Symptom appraisal in uncertainty: a theory-driven thematic analysis with survivors of childhood cancer

Abstract

Objective: Somatic symptoms capture attention, demand interpretation, and promote health behaviors. Symptom appraisal is particularly impactful within uncertain health contexts such as cancer survivorship. Yet, little is known about how individuals make sense of somatic symptoms within uncertain health contexts, nor how this process guides health behaviors.Design: 25 adolescent and young adult survivors of childhood cancer completed semi-structured interviews regarding how they appraise and respond to changing somatic sensations within the uncertain context of survivorship.Main Outcome Measures: Interviews were transcribed verbatim and subjected to a hybrid deductive-inductive thematic analysis, guided by the Cancer Threat Interpretation model. Results:Theme 1 ('symptoms as signals of bodily threat') captured that participants commonly interpret everyday sensations as indicating cancer recurrence or new illness. Theme 2 ('playing detective with bodily signals') captured the cognitive and behavioral strategies that participants described using to determine whether somatic sensations indicated a health threat. These two themes are qualified by the recognition that post-cancer symptoms are wily and influenced by psychological factors such as anxiety (Theme 3: 'living with symptom-related uncertainty').Conclusions: These data highlight the need for novel symptom management approaches that target how somatic sensations are appraised and responded to as signals of bodily threat.

Worry about somatic symptoms as a sign of cancer recurrence: prevalence and associations with fear of recurrence and quality of life in survivors of childhood cancer

“…These risks do not go unnoticed by survivors of childhood cancer (SCCs). Qualitative studies have indicated that SCCs are vigilant for and worry about somatic symptoms such as aches and pains, fatigue, and dyspnea as signs of recurrent cancer, even when those symptoms have a benign cause 3,4 . Pain has been identified as a particularly common source of worry; however a wide variety of somatic symptoms appear to trigger cancer‐related concerns.…”

“Living more and struggling less”: a qualitative descriptive study of patient experiences of physiotherapy informed by Acceptance and Commitment Therapy within a multidisciplinary pain management programme

“…During initial analysis, codes were generated inductively. Following reviewers' feedback, the data were re-analysed using a hybrid inductive-deductive approach [21,28] to deepen the analysis; this was appropriate as treatment was informed by the psychological flexibility model [29]. Codes for "openness", "awareness", and "engagement" --key facets of psychological flexibility [22] --were deductively applied.…”

Do qualitative interviews cause distress in adolescents and young adults asked to discuss fears of cancer recurrence?

“…The two interviewers (PhD and Masters level research psychologists; both female) did not have previous experience of conducting semi‐structured interviews but had received training and supervision in qualitative research methods. Participant inclusion criteria, consent information, and the full semi‐structured interview procedure are described elsewhere 4 . The study protocol was approved by the Stanford Medicine Institutional Review Board (IRB‐44463).…”