Kudos to Eunji Cho and her advisor Sharron Docherty for the submission of her Sigma Theta Tau International application entitled: “Flourishing in a Young Adult Survivor of Adolescent Cancer: A Single Case Study.” This proposal requests funding for a one-year period with a start date of June 1, 2018.

Advanced medical technology and care have dramatically increased the survival rates of adolescent cancer so that more than 80% of adolescents now survive their cancer treatment and live to young adulthood (National Cancer Institute, 2016). However, cancer diagnosis and its related experiences can have a life-challenging impact that follows these AYAs throughout life. Many studies are suggesting well-documented physical/psychosocial challenges and distress experienced by adolescents undergoing cancer treatment or by survivors after completing the treatment (Abrams, Hazen & Penson, 2007; Mattsson, Ringner, Ljungman & von Essen, 2007). On the other hand, there is a unique cohort of AYA cancer survivors describes a trajectory of extreme positive growth. They have abilities to move beyond the period of distress and suffering to emerge a high quality of life and capacity to find meaning from these experiences (Ishibashi et al., 2015; Parry & Chesler, 2005). The process of enduring through adversity to experience growth can be referred to a concept of human flourishing which has been suggested by positive psychologists as an ultimate goal of human life (Fosha, 2009; Seligman, 2011).

Human flourishing, a concept introduced into health care in the past decade, moves beyond the positive affect, life satisfaction, and happiness, to the development of qualities such as autonomy, sense of mastery, personal growth, positive relations with others, self-acceptance, and a purpose in life (Diener et al., 2010; Fosha, 2009; Fredrickson & Losada, 2005; Keyes, 2002; Ryff, 1989; Seligman, 2011). Recent scholars such as VanderWeele (2017) in positive psychology have identified at least five broad domains of human flourishing: 1) happiness and life satisfaction; 2) health (mental and physical); 3) meaning and purpose; 4) character and virtue; and 5) close social relationships. This concept has potential to capture the unique experience and life course trajectories of AYAs with cancer who have shown positive changes. However, human flourishing has rarely been applied to AYAs with cancer although this population has enough capacity to develop their own strategies to become flourishing and has the potential to use these strategies during their ongoing future lives. Also, existing descriptions of flourishing following a life-threatening illness are generally limited to isolating components such as positive emotions, life satisfaction, sense of autonomy, optimism, social relationships, or meaning of life. While these components are essential to understanding the state of flourishing, they do little to expose the process through which individuals have transitioned towards this state. Finally, many studies in healthcare are using this term as a synonym of subjective well-being which does not cover the full extent of flourishing. In order to move the science of the functioning of human flourishing in AYAs with cancer with a history of cancer treatment forward, a deeper understanding of nature, breadth, depth, structure, and mechanisms of the concept in this population is needed. A single case study with multiple data collection methods will be conducted to investigate the experience of one exemplary case of flourishing AYAs who have diagnosed with adolescent cancer.

The purposes of this single case study are to 1) explore the unique attributes and process of becoming flourishing in AYAs with cancer, 2) test the conceptual framework developed from a concept analysis, and 3) check the feasibility of study design and data collection methods for the larger, multiple case study in future. The study will include several data collection methods such as timeline drawing, autobiographical writing, interview with several individuals who have witnessed the positive changes of an AYA cancer survivor during one's cancer-related experiences, and a self-reported measurement. Study findings will be used to 1) modify the conceptual framework based on the results, 2) provide evidence for case selection of the next, larger dissertation study, and 3) reshape the study design as well as data collection methods if necessary.