“It Becomes a Family I'm a Part of…We Get to Carry Each Other”: Themes from Qualitative Interview of Patients Enrolled in an Inpatient Palliative Care Support Program for Adolescents and Young Adults

Abstract

Background:

The pediatric palliative care literature provides little evidence regarding the lived experiences of adolescents and young adults (AYAs).

Objectives:

We sought to evaluate the aspects of a palliative care peer support program, which were most helpful to patients, and identify areas for improvement to better address their psychosocial needs.

Design:

This was a retrospective, cross-sectional study, which described self-reported Streetlight program evaluation using thematic analysis of interviews with AYAs. A total of 10 interviews was completed.

Setting/Subjects:

Thirty-three current and former Streetlight participants (13–30), enrolled in the Streetlight program for at least six months, were recruited during hospital admissions and clinic visits at UF Health Shands Hospital in the United States. Of the 33, 2 participants died before interviews could be conducted. A total of 10 interviews were conducted.

Results:

Thematic analysis of the 10 individuals identified 5 themes. They were (1) normalization of life in hospital, (2) mental health and instillation of hope, (3) companionship and connection, (4) diversity of volunteers, and (5) gratitude.

Conclusions:

Results suggest that AYAs who participated in a peer support, palliative care program benefitted from their exposure to volunteer social support. Addressing the need for continued study of this population provides opportunities to expand peer support, pediatric palliative care programs to other hospitals and care facilities.

Introduction

Adolescents in palliative care environments report a lack of meaningful relationships and social support.^1–6 Specific interventions are needed to increase social support for Adolescent and Young Adult (AYA) populations who are frequently hospitalized.^1,7 Social support can reduce pain, build relationships, and improve the experiences of AYA patients; however, limited literature exists on specific interventions highlighting the lived experiences of these patients. To address this gap, we interviewed AYA patients with chronic illnesses about their experiences in a novel, palliative care in-patient peer support intervention program.

This study is the second of a two-series article from a mixed-methods study.⁸ Quantitative survey-based results were reported in the first study, and this study represents findings from semistructured qualitative interviews. The analysis of qualitative interview data had two aims: to understand the lived experiences of AYAs enrolled in the program and to identify implications related to providing social support for frequently hospitalized AYAs. This approach extends the literature regarding the patient-perspective of AYA psychosocial interventions by exploring patient reports on programmatic experience and social bonds with volunteers.

Clinical palliative care program

Streetlight at UF Health directly supports AYAs at University of Florida Health and UF Health Shands Children's Hospital.⁹ Patients typically have chronic and life-limiting illnesses such as cancer, sickle cell disease, cystic fibrosis, and autoimmune illnesses. The program focuses on Designated Palliative AYA patients (13–30 years of age) living with chronic or terminal illnesses, or who have been admitted at least three times in recent years. Streetlight aims to build meaningful and consistent relationships, promote resilience and identity development through companionship, and improve quality of life for AYA patients. Additional information on program structure, staffing, activities, and daily patient volume are discussed on the program website⁹ and in recent related publications.^8,10

Methods

Research team

The research team included three PhD-level faculty members, one masters student, seven doctoral students, and two program administrators. Each team member had specific duties related to recruitment, consenting, qualitative data collection, and analyses. Program administrators completed research recruitment according to institutional review board approval. The last author obtained verbal and written consent from all participants. Audio recordings were automatically transcribed and cleaned up through a Health Insurance Portability and Accountability Act (HIPAA) approved online platform. Then four doctoral student authors conducted thematic analyses of data under the last author's supervision. It should be noted that all researchers involved in this study have some connection to the Streetlight program or its staff (e.g., administrators, medical staff, volunteers, former members who became volunteers, and counseling students interested in palliative care). Research team members frequently reflected upon and discussed potential for researcher bias and attempted to bracket their experiences accordingly.

Setting and participants

Purposeful sampling was used to recruit patients admitted to UF Health. Participants were 13 years of age or older, who had been involved in Streetlight for at least six months at the time of recruitment. Semistructured interviews were used to evaluate the impact of the Streetlight program. The quantitative survey study was conducted first. Then invitations were sent for patients who indicated interest in qualitative interviews.

Both former and current (N = 1767) Streetlight patients were eligible to participate. The study team recruited Streetlight patients during hospitalizations or outpatient appointments (N = 208). Ninety-five patients were consented for the qualitative study. Study recruitment started in Spring 2017 and ended in Summer 2020.

Descriptive data on patient demographic characteristics are provided in Table 2, which represents the original sample of 95 patients recruited for the original study. Demographics of the interview participants are not provided to preserve anonymity of participants. Of note, 12 patients died after their enrollment in the study due to progression of disease. We still used completed responses from these patients to report on outcomes among the difficult-to-reach group of AYAs in end of life.

Table 1.

Semistructured Interview Questions

Qualitative semistructured questions
1. What brought you in the hospital?	1a. Can you tell me what that is like?
2. Can you describe in your own words what SL is about?	2a. Can you be more specific? 2b. What do you mean by? 2c. How does this apply to you?
3. What is your involvement with SL?	3a. What has SL been like for you? 3b. What about for your family? Friends? 3c. Have they mentioned anything to you about SL?
4. Is there a memory or memories that stick out for you about SL experiences, conversations, or events?
5. How is SL different from any other support you get?
6. What would being a patient in pediatrics be like if SL did not exist?
7. Is there anything about SL you would change or do differently?	7a. If yes, can you say more?
8. Is there anything else you would like to add that I have not asked about?

SL, streetlight.

Table 2.

Patient Demographic Characteristics

Participant characteristics (N = 95)	Mean (SD) or N (%) Med (range)
Age	21.5 years (4.62)
	Med. 22 years (13–32)
Gender
Female	35 (36.8%)
Male	33 (34.7%)
Other/prefer not to answer	1 (1.1%)
Missing	26 (27.4%)
In hospital during survey	53 (55.8%)
Missing	29 (30.5%)
Diagnosis
Cancer	14 (14.7%)
Cystic fibrosis	19 (20.0%)
Blood disease	8 (8.4%)
Autoimmune disease	7 (7.4%)
Transplant	5 (5.3%)
Other	13 (13.7%)
Missing	29 (30.5%)
Ethnicity
Black/African American	12 (12.6%)
Hispanic/Latino	12 (12.6%)
White/Caucasian	42 (44.2%)
Other	2 (2.1%)
Missing	27 (28.4%)
Education
Attends virtual school	6 (6.3%)
I go to private school	1 (1.1%)
I am homeschooled	4 (4.2%)
I am in college	18 (18.9%)
I am in graduate school	3 (3.2%)
I am in medical school	1 (1.1%)
In law school	0 (0%)
Not involved in any of the above types of schooling	25 (26.3%)

Data collection

Interviews

Post-survey, patients were invited to participate in qualitative interviews about their experiences in Streetlight. The research team co-developed semistructured, open-ended interview questions to capture patients' perceived impact of the program. Institutional approval was obtained for all interview questions (See Table 2). All individual interviews were coordinated, scheduled, and conducted by the 5th, 6th, 8th, and 13th authors. Individual interviews ranged from 30 to 60 minutes with a mean duration of 45 minutes. Graduate student authors created preliminary line-by-line codes of interview transcripts.¹¹ The preliminary codes were compared iteratively (repetitively and recursively) among dyads of student coders and the doctoral supervisor (last author) until agreement was reached on the final codes. The last author provided oversight of the analysis process and confirmation of uncovered themes.

Data analysis

In accordance with Braun and Clarke's¹¹ guidance, reflexive thematic analyses were conducted through the following steps: (a) the analysis team immersed itself within the data; reading, reviewing, and reexamining transcribed interviews, highlighting and discussing uncovered themes among us; (b) we created codes systematically across all the transcripts and connected the raw data based on the initial codes; (c) we combed through all the themes across the entire dataset and organized the codes into emergent themes; (d) we revised themes by carefully checking all extracted themes from each set of extracts (all transcripts and step a) and checked again throughout the entire dataset (step b); (e) we defined and named themes through iterative and recursive analyses and fine-tuning, thus capturing the participants' stories, and creating a thematic record of our analyses; and finally, (f) we drafted the article, outlining the uncovered themes, citing representative quotes from the raw data, and linking our findings to relevant literature.

The coding was initially inductive and subsequent iterative analyses were deductive. Themes were reorganized and renamed as analysis progressed. The research team determined thematic saturation¹² was reached after analyzing interview 10. We did not utilize any data analysis software.

Investigator triangulation process

All coding and analysis were conducted by hand and included three doctoral students and a master's student. The last author worked with each student and served as peer debriefer, reviewing and discussing the codes and grouping of codes into themes. Table 3 outlines the research team's qualitative procedures according to the Consolidated criteria for Reporting Qualitative research guidelines (See Table 3).¹³

Table 3.

Consolidated Criteria for Reporting Qualitative Studies (COREQ: 32-Item Checklist)

No. of item topic	Guide questions/description	Description	Page no.
Domain 1: Research team and reflexivity
Personal characteristics
1. Interviewer/facilitator	Which authors conducted the interview or focus group?	Interviews were conducted by the last author (Ana Puig, faculty supervisor) and 3 other (at the time) doctoral student researchers.	1, 4
2. Credentials	What were the researcher's credentials? E.g., PhD, MD	1 author has an MD, 8 have PhDs, 1 has a JD, 2 have Master's degrees, and 1 is a doctoral student.	1
3. Occupation	What was their occupation at the time of the study?	1 author was a master's student (now PhD student), 2 authors were program administrators, 8 authors were PhD students, 1 was a JD student and former SL team member, and 2 were faculty in the College of Medicine and Education, respectively.	1, 4
4. Gender	Was the researcher male or female?	Researchers were males and females.	1
5. Experience and training	What experience or training did the researchers have?	All Master's and doctoral student researchers were trained in qualitative interview processes by the last author who served as research PI and faculty supervisor. The PI is a faculty member in mental health counseling and counselor education with over 18 years of experience conducting research, including the use of qualitative, quantitative, and mixed-methods approaches. Furthermore, the PI has over 50 refereed publications, including journal articles, book chapters, and co-authored books.	1, 4
Relationship with participants		4 of the researchers were administrators or volunteer members in the SL program.	1, 4
6. Relationship established	Was a relationship established before study commencement?	4 of the researchers who were administrators or volunteer members in the SL program had established relationships with potential participants a priori. The PI secured consent from all who agreed to participate.
7. Participant knowledge of interviewer	What did the participants know about the researcher? (e.g., personal goals, reasons for doing the research)	Participants learned the research goals through informed consent document approved by the institutions IRB 01. In addition, none of the MEd/EdS or PhD students conducting and/or analyzing interviews had a previous relationship with participants. Some of the other team members are SL leadership or staff (3) and 1 is a pediatric oncologist.
8. Interviewer characteristics	What characteristics were reported about the interviewer/facilitator? E.g., bias, assumptions, reasons, and interests in the research topic	All interviewers have a counseling background and were interested in palliative care research with adolescents and young adults.
Domain 2: Study design
Theoretical framework		The Social Support Theory was used to conduct research and analyze data.	12
9. Methodological orientation and theory	What methodological orientation was stated to underpin the study?	Braun and Clarke's widely used reflexive thematic analysis was used due to its well-established reputation as a robust qualitative approach in psychological research. This method aligns well with the social support theory framework utilized in this study.	5–6, 12
10. Sampling	How were participants selected? E.g., purposive, convenience, consecutive, snowball	Purposive sampling was used due to our focus on the impacts of the SL Program.	5
11. Method of approach	How were participants approached? E.g., face-to-face, telephone, mail, e-mail	Participants were approached after completing surveys and indicating interest to participate in interviews. This took place during hospitalizations or outpatient appointments. The program administrators initiated the approach and the faculty supervisor followed with consent process once they indicated interest.	5
12. Sample size	How many participants were in the study?	A total of 10 participants completed qualitative interviews.	6
13. Nonparticipation	How many people refused to participate or dropped out? Reasons?	33 patients originally expressed interest. 21 were lost to follow-up due to discharge from hospital or nonresponse to phone calls. 2 patients died before being interviewed.
Setting
14. Setting of data collection	Where were the data collected? E.g., home, clinic, workplace	Interviews took place at bedside, in hospital.	6
15. Presence of nonparticipants	Was anyone else present besides the participants and researchers?	Parent(s) of minor participants were present during interviews.
16. Description of sample	What are the important characteristics of the sample? E.g., demographic data, date	Aggregate demographic data are provided in Table 2.	16–17
Data collection
17. Interview guide	Were questions, prompts, guides provided by the authors? Was it pilot tested?	Interview questions were asked verbally and no pilot was conducted.
18. Repeat interviews	Were repeat interviews carried out? If yes, how many?	No repeat interview was carried out.
19. Audio/visual recording	Did the research use audio or visual recording to collect data?	Audio-recording devices were used to collect data.
20. Field notes	Were field notes made during and/or after the interview or focus group?	No field note was made after the interviews.
21. Duration	What was the duration of interviews or focus group?	Interviews ranged from 30 to 60 minutes with a mean duration of 45 minutes.	5
22. Data saturation	Was data saturation discussed?	Data saturation was discussed during team meetings about the analysis process (uncovering coding and themes). The research team determined thematic saturation was reached after analyzing interview 10.	5
23. Transcripts returned	Were transcripts returned to participants for comment	No transcript was returned to participants. Lack of member checking is a limitation of this study.
Domain 3: Analysis and findings
Data analysis
24. No. of data coders	How many data coders coded the data?	4	5
25. Description of coding tree	Did authors provide a description of the coding tree?	Braun and Clarke's analysis process was followed and is described in detail.	5
26. Derivation of themes	Were themes identified in advance or derived from the data?	All themes were derived from initial and recursive coding of transcripts.Saturation was reached among 4 data analysts through iterative and recursive process.	5
27. Software	Qualitative software used?	No.
28. Participant Checking	Did participants provide feedback on the findings?	No. This is a limitation of the study.
Reporting
29. Quotations presented	Were participant quotations presented to illustrate the themes/findings? Was each quotation identified? E.g., participant number	Diverse representation of quotations is provided in the Results section. They are not tied to participant number to ensure anonymity.	7–11
30. Data and findings consistent	Was there consistency between the data presented and the findings?	We conducted investigator triangulation, carried out iterative and recursive analyses, and reached consensus among the analyses team. The coding was initially inductive and subsequent iterative analyses were deductive.	5
31. Clarity of major themes	Were major themes clearly presented in the findings?	All major themes clearly outlined and reported: (1) Normalization of Life in Hospital, (2) Mental Health and Instillation of Hope, (3) Companionship and Connection, (4) Diversity of Volunteers, and (5) Gratitude.	6–11
32. Clarity of minor themes	Is there a description of diverse cases or discussion of minor themes?	Unique elements of major themes discussed in the narrative. No minor theme is reported.	E.g., Volunteer members who were former patients (p. 11)

PI, principal investigator.

Results

Participants

A total of 33 current and former Streetlight patients participated in the qualitative interviews at the conclusion of the initial survey. Of these, two participants died before interviews could be conducted (N = 31). Ten (30%) semistructured interviews were completed due to loss of contact post-discharge. The interviews (N = 10) yielded the following themes: Normalization of Life in Hospital, Mental Health and Instillation of Hope, Companionship and Connection, Diversity of Volunteers, and Gratitude.

Normalization of life in the hospital

Patients benefited from volunteers normalizing life in the hospital and being distracted from their illness and treatments. One patient reflected, “They really helped you feel kind of like a normal life in a sense because you had visitors, people that you saw and you know, you made…I made great friends of them…It literally just makes staying in the hospital for such a long period of time just suck less.” Streetlight patients endure long hospitalizations frequently, which they experience as life limiting and stressful, and they identified projects and opportunities provided by Streetlight volunteers, such as hosting snack parties and movie nights, performing music together, or playing video games.

These activities over common passions and interests normalized hospital interactions. A patient explained, “[To have volunteer members] close to your age and just be able to hang out with that and just forget everything that you're going through at the time…they're always there to listen. They were always there to help support me.” Overall, patients reported these age-appropriate interactions and activities facilitated relationship building, and provided entertainment and distraction from living with an illness.

Mental health and instillation of hope

Participants described how interactions with Streetlight benefitted their mental health and well-being. Regarding mental health, one patient said, “Your mental status is really the most difficult part.” Amidst these hardships, patients emphasized how Streetlight members mitigated some of this difficulty through emotional, psychological, and physical support. A patient described, “When Streetlight comes in you are able to relax your mind and feel normal and loved and happy and that helps your body heal inside.” Patients expressed how these feelings of relaxation and support helped improve their mental health.

Participants described their experience with Streetlight as an installation of hope in times of extreme distress. When faced with the emotional difficulty of living with illness, patients gained a sense of hopefulness from interactions with the Streetlight Team. A patient explained, “At really, really dark times it can be a really profound brightness and hope and that was a big thing I got from Streetlight…even when I was going through something that was so debilitating and demoralizing.” Patients affirmed the benefit of Streetlight's social support in uplifting and encouraging their perseverance, hope, and mental health.

Companionship and connection

Patients often reflected on the depth of connection between themselves and Streetlight Team members, describing these relationships as friendships. Patients felt disconnected from their communities during treatment, and they articulated that Streetlight provided a sense of friendship, while at the hospital, “It's like being in a new school all by yourself and Streetlight is that someone who comes alongside you [and] makes you feel like you are hanging out with friends.” These friendships were significant due to their illness and related treatment, as patients expressed the detriment of physical distance from their friends and loved ones back home, while receiving treatment.

In addition to the physical distance, patients often felt emotionally distant from their friends, but they felt as if they could connect with Streetlight members. One patient stated, “You feel you can relate to them…You don't always feel that relation with, you know, your friends.” Patients identified Streetlight volunteers as relatable and empathetic, as people who they could talk to about their illness. Streetlight also offered opportunities for patients to meet other patients and forge friendships with each other. This peer-to-peer, “just being able to kind of talk to [each other] like patient to patient,” communication was valuable to patients. A patient described, “You end up making these friendships and friendships become family… I gained two or three beautiful friendships.” These relationships between Streetlight Team members and patients became meaningful friendships that counteracted the physical and emotional isolation experienced by patients during treatment.

Beyond friendship, Streetlight patients described long-lasting, family-like relationships that transcended their hospital experience. A patient remarked, “It's a community, but it becomes a family I'm part of…we get to carry each other,” quoting the Streetlight motto, which highlights the program's central goal to provide AYA patients with reciprocal and substantive companionship during treatment. Patients experienced being part of a community of time-enduring bonds among patients, volunteers, and family members. One patient said, “[They] support you and let you know that you're not fighting that fight alone…you have other people that are cheering you on.” Patients noted Streetlight's supportive atmosphere, a community that understood the complexities of their illness, helped them develop valuable friendships that supported them through treatment.

Diversity of volunteers

Patients noted that their ability to cope with their illness was highlighted by the cultural diversity and lived experiences of the Streetlight Team. Patients reported that Streetlight volunteers had a diverse range of medical experiences, including many volunteers who had previously received support from Streetlight as patients. Their experiences as former patients with similar diagnoses were a point of connection between these volunteers and patients. A patient (later turned volunteer) stated, “I've kind of seen both sides of it… I can relate to them on this one aspect.” This relatability evolved into a giving of informational and emotional support, with former patients sharing their experiences in meaningful and supportive ways. Patients identified that these volunteers who had relevant medical experience were great resources for them, while going through treatment.

In addition to diversity in medical experiences, patients reflected on their relationships with Streetlight volunteers of multiple cultural backgrounds, countries of origin, and language proficiency. This cultural diversity was impactful for Latinx patients whose family members did not speak fluent English. One patient expressed, “Students who spoke Spanish were able to talk to my mom.” Being able to connect with Spanish-speaking volunteers helped patients and families feel supported. While this study did not collect volunteer demographics related to race and ethnicity, the racial diversity in the volunteer team seeks to meet the needs of a racially diverse patient population so patients of all racial and ethnic backgrounds can feel supported and validated. Patients identified that diversity in the lived experiences of the Streetlight Team helped them feel supported during treatment.

Gratitude

The final qualitative theme was gratitude. Patients expressed an appreciation for Streetlight, “If I ever win the lottery, I know I'm going to give a really good amount to them so they can always stay afloat and not worry about it because that organization has done so much for me. It's going to keep growing and growing and do more and more for others.” Some patients expressed gratitude for what they perceived as intentional relationship building: “You [Streetlight staff and volunteer members] are here because you want to be with me. Other than a new heart, I gained incredible people in my life, people I can trust.” Patients expressed gratitude for the relationships and support received through Streetlight.

A unique element of gratitude was from volunteers who were former patients. Patients were thankful for relationships to volunteers who were former patients, and these volunteers were thankful for the ability to reciprocate. A volunteer member who received Streetlight services as a patient stated they were grateful they had the opportunity to serve as a volunteer and “be able to give back to other patients, support other patients and be there for other patients and provide them with a friend or someone to talk to.” Returning to Streetlight as a care provider, these volunteers continued their illness journey in a new role by offering their experiences as a former patient.

Discussion

Qualitative interviews provided insight into relationships made between volunteers and patients. These interviews highlighted significant bonds that endured over the course of patients' hospitalizations, which helped to normalize life in the hospital and provide emotional support. These relationships helped patients manage difficult hospitalizations and living with chronic illnesses by supporting their ability to cope with adversity through social support.

Recent work reviewing the scope of southeastern U.S. childrens hospital AYA support by Hebert has shown similarities of the Streetlight program's components with other hospitals, particularly the teen lounge shared space and 1-on-1 inpatient visitation service.¹⁴ In examining Streetlight as a case study in comparison to these hospitals and in relation to predictors of Health-Related Quality of Life using interview data collected from this study, she found Streetlight patient perspectives to overlap with major predictors of coping skills, psychosocial factors, and mental health status. In addition, the family-like bonds and longevity of relationships emerged as unique factors of the Streetlight program. Another gap mentioned in the review was the availability of online social spaces for AYAs, a service that Streetlight has recently expanded upon since 2018, of which qualitative and quantitative reviews are already under way.^15–17

Themes from these patient interviews reflect several constructs relevant to social support theory.¹⁸ These relationships within the Streetlight community can be conceptualized as emotional and companionship-based types of social support outlined by patients' endorsements of volunteers as confidants and supportive presences. In addition, instrumental support manifested in distraction from hospitalization by offering materials and events to reduce boredom during hospital stays. Future research efforts may benefit from incorporating measures previously developed for more multidimensional evaluations of social support.

The core element of Streetlight's social support experienced by patients is the volunteer team and its members' diversity of experiences. This diversity may be related to the extensive selection and training process of volunteers, including multiple rounds of essay applications and interviews, followed by 60 hours of palliative care, thanatology, and illness-specific training during their two-year minimum service in Streetlight. This comprehensive volunteer management may correlate with the passion identified by patients, as program directors aim to select and cultivate volunteers with intrinsic motivation to serve chronically ill AYAs.

Program directors prioritize developing intrinsic motivation by incorporating mission building efforts through weekly palliative care education,^19,20 regular volunteer social events, and ceremonies honoring patients at end of life. This intrinsic motivation is poignant in volunteers who were former patients, whose relationships indicate highly positive experiences by patients in interviews. Characteristics of diversity in background and language capabilities endorsed by patients reflect the importance of selecting diverse volunteers and health care providers to match the diversity of patient populations.²¹ The diversity of identities and lived experiences of volunteers combined with the intensity of their selection and training may account for perceptions of the uniqueness of Streetlight by patients.

While these findings speak to patients' perceptions of Streetlight's impact on their ability to endure difficult hospitalizations, it is important to consider these findings in light of several limitations. Due to the schedule of measurements, interview participants may have been primed by questions on the survey questionnaire, which they were given first. However, during the interview process, interviewers utilized open-ended questions and probed using negatively framed questions as well. Another limitation of our qualitative findings is the potential lack of generalizability to larger patient populations, given the small sample size and high proportion of patients who agreed to interview being lost to follow-up (n = 23, [70%]).

In addition, it is important to consider that patients within this sample had engaged with the Streetlight program for at least six months. Future research should be conducted to investigate how long the Streetlight program takes to produce the intended effect. Interviews were not able to be conducted with many of the patients who died following their enrollment into this study, which may reflect the difficulty in conducting time-intensive assessments for this population. Recognizing the need to improve recruitment strategies, we gained IRB approval to expand study recruitment with e-consenting and electronic survey distribution strategies through REDCap, which helped to expedite enrollment. Future research should continue to offer multiple modes of participation for AYA palliative populations.

Conclusion

In this qualitative study, we completed a program evaluation and exploration of psychosocial outcomes of Streetlight, a palliative care intervention program. Our findings demonstrate the need for increased research in volunteer protocol development for volunteer training and materials to better understand the unique experiences of volunteers. Our results indicate that Streetlight has powerful perceived impacts for AYAs during lengthy hospital stays. Further research utilizing more rigorous study designs should be conducted to determine program optimal dosage and impact on AYA patients who are frequently hospitalized. This vulnerable population may benefit from similar programs being implemented across pediatric units in hospitals across the country.

Footnotes

Authors' Contributions

A.W. led data collection, analysis, design, and article writing and editing. J.R. worked on article writing, IRB revision processes, reviews, and editing. A.S. worked on article writing, reviews, and editing. Z.M. worked on data entry and research recruitment. E.Y. worked on preliminary coding for survey analyses. M.M. worked on research recruitment and preliminary study design. K.M. worked on research recruitment efforts. E.R. worked on research recruitment, survey instrument design, and preliminary analyses. E.L. worked on developing study design and article writing, editing, and review. L.H. worked on study design, IRB approval processes, and recruitment. E.M. worked on recruitment and article revisions, and facilitated Streetlight program staff support for the project. Z.A.-M. led the Streetlight evaluation survey development efforts. J.L. led team collaboration with unit health care teams to assess patients' eligibility, provided article edits and reviews, and assisted with IRB approval process. A.P. led the team as project PI, developed study design, and led recruitment team trainings.

Funding Information

Funding agency: Children's Miracle Network; Award Number: 2909CCIAST.

Author Disclosure Statement

No competing financial interests exist.

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