Trajectories of Identity Development in Adolescents with Cancer

Friday, 26 July 2013: 9:10 AM

Kristin Stegenga, PhD, RN, CNS, CPON
Pediatric Hematology/Oncology, Children's Mercy Hospital, Kansas City, MO
Catherine Fiona Macpherson, PhD, RN, CPON
Seattle Children's Hospital, University of Washington School of Nursing and Seattle Children's Hospital, Seattle, WA

Learning Objective 1: 1. describe the dual trajectories of adolescent and cancer identity development across the first year following cancer diagnosis.

Learning Objective 2: 2. discuss the implications that these dual trajectories have on the care of adolescents to promote optimal health and development

Purpose: For adolescents with cancer (AWC), cancer poses a threat not only to their lives, but also to their quality of life (QOL). This threat to QOL results from co-occurring challenges to successful achievement of normal developmental tasks such as identity development. The purpose of this longitudinal qualitative study was to explore salient aspects of adolescent development as influenced by cancer.

Methods: Fifteen AWC participated in up to 4 quarterly interviews over the first year following cancer diagnosis exploring their developmental and cancer-related experiences with the intent of generating knowledge related to adolescent development in cancer. Inductive content analysis and constant comparative method were utilized to identify salient themes within and across timeframes.

Results: The work of adolescent identity development is both challenged and enhanced by cancer from the time of diagnosis. AWC are constantly negotiating and renegotiating their identity, both internally and also the “face” they allow the world to see. This is both normative and non-normative as they negotiate from the perspectives of their adolescent and their cancer selves. Peer and family relationships, already of importance, must be renegotiated within this context as must key issues of physical appearance and body image, particularly hair loss.

Conclusion: AWC are actively negotiating their present realities as both an adolescent and as a cancer patient while making specific plans for the future. Using longitudinal qualitative methods to understand the progression through the simultaneous tasks of adolescence and cancer provides nurses the opportunity to understand patient trajectories and identify key timepoints for intervention. Findings can guide nurses in optimizing adolescent development through a greater understanding of specific challenges associated with negotiating relationships with peers or how symptoms might affect adherence to medication regimens. Nurses can apply findings to promote the health of AWC around the world as they negotiate this dual dynamic.