Date of Degree

9-2022

Document Type

Dissertation

Degree Name

Ph.D.

Program

Psychology

Advisor

Jennifer Ford

Committee Members

Regina Miranda

Tracey Revenson

Cheryl Carmichael

Michael Hoyt

Subject Categories

Clinical Psychology | Health Psychology | Psychology

Abstract

For many young adults (YA, aged 18-39) who have recently survived cancer, planning and working towards goals for the future is a fraught process. Prior research consistently identifies the challenges of survivorship, including: rebuilding personal identity, accepting the impact of cancer-related interruptions on personal goals, navigating new roles in significant close relationships, and initiating new relationships as a survivor. However, there is limited research describing the mechanisms underlying these persistent challenges, which poses difficulties when tailoring evidence-based psychological intervention. The present study consolidates both established and newly hypothesized survivorship challenges into a novel conceptual model, hypothesizing that they are interrelated, and mutually reinforcing, to perpetuate social isolation and avoidance of the future in young survivors.

This dissertation study elucidated what YA survivors experience as they envision their lives in the future, with a focus on goals, such as family-building, which may be shared with a close other. We hypothesized that YA may struggle to plan for the future because they experience interfering emotions and thoughts related to their health, often regarding recurrence of cancer or late effects of treatment. Many of these struggles may be difficult to share with a partner. In particular, self-conscious emotions, such as embarrassment, shame, guilt, or pride associated with being a cancer survivor, may explain how relating to others without cancer can be challenging.

This qualitative study utilized a semi-structured interview to prompt YA survivors to imagine significant future events in their close relationships, identifying future-oriented thoughts, beliefs, coping strategies, and emotions as they arose. Participants included 35 YAs treated for cancer within the past five years. Interviews were conducted remotely over a secure video platform and professionally transcribed. Analysis software was used to test deductive codes based on a priori research questions, and inductive codes based on bottom-up consensus coding of transcripts. Quantitative data regarding demographics and mental health were used to augment analyses and interpretation. The process of thematic text analysis was used to identify significant themes and subthemes in the data. Findings indicated good support for the hypothesized conceptual model, including the impact of health anxiety and social isolation on close relationships and psychosocial well-being. In some cases, social isolation was worsened by the impacts of COVID-19.

In addition to deductive findings regarding the interfering nature of cancer-related worry in planning for the future, inductive themes gleaned from analyses included the prominence of grief (e.g. loss of fertility due to treatment, death of peers). Participants overwhelmingly requested tailored and ongoing mental health support in survivorship, and the majority of participants had attended peer support groups. This study provides a strong foundation for broader quantitative study confirming the themes hypothesized by the conceptual model presented here. It also provides a preliminary basis for clinical intervention to improve future planning based on mitigating social isolation and addressing the short- and long-term impacts of decisional avoidance in the context of health anxiety.

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