The Exploration of Behavioral and Psychological Processes That Influence Hope Among Young Adults with Advanced Cancer

Background and Purpose:

When young adults (YAs) aged 18-39 learn that they have an advanced cancer, their previous ways of living and future ambitions change abruptly.  Life prior to advanced cancer likely included excellent health, hearty social lives, and hopes to attain relationship, education, and career goals. Due to their young age, many YAs have had a shortened timeframe to build coping strategies, support systems, and financial capital.   Thus, placing them at risk for negative outcomes from their illness such as depression, isolation, despair, and desire to surrender.  Research with middle and older aged cancer survivors points to the potential outcomes of these negative states such as desire for hastened death and suicide.  Although cancer ranks as the leading cause of death for YA females and second leading cause of death for YA males, there is a dearth of literature addressing factors that influence coping for this developmentally unique, and logistically challenging population to recruit.  This presentation reviews findings from an original study that explored the behavioral and psychological processes that YAs engaged as they searched for hope while living with a life-limiting cancer.

Methods:

This study incorporated Glaser’s classic grounded theory methods. Theoretical sampling led to the recruitment of 13 YAs (ages 23-38) diagnosed with stage III, IV, or blood cancers.  Participants completed a semi-structured interview and a new instrument, The Hope Timeline, to determine pivotal moments and factors that influenced their capacity to hope throughout their illness.  Interviews were recorded and transcribed verbatim and analyzed using open, selective, and theoretical coding. 

Results:

The resulting theory of contingent hope describes YAs’ tenuous hold on hope as they endeavor to cope with advanced cancer.  Illness threats appear in an unpredictable manner and create a plethora of disruptions to roles and goal attainment. These YAs find themselves in a state of disoriented grief, where virtually all familiar aspects of their lives become unrecognizable. They struggle with unrelenting physical and psychosocial burdens which culminate in feeling broken, socially isolated, and moments of despair.  YAs describe feeling betrayed by their bodies and extended periods of dissociation. The exploration of hope becomes a continuous, emotionally intensive process that appears contingent on each individual’s ability to execute the following: navigating uncertainty; grieving losses, finding bearings, and reclaiming life.  As the YAs become adept at negotiating these processes, they exhibit increased confidence in their physical and mental functioning; thus, prompting perceptions of an integrated self and feelings of hopefulness. When hope remains consistent, YAs begin to believe in the possibility of finding normalcy, connection, and their purpose in society.

Conclusions and Implications:

This study highlights the need for ongoing assessment of YAs with advanced cancer to discover their motivating factors and potential for despair and feeling broken. Further research should investigate individual and group interventions for YAs with advanced cancer that reduce the impacts of disoriented grief, isolation, body betrayal, depression, and internalized stigma.