Doctoral Dissertations

Date of Award

12-2017

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Nursing

Major Professor

Sadie P. Hutson

Committee Members

Joanne Hall, Katherine M. Newman, Jennifer M. Jabson

Abstract

Melanoma is a dangerous form of skin cancer that can spread throughout the body without treatment. The population of melanoma survivors has grown for several reasons including rising melanoma incidence, earlier detection, and treatment advances. The eastern Tennessee area is designated as an Appalachian region of the country where many people still live in abject poverty and lack access to adequate healthcare resources. Eight counties were found to have the highest melanoma incidence rates in Tennessee. Currently, post-treatment melanoma surveillance is disjointed, and falls on a variety of healthcare providers. The health-related experiences and post-treatment needs of melanoma survivors are essentially unknown in Tennessee. While additional resources are needed, there are limited local providers and facilities in rural Tennessee. The purpose of this qualitative interpretive description study was to understand the experiences related to melanoma survivorship from the perspective of the patients themselves.

Thorne’s (2008) framework for interpretive description research was used for this qualitative study. Sixteen participants were interviewed from counties in the east Tennessee Appalachian region. Qualitative data analysis using interpretive description recommendations allowed the identification of four themes: 1) Sitting in the driver’s seat of follow-up care, 2) Living in a skin world, 3) Once bitten, twice shy, and 4) Watch me like a hawk. Melanoma survivors living in east Tennessee experience follow-up similarly to other individuals living with cancer who also have specific cultural, geographical, and regional barriers to surveillance. Their implicit needs are basic and consistent with the standard of care we offer other cancer survivors. Future research suggestions include taking a closer look at types of melanoma in other diverse populations, less invasive or less urgent post-treatment management options, and best practice programs that benefit melanoma survivors with psychosocial distress in long-term follow-up.

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