Part I: An introduction to conducting qualitative research in children with cancer

Psychosocial difficulties in adolescent and young adult survivors of childhood cancer

BACKGROUND

With a large number of children surviving cancer worldwide, numerous investigations have assessed psychological and social adjustment among childhood cancer survivors. According to these studies, it is unclear whether childhood cancer survivors successfully adjust to daily life after being discharged from hospital, especially for adolescent and young adult survivors who have unique needs and concerns. The primary aim of this study was to identify the factors underlying psychosocial difficulties faced by adolescent and young adult survivors in their day-to-day lives after being discharged from hospital.

METHODS

Semi-structured interviews were conducted. Twenty-five childhood cancer survivors were recruited from two regional cancer institutions in Japan. Content analysis was applied to the responses.

RESULTS

Nineteen attributes were extracted and classified into four categories as follows: physical difficulties, interpersonal difficulties, behavioral difficulties, and uncertainty about the future. The attributes indicated by >50% of the participants were "I am worried about not feeling well," "I have difficulty continuing treatment in daily life," "I have difficulty moving my body," "I have to be absent from school or work because of illness," and "I am left behind academically."

CONCLUSIONS

This study identified important factors of psychosocial day-to-day difficulties. Clinically, these results suggest that it is important to watch for these signs and to provide early support to survivors so that their daily life and development are not hindered by the treatment and its side-effects, and to offer long-term support focusing on individual patient characteristics such as sex, age, and cancer history.

Embodied suffering: experiences of fear in adolescent girls with cancer

Previously, fear in adolescents with cancer has been sparsely described from an emic perspective. The aim of this study was to illuminate fear in adolescents with personal experience of cancer. The participants were six adolescent girls between the age of 14 and 16 years who were no longer under active treatment for cancer but still went for regular check-ups. Open interviews were conducted. Data were analysed according to the phenomenological hermeneutic method. In the result one main theme was identified: 'an embodied fear--a threat to the personal self'. This theme was built up by three separate but intertwined themes: ;experiencing fear related to the physical body', 'experiencing existential fear' and 'experiencing fear related to the social self'. In the comprehensive understanding the fear was interpreted from youth cultural aspects as well as a holistic perspective. The importance of professionals taking the whole person and their situation into account when meeting the fear is underlined.

A review of qualitative research on the childhood cancer experience from the perspective of siblings: a need to give them a voice

Researchers are increasingly adopting the qualitative research paradigm to study the world of siblings of children with cancer. The purpose of this review article is to identify the contributions of qualitative research in advancing the understanding of the childhood cancer experience from the perspective of siblings. Articles were selected for inclusion if (1) written in English; (2) published in a peer-reviewed journal between 1979 and present or, if a doctoral dissertation, easily accessible to the authors; (4) cited a specific qualitative research design or some type of qualitative research method of data collection and analysis; and (4) involved siblings of children with cancer as sole research participants or as research participants within the context of the family. Twenty-seven qualitative research studies were reviewed. Three themes emerged from an analysis of the primary findings: (1) changing lives, (2) intense feelings, and (3) unmet needs. Limitations in the conceptualization, research design, and research methods of the qualitative studies are discussed. Suggestions that will help researchers in conducting qualitative research with siblings are also presented.

Cancer symptom transition periods of children and families

BACKGROUND

Children with cancer are reported to experience many symptoms during the cancer trajectory. However, minimal qualitative research has been conducted that explores children's and families' experiences of symptoms. An understanding of the symptom trajectory, grounded in children's and families' experiences, is essential to providing comprehensive and sensitive care to children with cancer and their families.

AIM

This paper reports a study designed to explore and describe the symptom course in childhood cancer as experienced by children and their families.

DESIGN

Guided by the philosophy of interpretive interactionism, a longitudinal qualitative study was undertaken. A purposive sample of 39 families of children with cancer who resided in Western Canada participated. The children ranged in age from 4.5 to 18 years and varied in their cancer diagnoses.

METHODS

Multiple data collection methods included formal and informal interviewing and participant observation. Data were analysed by the constant comparative method. Development of illness narratives added to an understanding of children's and families' experiences.

FINDINGS

A substantive theory entitled 'Children's and Families' Lived Experience of Childhood Cancer Symptoms' emerged from the findings. This depicts the experience of cancer in relation to children's changing symptom trajectory. A core category of the theory, 'passage through the transition periods', shows how changing symptom experiences affected children's and families' ways of being in the world. These were reflected in six transition periods: (1) it is just the flu; (2) it is more than the flu; (3) it hits home; (4) it is nasty; (5) it is not so bad, it is pretty good; and (6) it is 'dragsville'. The changing roles and responsibilities of family members, and how the family existed in the cancer world, varied depending on the transition period through which they were passing.

CONCLUSIONS

Transition periods not only reinforce the dynamic nature of the experience of childhood cancer but, more importantly, show how symptoms can greatly affect the quality of children's and families' day-to-day living. Interpreting cancer in the context of the symptom trajectory provides nurses with a new perspective for understanding childhood cancer, and will assist in the development of symptom relief strategies that will help to contain symptoms and improve overall quality of life for children and families.

Adopting the qualitative paradigm to understanding children's perspectives of illness: barrier or facilitator?

Reliance on the traditional quantitative paradigm has been the norm for exploring the phenomenon of children's illness experiences. Although it provides valuable information on the psychosocial sequelae of children in response to illness, an account of children's perspectives of the illness experience is missing. Accordingly, researchers since the early 1980s have been advocating the need to adopt the qualitative paradigm in the study of children's illness experiences. Nonetheless, even though there is a call for more qualitative research, the majority of research being conducted today still supports the quantitative paradigm. This report examines why researchers may be reluctant to adopt the qualitative paradigm. Specifically, the author proposes that this reluctance may stem from researchers' perceiving children as being less competent and social than adults, which would explain the need to research children solely from an objective, impersonal stance. Primary philosophical principles of the qualitative paradigm may be seen as barriers to accessing children's thoughts. The author suggests, however, that when children are viewed from an alternative perspective, the major principles of the qualitative paradigm may actually serve as facilitators to apprehending their thoughts and feelings. The following key principles of the qualitative research paradigm are examined: (a) realities are constructed by human beings who are viewed as active agents making sense out of the realities they encounter; (b) realities are multiple and must be perceived holistically and from various vantage points; and (c) realities are shared and mutually shaped by the researcher and research participants. Key strategies that promote successful use of the qualitative paradigm in the study of children's illness experiences are also discussed.