Introduction: Studies centered on understanding quality of life (QoL) among Native American cancer survivors are underrepresented in the literature. This knowledge gap presents a risk of underestimating and failing to adequately address the true burden of cancer in this population. Purpose: The purpose of this study was to gain a person-centered, comprehensive understanding of factors that influence QoL among Native American cancer survivors and how they manifest in survivors daily lives. Methods: We used a convergent mixed methods design to analyze data from 831 QoL surveys and 52 interviews with geographically and clinically diverse samples of Native cancer survivors. We employed latent class analysis (LCA) to identify “classes” of survivors with similar response patterns across physical, mental/emotional, social, and spiritual QoL domains (quantitative) and thematic analysis to identify themes of advice survivors’ had for other Native survivors and how that advice reflected survivors’ experiences and QoL after diagnosis (qualitative). Findings from the quantitative and qualitative studies were integrated to identify “meta-themes” of factors that influence QoL after cancer and how those factors operate in the context of survivors’ daily lives. Results: LCA identified four classes of survivors with unique QoL profiles: Positive QoL (42%); Well, overwhelmed (30%); Mildly burdened (17%); and Poor QoL (12%). We identified four meta-themes from our integrated analysis: 1) Culture: Value systems and spirituality are benchmarks for evaluating the cancer experience; 2) Years since diagnosis: Treatment and non-treatment related mechanisms influence healing over time; 3) Geographical context impacts access to medical and cultural resources for healing; and 4) Perceived control over cancer: Gaining control through self-advocacy and support. Discussion: Ignoring heterogeneity and contextual influences on QoL underestimates and misspecifies needs of many Native survivors. Conclusion: Interventions to support Native cancer survivors must support the whole person on their path to establishing harmony and balance after cancer.
University of Minnesota Ph.D. dissertation. May 2019. Major: Epidemiology. Advisors: Eileen Harwood, DeAnn Lazovich. 1 computer file (PDF); viii, 133 pages.
Quality of life among Native American cancer survivors: Approaching harmony and balance after cancer.
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