Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Anita J. Hunter, PhD, RN, CPNP, Chair; Sally B. Hardin, PhD , RN, FAAN; Cynthia D. Connelly, PhD , RN


Cancer survivors, childhood Cancer, children & youth, nursing, quality of life, resilience, Taiwanese


Survivors of childhood cancer are at risk to develop physiologic-psychosocial complications that affect their quality of life. This study explored how the independent variables of illness-related risk (ILLRK), individual risks (IRK), protective factors (PF) and resilience (RS) affected the dependent variable---quality of life (QOL)--in Taiwanese survivors of childhood cancer. Triangulated research methodology was employed to (1) identify the statistical relationships between the variables and (2) explore qualitatively what these variables meant to the subjects and how their perceptions further explained the statistical results. Haase's (2004) Adolescent Resilience Model was used as the theoretical framework. Ninety-eight Taiwanese adolescent cancer survivors, diagnosed with brain tumors or leukemia before the age of 16 years, surviving at least 5 years after diagnosis, were recruited. From this sample, 12 were selected for the interview segment. Four valid and reliable Likert-scale instruments were used to assess the variables, while a semi-structured interview format was used for the qualitative component. Descriptive statistics, ANOVA, and multiple regressions were used to describe the sample, and analyze the data. Analysis of the interview data looked for recurring themes. Quantitative findings: (1) statistical significance (p < .001) between the QOL in survivors of brain tumor and leukemia; (2) statistically positive relationships (p < .001) between PF, RS, and QOL; (3) statistically negative relationships (p < .001) between ILLRK, IRK and QOL. The significant predictors affecting QOL were ILLRK, IRK, RS and cancer types. Qualitative findings: (1) theme of loss of self explained IRK; (2) chronic fear explained ILLRK; (3) good sense of self explained PF; (4) rebounding even using less than optimal coping strategies explained RS; (5) control of one's life explained QOL. Culture influenced ones sense of self and control. Resilience is critical to achieving optimal quality of life. Protective factors can predict type of resilience and quality of life. Interventions to enhance protective factors are critical. Cancer type also contributes to lower QOL. Different interventions for brain tumors or leukemia survivors must be considered. Cultural beliefs and practices can influence how survivors interpret risks, resilience, and quality of life. These results can support nursing efforts to effect changes in health policy, nursing education, and nursing practice in Taiwan.

Document Type

Dissertation: Open Access



Included in

Nursing Commons