Adolescents and young adults with cancer: How multidisciplinary health care teams adapt their practices to better meet their specific needs.

Objective: Dedicated adolescent and young adult (AYA) cancer units have emerged from the early 1990s to address multiple challenges faced by AYA patients with cancer. Specific needs of AYA patients have been considered in an increasing number of studies. However, few describe how the health care professionals (HCPs) perceive their patients' needs and how they actually adjust their day-to-day practices to meet such needs. The purpose of this study is to identify and describe the practical methods of care and teamwork implemented by HCPs in response to what they perceive as essential to support psychosocial development of AYA patients.

Methods: Qualitative research was conducted between 2012 and 2014 with 31 HCPs from a recently created haematology AYA unit in France. The transcripts of open-ended interviews were subject to inductive analysis using constant comparison as recommended by the grounded theory methods.

Results: Our results show how HCPs adapt their practices and care relationships to support three major developmental milestones related to identity construction in AYAs: self-determination and individuation from parents, gender and sexual identity, and social life and connectedness to peers and adults (other than parents). Our results also show how HCPs adapt their practices and organisational methods to enhance the flexibility required to address their young patients, thus setting consistent and high standards for the whole team. Such adaptation is made possible through collaborative work and collective processes that facilitate self-reflection.

Conclusions: Our findings shed light on some meaningful young patient-friendly practices of care and advocate for AYA-dedicated units.