Exploring academic mobbing among graduate nursing students: a mixed-methods study.

Adolescents and young adults (AYAs) with cancer are generally defined in the oncology literature as patients between the ages of 15 and 39 []. This population is at a critical developmental stage characterized by the transition from adolescence to adulthood and faces multiple developmental tasks, including completing education, starting a career, and establishing interpersonal relationships. When cancer is diagnosed and treatment begins during this period, the normal developmental trajectory is often seriously disrupted []. These patients must confront not only the disease itself, but also fear of death and uncertainty about the future []. Advance care planning (ACP) refers to a process in which patients, family members, and healthcare professionals discuss preferences for future medical care. Its primary goal is to ensure that, when patients lose the capacity to make autonomous decisions, the care they receive remains consistent with their personal wishes []. For AYAs with cancer, ACP can help them maintain a sense of control over their lives and preserve autonomy in the context of illness. Studies have shown that AYA patients generally wish to be informed about their condition and to participate in medical decision-making; they also hope to retain the right to choose or refuse treatment and to make plans for personal matters, including how they will be remembered after death []. Unlike children, whose decisions are primarily made by their parents, and older adults, who have generally established stable values and accumulated life experience, the AYA population is in a critical period of identity formation []. These developmental characteristics give rise to several core features of ACP in the AYA population. First, AYAs tend to seek a level of participation in medical decision-making that is commensurate with their maturity and desire to be regarded as individuals whose perspectives are taken seriously, at the same time, they remain dependent on family support in reality and must negotiate a balance between their own wishes and the feelings of their family members []. Second, their values and treatment preferences may change over the course of the disease trajectory and across life stages, requiring ongoing adjustment rather than a one-time determination []. Third, for adult AYAs, illness often interrupts the process of establishing an independent social identity and may even result in regression of social roles because of the disease []. This means that ACP concerns not only end-of-life choices, but also how to preserve their developing sense of self-worth and social connectedness in the course of medical decision-making. In addition, the age range of 15–39 years spans the legal transition from minor to adult status, making the implementation of ACP more complex. Communication barriers are also more diverse, including concerns about family members' reactions [], the desire to control information [], and avoidance on the part of healthcare professionals []. These particularities indicate that ACP for AYAs cannot simply adopt an adult-based model.