Symptom appraisal in uncertainty: A theory-driven thematic analysis with survivors of childhood cancer

Objective: Somatic symptoms capture attention, demand interpretation, and promote health behaviors. Symptom appraisal is particularly impactful within uncertain health contexts such as cancer survivorship. Yet, little is known about how individuals make sense of somatic symptoms within uncertain health contexts, nor how this process guides health behaviors.
Design: 25 adolescent and young adult survivors of childhood cancer completed semi-structured interviews regarding how they appraise and respond to changing somatic sensations within the uncertain context of survivorship.
Main Outcome Measures: Interviews were transcribed verbatim and subjected to a hybrid deductive-inductive thematic analysis, guided by the Cancer Threat Interpretation model.
Results: Theme 1 (‘symptoms as signals of bodily threat’) captured that participants commonly interpret everyday sensations as indicating cancer recurrence or new illness. Theme 2 (‘playing detective with bodily signals’) captured the cognitive and behavioral strategies that participants described using to determine whether somatic sensations indicated a health threat. These two themes are qualified by the recognition that post-cancer symptoms are wily and influenced by psychological factors such as anxiety (Theme 3: ‘living with symptom-related uncertainty’).
Conclusions: These data highlight the need for novel symptom management approaches that target how somatic sensations are appraised and responded to as signals of bodily threat.