Date of Award

2023

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

Committee Chair

Patricia A. Carter

Committee Member

Louise C. O'Keefe

Committee Member

Shameka L. Cody

Committee Member

Monica Beck

Committee Member

Valerie Crabtree

Subject(s)

Cancer in children, Sleep disorders in children--Treatment

Abstract

Pediatric and adolescent young adult (AYA) cancer survivors disproportionately experience sleep disorders compared to healthy peers. This dissertation examines the facilitators and barriers that influence advanced practice providers' (APPs) ability to evaluate and refer pediatric/AYA hematology oncology cancer survivors to sleep specialists. The first manuscript provides an integrative review of APPs' behaviors in screening for sleep disorders in pediatric/AYA cancer survivors using the Social Cognitive Theory as a guide. The second manuscript defines the concept of sleep disorders in pediatric cancer survivors using the Walker and Avant method. The third manuscript provides a qualitative analysis from interviews with hematology/oncology (heme/onc) APPs from around the United States that care for pediatric/AYA cancer survivors. Manuscript one reviewed studies from 2010-2022. The main themes from the review included APPs’: (a) personal factors, (b) environmental factors, and (c) behavioral factors that influence the providers' abilities to screen and refer patients to sleep specialists. Manuscript two defines the concept of sleep disorders in pediatric cancer survivors by identifying the concept's attributes, cases, antecedents, consequences, and measurements of the concept. Manuscript three evaluates the qualitative data by exploring the personal behaviors that influence the APPs' perceived abilities to screen and refer patients to sleep specialists using the Social Cognitive Theory as a framework for data analysis. The participants reported understanding that sleep disorders are present in their patient population and that they impact outcomes and quality of life. The APPs reported that they lacked the knowledge of whom to refer to for sleep disorders and the skills to assess and evaluate. The APPs identified gaps in knowledge and skills and reported wanting to know how to optimize the care they give their patients by learning more. Pediatric/AYA cancer survivors deserve the right to have proper evaluations and referrals for sleep disorders to optimize overall outcomes throughout the cancer continuum. Future studies are needed to support interventions for APPs to be able to optimize the care of these patients. Understanding the personal factors that impact APPs' ability to evaluate and refer pediatric/AYA cancer survivors is the first step in understanding the behaviors of referrals and evaluations and improving outcomes for this patient population.

Comments

Submitted ... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the joint Nursing Science Ph.D. Program ...

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Available for download on Friday, July 11, 2025

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