 2009; 23: 42-46
        • Kelly D.
        Developing age appropriate psychosexual support for adolescent cancer survivors: A discussion paper.
        The Journal of Sexual Medicine. 2013; 10: 133-138https://doi.org/10.1111/jsm.12048
        • Keyes C.L.M.
        The mental health continuum: From languishing to flourishing in life.
        Journal of Health and Social Behavior. 2002; 43: 207-222https://doi.org/10.2307/3090197
        • Marshall S.
        • Grinyer A.
        • Limmer M.
        Dual Liminality: A framework for conceptualizing the experience of adolescents and young adults with Cancer.
        Journal of Adolescent and Young Adult Oncology. 2019; 8: 26-31https://doi.org/10.1089/jayao.2018.0030
        • Masten A.S.
        • Wright M.O.
        Resilience over the lifespan: Developmental perspectives on resistance, recovery, and transformation.
        in: Reich J.W. Handbook of adult resilience (pp. 213–237). Guilford Publications, 2009
        • Mertens A.C.
        • Gilleland Marchak J.
        Mental health status of adolescent cancer survivors.
        Clinical Oncology in Adolescents and Young Adults. 2015; https://doi.org/10.2147/coaya.S49174
        • Michel G.
        • Francois C.
        • Harju E.
        • Dehler S.
        • Roser K.
        The long-term impact of cancer: Evaluating psychological distress in adolescent and young adult cancer survivors in Switzerland.
        Psychooncology. 2019; 28: 577-585https://doi.org/10.1002/pon.4981
        • Miller K.D.
        • Fidler-Benaoudia M.
        • Keegan T.H.
        • Hipp H.S.
        • Jemal A.
        • Siegel R.L.
        Cancer statistics for adolescents and young adults, 2020.
        CA: a Cancer Journal for Clinicians. 2020; https://doi.org/10.3322/caac.21637
        • Morton M.
        We can work it out: The importance of rupture and repair processes in infancy and adult life for flourishing.
        Health Care Analysis. 2016; 24: 119-132https://doi.org/10.1007/s10728-016-0319-1
        • Nabors L.
        • Odar-Stough C.
        • Peugh J.
        • Merianos A.L.
        • Cunningham J.
        • Yockey R.A.
        Adolescent flourishing in relation to having asthma: Results from a population-based cross-sectional study.
        The Journal of Asthma. 2018; 55: 132-136https://doi.org/10.1080/02770903.2017.1316390
        • North R.
        • Holahan C.
        • Carlson C.
        • Pahl S.
        From failure to flourishing: The roles of acceptance and goal reengagement.
        Journal of adult development. 2014; 21 (212p): 239-250
        • Orkibi H.
        • Hamama L.
        • Gavriel-Fried B.
        • Ronen T.
        Pathways to Adolescents’ flourishing: Linking self-control skills and positivity ratio through social support.
        Youth & Society. 2015; 50: 3-25https://doi.org/10.1177/0044118x15581171
        • Panjwani A.A.
        • Marin-Chollom A.M.
        • Pervil I.Z.
        • Erblich J.
        • Rubin L.R.
        • Schuster M.W.
        • Revenson T.A.
        Illness uncertainties tied to developmental tasks among young adult survivors of hematologic cancers.
        Journal of Adolescent and Young Adult Oncology. 2019; 8: 149-156https://doi.org/10.1089/jayao.2018.0024
        • Park C.L.
        • Chmielewski J.
        • Blank T.O.
        Post-traumatic growth: Finding positive meaning in cancer survivorship moderates the impact of intrusive thoughts on adjustment in younger adults.
        Psycho-oncology. 2010; 19 (1139p): 1139-1147
        • Parry C.
        • Chesler M.A.
        Thematic evidence of psychosocial thriving in childhood cancer survivors.
        Qualitative Health Research. 2005; 15: 1055-1073
        • Patterson P.
        • McDonald F.E.
        • Zebrack B.
        • Medlow S.
        Emerging issues among adolescent and young adult cancer survivors.
        Seminars in Oncology Nursing. 2015; 31: 53-59https://doi.org/10.1016/j.soncn.2014.11.006
        • Phillips F.
        • Jones B.L.
        Understanding the lived experience of Latino adolescent and young adult survivors of childhood cancer.
        Journal of Cancer Survivorship. 2014; 8: 39-48https://doi.org/10.1007/s11764-013-0310-x
        • Polit D.F.
        • Beck C.T.
        Sampling in qualitative research.
        in: Polit D.F. Beck C.T. Nursing research: Generating and assessing evidence for nursing practice (9th ed., pp. 515–531). Lippincott Williams & Wilkins, 2012
        • Rasmussen D.B.
        Human flourishing and the appeal to human nature.
        Social Philosophy and Policy. 1999; 16: 1-43https://doi.org/10.1017/S0265052500002235
        • Rotegård A.K.
        • Ruland C.M.
        • Solveig M.S.
        Nurse perceptions and experiences of patient health assets in oncology care: A qualitative study.
        Research and Theory for Nursing Practice. 2011; 25: 284-301https://doi.org/10.1891/1541-6577.25.4.284
        • Ryff C.D.
        • Keyes C.L.M.
        The structure of psychological well-being revisited.
        Journal of Personality and Social Psychology. 1995; 69: 719-727
        • Sameroff A.
        The transaction model.
        in: Sameroff A. The transactional model of development: How children and contexts shape each other (pp. 3–21). American Psychological Association, 2009
        • Sandelowski M.
        Whatever happened to qualitative description?.
        Research in Nursing & Health. 2000; 23: 334-340https://doi.org/10.1002/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G
        • Schilstra C.
        Riding the Cancer coaster.
        CreateSpace Independent Publishing Platform, 2015
        • Scrignaro M.
        • Nichelli F.
        • Cattaneo L.
        • Spinelli M.
        • Magrin M.E.
        • Fraschini D.
        • Jankovic M.
        From adjustment to thriving: Exploring well-being in young adult survivors of childhood Cancer and their siblings.
        Journal of Adolescent and Young Adult Oncology. 2016; 5: 330-336https://doi.org/10.1089/jayao.2016.0005
        • Seligman M.E.P.
        Flourish : A visionary new understanding of happiness and well-being.
        Atria Books, 2011
        • Sharp K.M.H.
        • Willard V.W.
        • Okado Y.
        • Tillery R.
        • Barnes S.
        • Long A.
        • Phipps S.
        Profiles of connectedness: Processes of resilience and growth in children with Cancer.
        Journal of Pediatric Psychology. 2015; 40: 904-913
        • Steinberg D.M.
        • Santiago R.A.
        • Tanenbaum M.L.
        • Cline G.D.
        • Schneider N.M.
        “It Made Me the Person I Am Today...”: Survivors of Childhood, Adolescent, and Young Adult Cancer Reflect on Their Experiences.
        Journal of Adolescent and Young Adult Oncology. 2019; https://doi.org/10.1089/jayao.2019.0122
        • Teall T.
        • Barrera M.
        • Barr R.
        • Silva M.
        • Greenberg M.
        Psychological resilience in adolescent and young adult survivors of lower extremity bone tumors.
        Pediatric Blood & Cancer. 2013; 60 (1228p): 1223-1230
        • Turner-Sack A.M.
        • Menna R.
        • Setchell S.R.
        • Maan C.
        • Cataudella D.
        Posttraumatic growth, coping strategies, and psychological distress in adolescent survivors of cancer.
        Journal of Pediatric Oncology Nursing. 2012; 29: 70-79https://doi.org/10.1177/1043454212439472
        • VanderWeele T.J.
        On the promotion of human flourishing.
        Proceedings of the National Academy of Sciences of the United States of America. 2017; 114: 8148-8156https://doi.org/10.1073/pnas.1702996114
        • VanderWeele T.J.
        • McNeely E.
        • Koh H.K.
        Reimagining health-flourishing.
        JAMA. 2019; 321: 1667-1668https://doi.org/10.1001/jama.2019.3035
        • Whiting M.
        • Sines D.
        Mind maps: Establishing “trustworthiness” in qualitative research.
        Nurse Researcher. 2012; 20: 21-27https://doi.org/10.7748/nr2012.09.20.1.21.c9304
        • Wicks L.
        • Mitchell A.
        The adolescent cancer experience: Loss of control and benefit finding.
        European Journal of Cancer Care. 2010; 19: 778-785
        • Woodgate R.L.
        • West C.H.
        • Tailor K.
        Existential anxiety and growth: An exploration of computerized drawings and perspectives of children and adolescents with cancer.
        Cancer Nursing. 2014; 37: 146-159https://doi.org/10.1097/NCC.0b013e31829ded29
        • Zamora E.R.
        • Yi J.
        • Akter J.
        • Kim J.
        • Warner E.L.
        • Kirchhoff A.C.
        “Having cancer was awful but also something good came out”: Post-traumatic growth among adult survivors of pediatric and adolescent cancer.
        European Journal of Oncology Nursing. 2017; 28: 21-27https://doi.org/10.1016/j.ejon.2017.02.001