Composing Sexuality in the Midst of Adolescent Cancer.

A cancer diagnosis heralds the onset of significant life changes. The various experiences of diagnosis, treatment, and recovery from cancer during adolescence and young adulthood are complex and disruptive. Emphasis on treatment and recovery often overshadows other social and developmental imperatives for adolescents and young adults. Acknowledging, exploring, and crafting one's own sexual identity is a significant milestone achieved during this time, and it is one that is interrupted by the arrival and treatment of cancer. There is value in understanding how adolescents and young adults compose sexuality amid cancer experiences, and how this composition contributes to their ongoing stream of life experiences after recovery. As part of a larger study of sexuality and adolescent cancer, we undertook a narrative inquiry with Anna and Mark, two young adults who experienced cancer during adolescence. Over 14 months, we met with Anna and Mark, drawing on different narrative inquiry approaches to explore their past and ongoing experiences and to build negotiated stories of those experiences. We explored resonant threads between the stories, which help show the depth and complexity of sexuality as it is experienced in the midst of and after cancer. Two resonant threads are discussed: inward and outward looking, and sexuality and survival. The inquiry reveals the richness of self-composition amid competing stories of cancer treatment, disruptions to family and socialization, survivorship, what it means to be a young man or woman in the world, and the sense of a developing sexual self.

Digital Storytelling as a Psychosocial Tool for Adult Cancer Survivors.

PURPOSE: To understand the meaning and impact for adult patients with cancer (past or present) of creating a digital story related to their cancer experience. PARTICIPANTS & SETTING: 10 participants made digital stories with the help of a research assistant trained in digital storytelling. This research took place in a large, urban center in Calgary, Alberta, Canada. METHODOLOGIC APPROACH: This research was done in the tradition of philosophical hermeneutics. Ten one-on-one interviews were conducted, and data were analyzed using an interpretive qualitative methodology. FINDINGS: Findings revealed that digital stories were cathartic; reconnected individuals with family, friends, and parts of their lives that had been interrupted from cancer therapy; helped participants reflect in a way that was often described as therapeutic; and bridged communication with others about their cancer experiences. IMPLICATIONS FOR NURSING: Digital stories can be used to highlight the immense psychosocial impact of cancer and point healthcare professionals and other researchers toward creative and nontraditional ways to address this issue.

"Family Is Who They Say They Are"a: Examining the Effects of Cancer on the Romantic Partners of Adolescents and Young Adults.

In this article, we discuss a study we conducted to examine the effects of cancer on romantic partners (i.e., boyfriends and girlfriends, social/romantic/intimate partners) of adolescents and young adults experiencing, or who have experienced, cancer. In this hermeneutic study, we interviewed partners who were involved with an adolescent/young adult with cancer, a cancer survivor who was in a relationship during his treatment, and two healthcare professionals who have worked with these couples and witnessed many other situations of impact, effect, and repercussion. Out of this study, we suggest that partners are affected in many ways that can vary from estrangement, to termination of the relationship, to premature decisions about remaining in the relationship, to family disregard of the partner, and to disregard of the family due to influence of, or relationship with, the partner. We discuss these findings within the context of the larger picture of the psychosocial relational impact of cancer on members beyond those in the immediate and biological family.

"A Tribe Apart": Sexuality and Cancer in Adolescence.

This qualitative study employed hermeneutic phenomenology and narrative inquiry to examine the topic of sexuality and adolescents with cancer from the perspectives of survivors who had experienced cancer as adolescents. This investigation examined the potentially sensitive, disquieting, and often taboo issue of sexuality in the interest of optimizing wellness in young people, and, ultimately, in the health of adults. Understanding the adolescent body as a sensitive, sexual, and developing self can enrich our understanding of adolescent cancer and promote best health care and practices, examining ways that we might mitigate the long-term effects of arrested or delayed development of sexual identity. In this article, we discuss phase 1 of the study, which used hermeneutics as the method of inquiry. Findings included a general experience of adolescents having a sense of "losing themselves" while at the same time finding themselves in a new light. Other findings include the connection between sexuality, self, and identity; the unique "tribe" of adolescents with cancer; the necessity for sexuality to take a backseat to cancer; the changing mirror images from self and others; sexuality and fertility; and, ultimately, that sexuality is a relational experience.

Stories That Heal: Understanding the Effects of Creating Digital Stories With Pediatric and Adolescent/Young Adult Oncology Patients.

The purpose of this philosophical hermeneutic study was to determine if, and understand how, digital stories might be effective therapeutic tools to use with children and adolescents/young adults (AYA) with cancer, thus helping mitigate suffering. Sixteen participants made digital stories with the help of a research assistant trained in digital storytelling and were interviewed following the completion of their stories. Findings from this research revealed that digital stories were a way to have others understand their experiences of cancer, allowed for further healing from their sometimes traumatic experiences, had unexpected therapeutic effects, and were a way to reconcile past experiences with current life. Digital stories, we conclude, show great promise with the pediatric and AYA oncology community and we believe are a way in which the psychosocial effects of cancer treatment may be addressed. Recommendations for incorporating digital stories into clinical practice and follow-up programs are offered.

"Stories Take Your Role Away From You": Understanding the Impact on Health Care Professionals of Viewing Digital Stories of Pediatric and Adolescent/Young Adult Oncology Patients.

The purpose of this philosophical hermeneutic study was to understand the effects on health care providers (HCPs) of watching digital stories made by (past and present) pediatric and adolescent/young adult (AYA) oncology patients. Twelve HCPs participated in a focus group where they watched digital stories made by pediatric/AYA oncology patients and participated in a discussion related to the impact the stories had on them personally and professionally. Findings from this research revealed that HCPs found digital stories to be powerful, therapeutic, and educational tools. Health care providers described uses for digital stories ranging from education of newly diagnosed families to training of new staff. Digital stories, we conclude, can be an efficient and effective way through which to understand the patient experience, implications from which can range from more efficient patient care delivery to decision making. Recommendations for incorporating digital storytelling into healthcare delivery are offered.

Examining the Effects of Childhood Cancer on the Parental Subsystem: Implications for Parents and Health Care Professionals-Part 3.

This article is the third part of a hermeneutic research study examining the impact of childhood cancer experiences on the parental relationship. In Part 1, we offered an exploration of the phenomenon with background literature; a description of the research question, method, and design; and finally a discussion of relationships that survived, thrived, or demised, with an emphasis on the notions of difference and trading. In Part 2, we furthered the interpretations to look at the complexities of issues such as teams, roles, focus, protection, intimacy, grieving, putting relationships on hold, and reclaiming them. In this article, we discuss the advice that the participants offered us and how that advice might have implications for other parents in similar situations and health care professionals working with families experiencing childhood cancer.

Taking One for the Team: Examining the Effects of Childhood Cancer on the Parental Subsystem-Part 2.

In this Part 2 of a three-part research paper, we further our interpretations from our hermeneutic study examining how having a child who has experienced cancer had an impact on the relationship between the parents. In Part 1, we identified the focus of the study and provided background to the topic. We also described the research question, method, and design before offering an interpretive analysis of couples whose relationships survived, thrived, or demised. In this article, we extend the interpretations under an overarching theme of "taking one for the team." Here, we discuss issues of changes in focus and roles, and the notions of tag teaming, protection, intimacy, and grieving. We examine the phenomenon of putting relationships on hold, then finding reclamation later. In Part 3, we offer implications of these findings for other parents in similar situations and for health care professionals working with these families.

Differences and Trading: Examining the Effects of Childhood Cancer on the Parental Subsystem-Part 1.

This article is the first of a three-part report of a research study that used hermeneutic inquiry to examine the effects of childhood cancer on the relationship between the parents of the child. In Part 1, we identity the topic of investigation and the relevant literature; describe the research question, method, and design; and begin our interpretations of the data with a focus on the couples who remained together and those who experienced relationship demise. In this analysis, we discovered that issues of difference and trading played a strong role in how the couples fared in their relationships. In Part 2 of this series, we focus on further interpretations, and in Part 3, we discuss the implications of the study for other parents and for health care professionals.

Point-of-Care Testing in Bathhouses: A Narrative Inquiry into the Experience of Receiving a Positive Preliminary HIV Test Result.

With a call to increase the accessibility of HIV testing, point-of-care testing for HIV is being readily adopted, but little attention has been paid to the experiences of people being tested at HIV point-of-care sites. Some testing environments, such as bathhouses, promote testing for HIV in higher-risk groups. In this narrative inquiry study we explored the experiences of people testing positive for HIV through point-of-care while at a bathhouse. Three narrative threads for reconsidering the practice were identified: (a) seeing complexities, understanding testing decisions in relation to time, place, and social context; (b) recognizing the impact and significance of secret and silent stories; and (c) tentative and tension-filled connections to care. It is important to understand testing experiences across time, place, and in diverse social contexts. These experiences are embedded within the larger life histories of people and raise questions about adequate support, follow-up, and counseling.