Young adulthood is generally a time when an individual completes a post-secondary education, decides on a career, and enters the workforce. When individuals are diagnosed with cancer during this stage in life, they often take time away from school or work to undergo treatment. The aim of this study was to collect data to get a richer understanding of the experiences of young adult cancer survivors who resumed an occupation of school or work following cancer treatment. Ten young adult cancer survivors were interviewed. An interpretative phenomenological approach allowed for the study of individuals’ lived experiences. An account of participants’ experiences is presented, organized by 4 master themes, “making the decision”, “actively adapting to changed lives”, “receiving support”, and “renewed sense of health and wellness”. These findings may be informative for cancer patients and survivors, as well as stakeholders, as they often have access to limited resources.

Thesis (Ph.D.)--Indiana University, 2009. / Title from screen (viewed on February 2, 2010). School of Nursing, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Joan E. Haase, Marion E. Broome, Janet S. Carpenter, Richard M. Frankel. Includes vitae. Includes bibliographical references (leaves 227-258).

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Indiana University-Purdue University Indianapolis (IUPUI) / Adolescents and young adults with cancer have poorer treatment and survivorship outcomes than either younger or older cancer patients. These individuals also have psychosocial late effects and engage in lifestyle behaviors that increase their risk of subsequent cancer and other chronic illnesses. Thus, there is a need to identify protective factors during the diagnosis and treatment period to foster healthy lifestyle behaviors. Connectedness with healthcare providers is a potential protective factor that may diminish risk-taking behaviors and foster healthcare self-management in adolescents with cancer. However, little is known about connectedness with healthcare providers from adolescents with cancer perspectives. The purpose of this study was to describe young adult cancer survivors' experiences of connectedness with their healthcare providers as they negotiated the experience across the cancer continuum from diagnosis to survivorship during adolescence. A qualitative, empirical phenomenological method guided this research. The sample consisted of 9 young adult cancer survivors who had cancer as adolescents. A broad, data generating question was constructed to elicit rich, narrative descriptions of participants' experiences of connectedness with healthcare providers, which were audio-taped and transcribed. The narrative data were analyzed using Colaizzi's method, which involved a systematic process of extracting and analyzing significant statements for formulated meanings and themes. Seven theme categories were identified and then used to develop a narrative of the essential structure of the experience of connectedness. Connectedness with healthcare providers is a multi-faceted experience that encompasses instances of not only connectedness, but also unconnectedness and disconnectedness. Effective strategies that foster connectedness with adolescents were identified. Behaviors that foster disconnectedness relate to a lack of respect for the adolescent's personhood. Findings indicate that connectedness with healthcare providers may make adolescents more likely to engage in care partnerships and effective self-management during treatment and into survivorship. When there is no connectedness or a disconnection with healthcare providers, a door shuts: there are feelings of helplessness and vulnerability, anger and resentment, and reluctance to connect with healthcare providers for cancer prevention. Clinical implications for healthcare providers are discussed. Future research should focus on connectedness theory development, measures, and interventions that foster adolescent-provider connectedness.

Physical activity (PA) has numerous benefits for cancer survivors, but limited research exists on PA interventions in young adult cancer survivors. Outdoor adventure therapy is a potential method of increasing PA in this demographic. The primary purpose of this non-randomized parallel group study was to determine whether the outdoor adventure camp experience (vs. wait list control) would increase participants’ PA levels immediately following the 7-day camp, as well as three months later. Secondary aims examined correlates of greater PA, including pre-post camp changes in sedentary behavior, exercise self-efficacy, environmental change self-efficacy, perceived barriers to exercise, physical activity enjoyment, and physical activity variety. Sixty-six control and 50 intervention participants were given validated quantitative questionnaires at baseline, 1 week (end of camp) and at the 3-month follow-up. Repeated measures multivariate analysis of variance (RMANOVA) was used to compare group changes over time. Using intent to treat analysis, adjusting for age, gender, age at diagnosis, and baseline minutes of PA per week, there was a significant difference (p=.0001) in minutes of PA per week between groups at both 1 week and 3 months. Bonferroni adjusted post-hoc analysis indicated that, relative to baseline, the intervention group had significantly (p=.0001) greater increases in PA at both 1 week (577 minutes vs. 9 minute increases) and 3 month follow-ups (133 minute increases vs. 75 minute decreases; p=.001) respectively. Significant intervention-related improvements were also observed in TV viewing hours/week (p=.001), hours sitting/week (p=.001), “Excuses” score of the Perceived Barriers to PA questionnaire (p=.04), Enjoyment of Structured Activities (p=.04), and PA Variety (p=.0001) at 1 week but not at the 3 month follow-up. No significant effects were observed for changes in exercise self-efficacy, environmental change self-efficacy, or the other subscales scores. In conclusion, outdoor adventure therapy has the potential to increase PA levels in cancer survivors both immediately following camp, as well as long-term. However, effects tend to wane after camp termination. Future research should explore the relationship between correlates of PA and PA levels in outdoor adventure therapy camp participants and methods to promote sustained PA after camp termination.