Forced Enlightenment: A Metasynthesis of Experiences During Childhood Cancer Survivorship

Cancer Nurs. 2020 May/Jun;43(3):E159-E171. doi: 10.1097/NCC.0000000000000775.


Background: Childhood cancer survivorship can be described as a lifelong experience that requires vigilant follow-up care and continual support. Although there is growing qualitative and quantitative literature on this experience, articles focusing on qualitative synthesis are lacking. Qualitative metasynthesis can further facilitate the knowledge of survivorship experiences to inform care.

Objective: The aim of this qualitative metasynthesis was to investigate the experiences of childhood cancer survivors and develop an integrated understanding of the survivorship experience.

Methods: The method of qualitative meta-ethnography guided this research. Data extracted from the studies were directly compared through reciprocal translation.

Results: A total of 18 qualitative articles met the inclusion criteria. The authors identified 4 key metaphors, including Transcendence, Lingering Shadows, Fortifying Bonds, and Ongoing Acclimation. The metaphors are brought together by 3 essential concepts that drive the survivorship experience: (1) recognition of wisdom gained, (2) acknowledgment of vulnerabilities, and (3) actions taken to manage present and future. Together, these metaphors and essential concepts make up the global theme "Forced Enlightenment."

Conclusion: This metasynthesis illuminates the complex nature of the childhood cancer survivorship experience, in which survivors work to grow beyond their treatment experience while inevitably being tied to it. Next steps should include further exploration of individual metaphors and validation of forced enlightenment as an experience.

Implications for practice: Each of the metaphors may be used to guide the development of nursing interventions. Translation to clinical practice should focus on prioritizing coping and adaptation skills during cancer treatment, which can be carried through survivorship.

Publication types

  • Meta-Analysis

MeSH terms

  • Cancer Survivors / psychology*
  • Humans
  • Qualitative Research
  • Survivorship*