The Development and Evaluation of a Health Literacy-Adapted Self-Management Intervention for Elderly Cancer Patients Undergoing Chemotherapy

PURPOSE: This study aimed to develop and evaluate the effectiveness of an adapted health literacy self-management intervention for elderly cancer patients undergoing chemotherapy. METHODS: The intervention in this study was systematically developed through the six stages of Intervention Mapping Protocol and was based on Fransen et al's causal pathway model. A quasi-experimental trial was conducted on a total of 52 elderly patients (26 in an experimental group and 26 in a control group) undergoing chemotherapy in Korea. The intervention consisted of seven sessions over 5 weeks. The experimental tool for this study was an adapted health literacy self-management intervention, which was designed to promote a reduction in the symptom experience and distress of elderly cancer patients through the promotion of self-management behavior. To develop efficient educational materials, the participants' health literacy was measured. To educate participants, clear communication and the teach-back method were used. In addition, for the improvement of self-efficacy, four sources were utilized. For the promotion of self-management behavior, five self-management skills were strengthened. Data were collected before and after the intervention from June 4 to September 14, 2018. The data were analyzed with SPSS/WIN 21.0. RESULTS: Following the intervention, self-management knowledge and behavior and, self-efficacy significantly improved in experimental group. Symptom experience and distress decreased in the experimental group compared to the control group. CONCLUSION: The self-management intervention presented in this study was found to be effective in increasing self-management knowledge and behavior and, self-efficacy, and ultimately in reducing symptom experience and distress for elderly patients undergoing chemotherapy.

The Development and Evaluation of a Health Literacy-Adapted Self-Management Intervention for Elderly Cancer Patients Undergoing Chemotherapy

PURPOSE@#This study aimed to develop and evaluate the effectiveness of an adapted health literacy self-management intervention for elderly cancer patients undergoing chemotherapy.@*METHODS@#The intervention in this study was systematically developed through the six stages of Intervention Mapping Protocol and was based on Fransen et al's causal pathway model. A quasi-experimental trial was conducted on a total of 52 elderly patients (26 in an experimental group and 26 in a control group) undergoing chemotherapy in Korea. The intervention consisted of seven sessions over 5 weeks. The experimental tool for this study was an adapted health literacy self-management intervention, which was designed to promote a reduction in the symptom experience and distress of elderly cancer patients through the promotion of self-management behavior. To develop efficient educational materials, the participants' health literacy was measured. To educate participants, clear communication and the teach-back method were used. In addition, for the improvement of self-efficacy, four sources were utilized. For the promotion of self-management behavior, five self-management skills were strengthened. Data were collected before and after the intervention from June 4 to September 14, 2018. The data were analyzed with SPSS/WIN 21.0.@*RESULTS@#Following the intervention, self-management knowledge and behavior and, self-efficacy significantly improved in experimental group. Symptom experience and distress decreased in the experimental group compared to the control group.@*CONCLUSION@#The self-management intervention presented in this study was found to be effective in increasing self-management knowledge and behavior and, self-efficacy, and ultimately in reducing symptom experience and distress for elderly patients undergoing chemotherapy.

The Experience of Uncertainty in Cancer Patients Undergoing Chemotherapy

PURPOSE: The purpose of this study was to investigate the experience of uncertainty in cancer patients undergoing chemotherapy in South Korea. METHODS: Data were obtained from in-depth interviews with ten cancer patients conducted from Mar. 21 to Nov. 11, 2017. The data were collected until saturation and analyzed via Colazzi's phenomenological method. RESULTS: In this study, 6 categories were extracted: Four categories contributed to uncertainty including ‘Confusion about cancer and course of treatment’, ‘Inner conflicts’, ‘Being overwhelmed by treatment’, and ‘Unknown future’. Two categories facilitated coping with uncertainty including ‘Seeking knowledge’ and ‘Need for spiritual peace’. CONCLUSION: Uncertainty experiences for cancer patients undergoing chemotherapy in different societies is largely similar. However, some experiences seemed unique to Korean patients. Also, there is a great deal of uncertainty about the treatment outcomes and loss of treatment opportunities in cancer patients undergoing chemotherapy. The results of this study will help oncology professionals develop patient-centered psychological interventions by improving understanding of the uncertainty of cancer patients undergoing chemotherapy.

Hospitalization Experience of Patients Admitted to Nursing Care Integrated Service Wards in Small and Medium-size General Hospitals / 간호행정학회지

PURPOSE: This study was conducted to identify meaning and essential structure of the hospitalization of patients in nursing care integrated service wards of small and medium-size general hospitals. METHODS: Experiential data were collected through in-depth interviews with 10 patients who had been hospitalized in nursing care integrated service wards of medium general hospitals. The main question was ‘Could you describe your hospitalization experience in nursing care integrated service wards of medium general hospitals?’, and collected data were analyzed using Colaizzi's Phenomenological Research Method. RESULTS: Four categories obtained were ‘Realize the system that is not established yet’, ‘Secure care services which are less of a psychological and financial burden’, ‘Thanks for care providers’, and ‘Confident of the hopeful system to desire to reuse in the future.’ CONCLUSION: Patients in nursing care integrated service wards of small and medium-size general hospitals were satisfied with the reduction of mental and financial burden caused by nursing and were thankful to nursing staff, who put a lot of efforts into nursing. But, at the same time, they were confused and inconvenienced by the services that were not yet completely established. To improve this situation, it is thought that institutional complements including development of a service standardization manual would be helpful.

Nationwide Survey for Current Status of Cancer Centers in Korea

PURPOSE: This study to identify the current status of cancer centers in Korea in terms of organization ofhospital. METHODS: 21 cancer centers, from regional cancer centers to the largest hospitals, were surveyed from October to November 2014. The questionnaire was developed by the board members of the Oncology Nursing Society. RESULTS: Centers specializing in cancer treatment were either cancer hospitals or centers affiliated with larger hospitals. 81% operated wards solely for cancer patients. The average number of beds was 354.2, and each center had independent laboratories, chemotherapy infusion rooms and pharmacies. Degree of nursing staff varied from grades 1 to 3. The nursing department and ward were jointly responsible for educating new nurses. In cancer nursing, the policy varied according to institution. For patient education, the oncology Advanced Practice Nurse (APN) mainly informed patients of the adverse effects of chemotherapy and central line care. 90.5% appointed oncology APNs, who were variously designated (47.6%). 10.5% of APNs held concurrent positions. CONCLUSION: As cancer has increased medical professional organizations have shown a variety of forms of organization and human resources management. A political approach seems to be required for institutions for nursing care, patient education, the role and qualifications of APN.

Factors Influencing Burden among Family Caregivers of Elderly Cancer Patients

PURPOSE: This study was to identify factors influencing burden among family caregivers of elderly cancer patients. METHODS: The participants were 217 family caregivers who visited inpatient & outpatient clinics for elderly cancer patients at two general hospitals. Data were collected utilizing the Perceived Health Status Scale, Herth Hope Index Scale, Medical Outcome Study-Social Support Scale, and Caregiver Reaction Assessment Scale. RESULTS: The level of burden in the participants was moderate to high. There were significant correlations among perceived health status, hope, social support and burden. In multiple regression analyses, the most powerful predictor of burden in family caregivers was hope (36.0%). Overall, other caregivers, perceived economic status, caring time, gender, patients' confusion, tangible support, and perceived health status explained 61.0% of the variance of burden among the participants. CONCLUSION: The study highlights the importance of hope on burden in family caregivers. Thereby, integrative interventions are needed to enhance hope and social support and to promote caregivers' health status for alleviating-burden among family caregivers.

Hospice Palliative Nurses' Experience of Caring for Terminal Cancer Patients

PURPOSE: The purpose of the study was to explore and describe hospice palliative nurses' experience of caring for terminal cancer patients. METHODS: Eleven hospice palliative nurses participated in the study. Data were collected through individual in-depth unstructured interviews with participants from November, 2012 to October, 2013. Theoretical sampling was used to the point of theoretical saturation. Data were analyzed using Corbin and Strauss' 'Grounded Theory Method.' RESULTS: From open coding, 25 sub-categories and 12 categories were identified. Analysis revealed that the core category was 'becoming stepping-stones between life and death enduring burdens', consisting of three phases: the phase of withdrawal, the phase of exertion, and the phase of maturity. Through this process, participants utilized various action/interactional strategies such as 'maintaining a distance', 'sharing intimate daily life', 'being a mediator for a peaceful death', 'grieving and remembering'. The consequences of these strategies were a transcendental perspective towards life and ambivalent feelings toward hospice nursing. CONCLUSION: In-depth understanding of the hospice palliative nurses' experience of caring for terminal cancer patients will guide nurse managers and policy makers to promote effective nursing strategies to better support hospice palliative nurses.

Satisfaction with Korean Oncology Advanced Practice Nurses' Role: A Study of Patients, Physicians, and Nurses

PURPOSE: The purpose of this study was to describe the level of satisfaction with the role of Korean oncology advanced practice nurses (KOAPNs) among cancer patients, physicians, and nurses. METHODS: This study was conducted with 176 patients who had experienced KOPANs' care more than three times, as well as 82 physicians and 190 nurses who have worked with KOAPNs at four hospitals in Korea. RESULTS: The results indicate that 1) Overall satisfaction in the patient group was high (3.61) and they were most satisfied with the 'attentiveness' domain; 2) Overall satisfaction in the physician group was also high (3.61), however, that in the nurse group was relatively low (3.28); 'coordination & cooperation' showed the highest score for satisfaction in both groups, while 'research' domain showed the lowest score; 3) Cancer type in patients, working department in physicians or nurses, and duration working with KOAPNs in nurses showed significant association with satisfaction; and 4) The ratio of KOAPNs-to-patient, time since introduction of the KOAPNs policy, and incentive system were institutional factors showing significant association with it. CONCLUSION: These findings suggest the necessity for identification and standardization of the roles of KOAPNs, as well as promotion of awareness of KOAPNs' care.

The Experience of Adult Korean Children Caring for Parents Institutionalized with Dementia

PURPOSE: The purpose of the study was to explore and describe the experience of adult Korean children who are caregivers for parents institutionalized with dementia. METHODS: Participants were fourteen adult children caregivers of elders institutionalized with dementia. Data were collected through in-depth unstructured interviews with individual participants from August to November, 2012. Theoretical sampling was used to the point of theoretical saturation. Data were analyzed using Strauss and Corbin's Grounded Theory Method. RESULTS: From open coding, 67 concepts, 29 sub-categories, and 14 categories were identified. Analysis revealed that the core category of the experience of adult children caring for their parents institutionalized with dementia was 'enduring the role of a prop' consisting of four phases: initial turmoil, exploration, role adjustment, and acclimation. To manage the role of a prop, participants utilized various action/interactional strategies such as overcoming the unfamiliarity, overseeing the nursing home care, and counterbalancing the caring roles. As a result, participants experienced ambivalence towards the existence of parents with dementia, changes in family relationships, altered viewpoint towards nursing homes, and restructuring of life. CONCLUSION: In-depth understanding of the experience will guide nurses to promote effective interventions in order to better support the Korean family caregivers of parents institutionalized with dementia.

The Job Experience of Oncology Nurse Specialists

PURPOSE: The purpose of the study was to explore and describe the job experiences of oncology nurse specialists. METHODS: Nine oncology nurse specialists participated in the study. Data were collected through in-depth unstructured interviews with individual participants from February to June, 2014. Theoretical sampling was used to the point of theoretical saturation. Data were analyzed using Corbin and Strauss's grounded theory method. RESULTS: From open coding, 98 concepts, 24 sub-categories, and 11 categories were identified. Analysis revealed that the core category of the job experiences of oncology nurse specialists was 'tightrope walking of professionalism without safeguards', consisting of four phases: Enthusiastic beginning, conflict, exertion, and internalization. To manage the 'tightrope walking of professionalism without safeguards', participants utilized various action/interactional strategies such as 'keeping the balance point' and 'taking a step forward.' As a result, participants experienced falling into a habitual routine and professional self-actualization. CONCLUSION: In-depth understanding of the job experiences of oncology nurse specialists will guide hospital administrators to promote effective interventions and policies to better support Korean oncology nurse specialists.

Predictive Factors for Depression in Breast Cancer Survivors

PURPOSE: This study was to identify the predictive factors for depression in breast cancer survivors. METHODS: The participants were 180 female survivors who visited outpatient clinics after mastectomy or partial resection for breast cancer and had completed adjuvant treatment such as chemotherapy and/or radiation therapy at a university hospital and a general hospital. Data were collected utilizing the Zung depression scale, the Mishel uncertainty scale, the Fitts & Osgoods body image scale, and the Zimet social support scale. RESULTS: The level of depression in the participants was moderate. There were significant correlations among depression, body image, uncertainty, and social support. There were significant differences in depression by education, economic state, perceived health status, fatigue, and pain. In regression analysis, the most powerful predictor of depression was body image (40%). Overall, body image, fatigue, social support, and uncertainty explained 62% of the variance of depression in the participants. CONCLUSION: Body image, fatigue, social support, and uncertainty were important predictors of depression. These results demonstrate the need for interventions to manage depression in breast cancer survivors.

Structural Relationship of Burnout and Related Variables among Family Caregivers of Cancer Patients

PURPOSE: The purpose of this study was to construct a structural equational model to explain and predict burnout in family caregivers of patients with cancer. The study was based on the Stress-Appraisal-Coping Model of Lazarus and Folkman (1984) and Family Stress Theory (Hill, 1958). METHODS: Data were collected from July 10 to September 30, 2012 through direct interviews and a self-report questionnaire survey. Participants in this study were 206 family caregivers providing care for patients with cancer in In-patient or Out-patient departments of three different general hospitals located in Busan. Measured variables were exogenous variables (social support and perceived health status) and endogenous variables (perceived stress, hope and burnout). RESULTS: Goodness of fit in the hypothetical model was chi2=174.07, TLI=.95, CFI=.97, RMSEA=.08. Perceived health status, perceived stress, and hope showed statistically significant direct effects on burnout of family caregivers. Social support affected burnout of family caregivers indirectly. These variables explained 68.5% of total variance in burnout. CONCLUSION: The results from this study suggest that perceived stress, perceived health status, and hope should be considered as major influential factors when developing nursing interventions to control burnout of family caregivers (of patients with cancer).

Nursing Home Placement: The Process of Decision Making and Adaptation among Adult Children Caregivers of Demented Parents in Korea

PURPOSE: The goal of this study was to explore and describe the process of nursing home placement decision making and adaptation among adult children caregivers of demented parents in Korea and to generate a substantive theory grounded in their experiences. METHODS: The participants were 16 adult children caregivers who had placed their demented elders into nursing homes. Data were collected by in-depth unstructured interviews with individual participants. Data were analyzed by Strauss and Corbin's Grounded Theory methodology. RESULTS: Analysis revealed that the core category of the process of nursing home placement decision making and adaptation among adult children caregivers was accepting the inevitable and reorienting to changes. It consisted of four phases: realizing a dead end, seeking a way out, accepting the inevitable decision, and reorienting to changes. Participants were driven to the corner of making the inevitable decision by the overwhelming care situation and confronted by various challenges in dealing with the decision. But they managed to accept the inevitableness of the decision and further learned to reorient themselves to the changed care situation utilizing various action/interaction strategies. CONCLUSION: The findings of the study provide the basic information for developing proactive strategies to support family caregivers better in the difficult period of nursing home placement.

Relationships between Stress, Ways of Coping and Burnout of Family Caregivers of Cancer Patients

PURPOSE: The study was to examine the relationships between stress, ways of coping and burnout among family caregivers of cancer patients. METHODS: Data were collected by self-reported questionnaires from 207 family caregivers of cancer patients at one university hospital and one general hospital in Busan, Korea. The instruments included a Stress Scale, a Ways of Coping Scale and a Burnout Scale. The collected data were analyzed using frequency, percentage, t-test, ANOVA, Scheffe's test, and Pearson's correlation coefficients with the SPSS WIN 19.0 program. RESULTS: Stress was found to have significant relationships with age, relation to the patient, education, monthly income, degree of care-giving, financial burden and activities of daily living of patient. In active coping, there were significant differences according to education and religion. Passive coping was significantly related to gender. In burnout, there were significant differences according to age, relation to the patient, education, occupational status, monthly income, degree of care-giving, financial burden and activities of daily living of patient. Stress and burnout showed a positive correlation, while there was a negative correlation between burnout and active coping. CONCLUSION: These results suggest that promoting active coping would better support family caregivers of cancer patients in managing burnout effectively.

The Lived Experience of the Burnout of Nurses Working in Oncology Wards

PURPOSE: This study was done to understand the meanings and nature of experiences of the burnout of nurses working in oncology wards. METHODS: The hermeneutic phenomenology developed by van-Manen was used. The period for data collection was from November, 2006 to May, 2007. This study took place in 3 university hospitals in B & U cities. Nine nurses working in oncology wards participated. Data collection was done through individual in-depth interviews. RESULTS: The eight most common themes demonstrated by participants from this study were 'being fed up with endless demands', 'collapsing in front of deaths', 'gasping for breath due to overwhelming tasks', 'uncontrollable suffering of body', 'gradually loosing self-esteem', 'frustration from the work world', 'beleaguered relationships', and 'desire to escape'. CONCLUSION: The results of this study indicate that there is a need to develop a preventive burnout program for nurses working in oncology wards.

Relationships between Family Support, Perceived Health Status, and Self-esteem in Korean Women with Breast Cancer / 종양간호학회지

PURPOSE: The study was to identify relationships between the family support, perceived health status and self esteem in Korean women with breast cancer. METHODS: Data were collected by questionnaires from 214 women with breast cancer in inpatient and outpatient settings at three different university hospitals and one cancer hospital in B city, Korea. The instruments included Family Support Scale, Perceived Health Status Scale, and Self Esteem Scale. The collected data were analyzed using frequency, percentage, t-test, ANOVA, Scheffe's test, and Pearson's correlation coefficients by SPSS WIN 15.0 program. RESULTS: There were significant differences in the family support by age, education, and cost burden. There were significant differences in the perceived health status by education, occupation, economic status, pain, fatigue, and cancer insurance. There were significant differences in the self esteem by age, occupation, economic status, type of religion, pain, fatigue, and cancer insurance. Self-esteem was significantly correlated with family support and perceived health status. CONCLUSION: These results suggested that promoting perceived health status and enhancing family support would increase self-esteem effectively among Korean women with breast cancer.

The Influencing Factors on Quality of Life among Breast Cancer Survivors / 종양간호학회지

PURPOSE: This study was aimed to identify the influencing factors on the quality of life among breast cancer survivors. METHODS: The subjects were 159 female patients who visited out-patient department (OPD) after the mass removal surgery for breast cancer and had completed adjuvant treatments such as chemotherapy, radiation therapy at a university hospital and a general hospital. Data collection was conducted using the Ferrell QOL scale, the Mishel uncertainty scale, the Fitts & Osgoods body image scale revised by Jeon & Kim. the Rosenberg self-esteem scale, and the Kang family support scale. RESULTS: The level of QOL in the participants was in the middle. There were a significant correlation between QOL, uncertainty, self-esteem, and family support. There were significant differences in QOL with the perceived health condition and the best support person. In a regression analysis, the most powerful predictor of QOL was body image (21.7%). Altogether uncertainty and perceived health condition explained 28.6% of the variance of QOL of the participants. CONCLUSION: Body image, uncertainty, and perceived health condition were important predictors of QOL. These results demonstrated the need for developing interventions to improve QOL of breast cancer survivors.

Psychosocial Adjustment of Low-Income Koreans with Cancer

PURPOSE: To describe psychosocial adjustment of low-income Koreans who have cancer. METHODS: Data were collected during 2008 using individual in-depth interviews with 18 Korean people with cancer. The income status of the participants was low, 11 were recipients of the National Basic Livelihood Protection program. Mean age was 58.3 yr and 11 were female. Five participants had stomach cancer, five, colorectal cancer, and four, breast cancer. Data were analyzed using grounded theory methodology. RESULTS: The core category emerged as 'bearing up alone with double suffering'. 'Poverty and cancer: A double suffering' emerged as a causal condition. The adjustment process consisted of three stages: 'forming a treatment will to live' ,'practicing for the cure',and 'restructuring self and repaying favors'. Each stage indicated action-interaction strategies which were employed to bear up alone with double suffering during the illness process. Self-reflection, parental responsibility, and support from the public sector played important roles in overcoming the double suffering. Two types of consequences were identified: Transcended life and strained life suppressed by poverty and cancer. CONCLUSION: The results provide insights into the psychosocial adjustment process for low income Korean with cancer and can be used in developing and implementing efficient home-care services for these people.

Influencing Factors on Hope Among Patients with Breast Cancer / 종양간호학회지

PURPOSE: This study was aimed to identify the influencing factors on hope in the patients suffering with breast cancers. METHODS: The subjects were 150 women who were diagnosed with breast cancer at three university hospitals and a general hospital. Data collection was conducted by hope scale, family support scale, self esteem scale, depression scale, pain scale, and fatigue scale. The collected data were analyzed using frequency, percentage, t-test, ANOVA, Pearson's correlation coefficients, and stepwise multiple regression. RESULTS: Level of hope in the participants was high. There were a significant correlation among hope, family support, effects of religion, self esteem, depression, pain and fatigue. There were significant differences in hope by the age, education level, and cost burden. The most powerful predictor of hope was self esteem (38.2%). Altogether family support, effects of religion, depression, and fatigue explained 50.4% of hope of the participants. CONCLUSION: The findings of the study suggested that the concepts of self esteem, family support, effects of religion, depression and fatigue should be considered important factors in developing hope promoting program for breast cancer patients.

Influencing Factors on Spiritual Health in Women Cancer Patients / 성인간호학회지

PURPOSE: This study was done to identify the influencing factors of spiritual health in patients suffering from women cancers. METHODS: The subjects were 130 in woman patients who were diagnosed with women cancer(breast Ca & uterine Ca) at three university hospitals and one general hospital. Data collection was conducted by using 4 questionnaires. The collected data were analyzed using frequency, percentage, t-test, ANOVA, Pearson's correlation coefficients, stepwise multiple regression. RESULTS: Spiritual health score was middle. There were a significant correlation between spiritual health and depression, pain, fatigue and effects of religion. There were significant differences in spiritual health according to the education level, monthly income, meaning of religion or god, Frequency of attendance at worship. The most powerful predictor of spiritual health was depression(27.2%). Altogether depression, effects of religion, pain, and education level explained 46.1% of spiritual health of women cancer patients. CONCLUSION: It suggested that concepts of depression, effects of religion, pain, and education level should be considered in developing spiritual health promoting program for women cancer patients.