A scoping review to map the concept, content, and outcome of wilderness programs for childhood cancer survivors

Objectives Systematic mapping of the concept, content, and outcome of wilderness programs for childhood cancer survivors. Design Scoping review. Search strategy Searches were performed in 13 databases and the grey literature. Included studies describe participation of childhood cancer survivors in wilderness programs where the role of nature had a contextual and therapeutic premise. At least two authors independently performed screening, data extraction and analysis. Results Database searches yielded 1848 articles, of which 15 met the inclusion criteria. The majority of programs (73%) employed adventure therapy. Five activity categories were identified as components of wilderness programs: challenge/risk, free time/leisure, experiential learning, physical activity and psychotherapeutic activities. A majority of the participating childhood cancer survivors were female, white, aged 8–40 years, with a wide range of cancer diagnoses. Reported outcomes included increased social involvement, self-esteem, self-confidence, self-efficacy, social support, and physical activity. Key gaps identified included the absence of randomized controlled trials (RCTs), lack of studies on long-term effects, lack of information on the multicultural aspects of programs, and missing information on engagement in nature activities after the program ended. Conclusions This scoping review guides childhood cancer survivors, their families, practitioners, clinicians and researchers in the development and optimization of wilderness programs for childhood cancer survivors. In addition, it informs the utilization of these programs, and identifies gaps in the evidence base of wilderness programs. It is recommended that future study reporting on wilderness programs include more detail and explicitly address the role of nature in the program. Performing RCTs on wilderness programs is challenging, as they occur in real-life contexts in which participants cannot be blinded. Creative solutions in the design of pragmatic trials and mixed method studies are thus needed for further investigation of the effectiveness and safety of wilderness programs in childhood cancer survivors.

Positionality in Embodied War Imaginaries: American Snipers

This paper maps the positionality of two soldiers embodied experiences as snipers for the US military. One, Chris Kyle who is labeled as “the most lethal sniper in US military history,” wrote a book uncritically glorifying his experiences, which was later turned into the Oscar nominated film American Sniper. His attempt to help veterans heal from PTSD by taking them shooting was a possible trigger that reignited the traumas of war, which can be traced to his eventual death. The other, Garett Reppenhagen, who was the first active duty member of the antiwar group Iraq Veterans Against the War, and currently works to help others heal from the traumas of war by getting them engaged in wilderness programs and environmental activism. Both stories expose a range of traumas of war, both within wartime and in peacetime, and we see the ways in which their narratives of war have different reflections of what it means to heal during times of peace. This paper juxtaposes these two stories, their war imaginaries, and how one works to reinforce the military dispositif, while the other works to impede it in favor of human rights.