The parental involvement process regarding childhood cancer survivors becoming independent: Focus on balancing health management and social lives from adolescence to adulthood.

AIM: This study aimed to elucidate the parental involvement process regarding childhood cancer survivors' (CCSs') independence while balancing their health management and social lives from adolescence to adulthood to obtain suggestions for long-term support for CCSs and their parents. METHODS: Semi-structured interviews were conducted with 19 parents of Japanese CCSs aged 16-25 years. The data were then qualitatively analyzed using the modified grounded theory approach. RESULTS: Three "categories" and 20 "concepts" were generated. The connections among these categories and concepts revealed the parental involvement process regarding CCSs' independence while balancing their health management and social lives. The first phase in this process is to "support careful behaviors," mainly during CCSs' treatment in the outpatient clinic or shortly after discharge. As CCSs recover after cancer treatment, parents "watch over, but feel conflicted," with "conflicts between protecting their sons/daughters and giving them independence." Then, parents reach a phase in which they "acknowledge and entrust," which includes "acknowledgment of development and efforts" of their sons/daughters, and develop an "attitude to entrust medical checkups to their sons/daughters, along with their preparation." The influencing factors of the three phases include "ongoing anxieties about the late effects of therapy and recurrence" and an "expectation for their sons/daughters to acquire abilities for living independently." CONCLUSIONS: These findings suggest that nurses need to accept parents' feelings and thoughts regarding conflicts with CCSs, recognition of CCSs' development, and values. These processes may help nurses and health-care professionals support parents from a comprehensive perspective.

The process of becoming independent while balancing health management and social life in adolescent and young adult childhood cancer survivors.

AIM: This study aimed to elucidate the process of how adolescent and young adult childhood cancer survivors (CCSs) become independent while balancing health management and social life with a view to providing long-term support. METHODS: Semi-structured interviews were conducted with 22 Japanese CCSs aged 16-25 years. The data were then qualitatively analysed using the modified grounded theory approach. RESULTS: Seven "categories" and 35 "concepts" were generated. The connections among these categories and concepts revealed the process of becoming independent while balancing health management and social life. The first phase in the process is "coordination within constraints," which includes "consciousness and worries about deteriorating health" and "adjustments to balance schoolwork and treatment." This phase changes into "challenges to being free and normal" and "release from constraints." Psychological development then occurs as "gratitude toward surrounding people" and "sustenance from experiencing a rare illness." However, CCSs also "face worries about the persistent effects of cancer," including "awareness of the necessity to continue hospital visits even into adulthood." Through these experiences, CCSs reach the phase of "finding a way to live with oneself," which integrates health management with social life. CONCLUSIONS: These findings may help parents and health, education, and social-care professionals anticipate and share changes in CCSs physical condition, daily life, and psychosocial development. CCSs need support in terms of coordinating cancer therapy and school life, trying what they want to do, self-managing their own health condition, and forming their identity, including making sense of their illness experience.

Cumulative fatigue symptoms among caregivers in Japan.

OBJECTIVE: To investigate the relationship of cumulative fatigue symptoms among caregivers in Japan with work environment issues and lifestyle behaviors. METHODS: The subjects were 376 women (mean age, 54 years) attending professional seminars for caregivers held between 1999 and 2002. After obtaining informed consent, a survey was conducted to ascertain work environment issues, lifestyle behaviors and fatigue levels. Fatigue was quantitatively assessed using the Cumulative Fatigue Symptoms Index (CFSI) developed by Kosugoh et al. Factors related to caregiver fatigue were identified using Pearson's correlation coefficient, the Mann-Whitney U-test and multiple regression analysis. RESULTS: Caregivers who felt an xiety or concern regarding care techniques, care content, personal relationships, work conditions, and physical fitness showed higher CFSI scores, while caregivers who exercised regularly and had proper eating behavior displayed lower CFSI scores. Anxiety/concern regarding physical fitness and proper eating behaviors were identified as significant predictors for all CFSI category scores (P<0.001). Regular exercise behavior (P<0.001), age (P<0.001), and years of work experience (P<0.001) also represented significant independent variables for some CFSI categories. CONCLUSION: Our results suggest that upgrading the knowledge and skills of care and nursing and modifying lifestyle behaviors could reduce the level of fatigue experienced by caregivers.