Development and Effects of Smartphone App-Based Exercise Program for Hemodialysis Patients

PURPOSE@#To examine the effects of a smartphone application-based exercise program on self-efficacy expectations (SEE) and outcome expectations regarding exercise (OEE), physical fitness, activity level, physiological indices, and health-related quality of life in a sample of hemodialysis patients.@*METHODS@#A quasi-experimental control group pre-test post-test design was used. Subjects were recruited from two university hospitals in G city. The subjects were assigned randomly by coin toss: 33 participants to the experimental group and 30 to the control group. A literature review and the self-efficacy theory were used to develop the smartphone program. Experts designed and verified the program to be userfriendly and in consideration of user interaction. Data were collected through a self-report pre-test post-test questionnaire and online medical records.@*RESULTS@#In the experimental group, the levels of physical fitness and physical activity were significantly improved post-test, but the scores on health-related quality of life and the physical indices did not improve. In the experimental group, the SEE and OEE post-test scores were also significantly higher than the pre-test scores, but the control group's scores did not change.@*CONCLUSION@#The smartphone application-based exercise program based on self-efficacy theory significantly improved the level of physical fitness and activity, SEE, and OEE for hemodialysis patients. The use of this application-based exercise program for hemodialysis patients might be an effective nursing intervention tool for improving SEE, OEE, level of physical fitness, and physical activity.

Development and Effects of Smartphone App-Based Exercise Program for Hemodialysis Patients

PURPOSE@#To examine the effects of a smartphone application-based exercise program on self-efficacy expectations (SEE) and outcome expectations regarding exercise (OEE), physical fitness, activity level, physiological indices, and health-related quality of life in a sample of hemodialysis patients.@*METHODS@#A quasi-experimental control group pre-test post-test design was used. Subjects were recruited from two university hospitals in G city. The subjects were assigned randomly by coin toss: 33 participants to the experimental group and 30 to the control group. A literature review and the self-efficacy theory were used to develop the smartphone program. Experts designed and verified the program to be userfriendly and in consideration of user interaction. Data were collected through a self-report pre-test post-test questionnaire and online medical records.@*RESULTS@#In the experimental group, the levels of physical fitness and physical activity were significantly improved post-test, but the scores on health-related quality of life and the physical indices did not improve. In the experimental group, the SEE and OEE post-test scores were also significantly higher than the pre-test scores, but the control group's scores did not change.@*CONCLUSION@#The smartphone application-based exercise program based on self-efficacy theory significantly improved the level of physical fitness and activity, SEE, and OEE for hemodialysis patients. The use of this application-based exercise program for hemodialysis patients might be an effective nursing intervention tool for improving SEE, OEE, level of physical fitness, and physical activity.

Development and Effects of Smartphone App-Based Exercise Program for Hemodialysis Patients

PURPOSE: To examine the effects of a smartphone application-based exercise program on self-efficacy expectations (SEE) and outcome expectations regarding exercise (OEE), physical fitness, activity level, physiological indices, and health-related quality of life in a sample of hemodialysis patients.METHODS: A quasi-experimental control group pre-test post-test design was used. Subjects were recruited from two university hospitals in G city. The subjects were assigned randomly by coin toss: 33 participants to the experimental group and 30 to the control group. A literature review and the self-efficacy theory were used to develop the smartphone program. Experts designed and verified the program to be userfriendly and in consideration of user interaction. Data were collected through a self-report pre-test post-test questionnaire and online medical records.RESULTS: In the experimental group, the levels of physical fitness and physical activity were significantly improved post-test, but the scores on health-related quality of life and the physical indices did not improve. In the experimental group, the SEE and OEE post-test scores were also significantly higher than the pre-test scores, but the control group's scores did not change.CONCLUSION: The smartphone application-based exercise program based on self-efficacy theory significantly improved the level of physical fitness and activity, SEE, and OEE for hemodialysis patients. The use of this application-based exercise program for hemodialysis patients might be an effective nursing intervention tool for improving SEE, OEE, level of physical fitness, and physical activity.

Experience of Hope in Terminal Cancer Patients: Applying Parse' s Human Becoming Methodology

PURPOSE: The purpose of this study was to explore the experience of hope of terminal cancer patients in Korea. METHODS: Seven participants receiving hospice care were interviewed about hope experiences based on Parse's research methodology. RESULTS: Practical propositions derived from the structure of the hope experience were: Terminal cancer patients are beings newly recognizing the value of their lives by maintaining their hopes while they are experiencing powerlessness due to feelings of loss and distress. Ways of truly being with them are accepting their experience of distress, understanding the existence of paradoxical relationships, active symptom management, and finding hope in the current situation. Through these processes, the patients restructure their remaining lives for peaceful death by changing their perceptions about death. This structure can be interpreted as 'the hope experience of terminal cancer patients is a process of changing the value of life, overcoming fear of death, enhancing meaning, and transcending.' CONCLUSION: The concept of 'true presence' applied in this study was proved to be an effective nursing practice improving quality of life of the patients. Parse's Human Becoming Methodology may be applied to terminal cancer patients in the future.

Factors Influencing Intention of Sexual Abstinence Among Female College Students Based on the Theory of Planned Behavior

PURPOSE: This study aimed to identify the factors that impact the intention of sexual abstinence among female college students. The approach was based on Ajzen's theory of planned behavior and the parent-adolescent communication of contextual factors. METHODS: A total of 189 female university students in the first to fourth grades at two universities in Honam region participated in the study. The collected data were analyzed using hierarchical stepwise multiple regression using SPSS 21.0. RESULTS: The major factor that influences the intention of sexual abstinence among female college students was attitudes toward sexual behavior (β=0.53, p<0.001). Other factors, in descending order of their impact, were subjective norms toward friends (β=0.25, p<0.001), experience of sexual intercourse (β=−0.19, p<0.001), and subjective norms toward parents (β=0.09, p=0.040). Taken together, the aforementioned factors explained 81.1 % of the total variance. CONCLUSION: Female college students' intention to abstain from sexual behaviors requires education promoting moderate and conservative positions. The participants' subjective norms concerning sexual behaviors as perceived by friends and parents were also important. The results of this study provide meaningful implications for education of parents, sexual education of female college students, and sexual counseling programs.

Influences of Occupational Stress, Ethical Dilemma, and Burnout on Turnover Intention in Hospital Nurses / 기본간호학회지

PURPOSE: The aim of this research was to identify the relationships between occupational stress, ethical dilemma, burnout and turnover intention and the factors influencing turnover intention in hospital nurses. METHODS: The participants, 215 nurses, were recruited from two university hospitals located in two provinces of Korea. Data were collected through self-report questionnaires. Collected data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients, and multiple regression with SPSS/WIN 22.0. RESULTS: Participants' scores for occupational stress, ethical dilemma, burnout and turnover intention were 3.96±0.45, 2.60±0.39, 3.71±0.70, and 3.50±0.90 respectively. The results show that the higher the score for occupational stress, ethical dilemma, and burnout the higher the score for turnover intention. The most important factor influencing turnover intention was burnout (β=.42, p < .001), followed by position (β=.21, p=.001), educational level (β=.21, p=.007), ethical dilemma (β=.13, p=.020) in that order. These factors explained 43.5% of total variance in turnover intention (F=19.34, p < .001). CONCLUSION: Changes in hospital structural management systems and support strategies should be developed and operated, taking into account burnout, ethical dilemma, and personal characteristics of clinical nurses in order to reduce turnover.

Reliability and Validity of the Korean Version of the Coping and Adaptation Processing Scale–Short-Form in Cancer Patients

PURPOSE: This study was conducted to assess the reliability and validity of the Korean version of the Coping and Adaptation Processing Scale-Short-Form in patients with cancer. METHODS: The original scale was translated into Korean using Brislin's translation model. The Korean Short-Form and the Functional Assessment Cancer Therapy-General were administered to 164 Korean patients with cancer using convenience sampling method. The collected data were analyzed using SPSS 23.0 and AMOS 23.0. Construct validity, criterion validity, test-retest reliability, and internal consistency reliability of the Korean Coping and Adaptation Processing Scale-Short-Form were evaluated. RESULTS: Exploratory factor analysis supported the construct validity with a four-factor solution that explained 60.6% of the total variance. Factor loadings of the 15 items on the four subscales ranged .52~.86. The four-subscale model was validated by confirmatory factor analysis (Normed χ2=1.38 (p=.013), GFI=.92, SRMR=.02, RMSEA=.05, TLI=.94, and CFI=.95), and criterion validity was demonstrated with the Functional Assessment Cancer Therapy-General. Cronbach's alpha for internal consistency of the total scale was .83 and ranged .68~.81 for all subscales, demonstrating sufficient test-retest reliability. CONCLUSION: The Korean version showed satisfactory construct and criterion validity, as well as internal consistency and test-retest reliability.

Structural Equation Modeling of Self-Care Behaviors in Kidney Transplant Patients Based on Self-Determination Theory

PURPOSE: The purpose of this study was to test a hypothesis explaining direct and indirect relationships among the factors affecting self-care behaviors of kidney transplant patients, based on self-determination theory. METHODS: Data were collected from 222 outpatients with kidney transplantation. The endogenous and exogenous variables of the hypothetical model consisted of healthcare provider's autonomy support, duration after kidney transplantation, basic psychological need satisfaction, autonomous and controlled motivation, depression, and self-care behaviors. Collected data were analyzed using SPSS/WIN 24.0 and AMOS 24.0. RESULTS: The hypothetical model demonstrated a good fit: RMSEA=.06, SRMR=.04, TLI=.94, CFI=.97. Statistically significant explanatory variables for the self-care behaviors of kidney transplant patients were duration after transplantation and basic psychological need satisfaction. Healthcare provider's autonomy support was indirectly significant, while autonomous motivation, controlled motivation and depression were not statistically significant for self-care behaviors. The variables accounted for 59.5% of the self-care behaviors of kidney transplant patients. CONCLUSION: It is necessary to develop an autonomy support program for healthcare providers to enhance the self-care behaviors of kidney transplant patients. Preventing the deterioration of self-care behaviors will be possible by conducting this program at one year and six years post-transplantation. In addition, the results suggest the need to developing personalized autonomy support programs for healthcare providers that can meet the basic psychological need satisfaction of kidney transplant patients.

Burnout amongst Nurses in Cancer Wards: Impact of Nursing Professionalism, Perfectionism, and Resilience

PURPOSE: This study aimed to investigate the relationship among nursing professionalism, perfectionism, resilience, and burnout, amongst nurses in cancer wards, and to further identify factors influencing burnout. METHODS: Conducted in June 2018, this descriptive cross-sectional study included 157 cancer wards nurses. The survey employed structured questionnaires including the Koreannursing Professional Value Scale, Multidimensional Perfectionism Scale, Dispositional Resilience Scale-15, and burnout subscale of the Professional Quality of Life Scale. Data were analyzed using descriptive statistics, independent t-tests, one-way ANOVA, Pearson's correlation coefficient, and entered multiple regression. RESULTS: The total burnout score was 31.20±4.87, out of a maximum of 50. Nursing professionalism (r =−.40, p < .001) and resilience (r=−.68, p < .001) showed a negative correlation with burnout, while socially-oriented perfectionism showed a positive correlation with burnout (r=.19, p=.016). Entered multiple regression revealed that 49.3% of the total variance in burnout was the consequence of nursing professionalism and resilience. CONCLUSION: Resilience had the largest effect on burnout, followed by nursing professionalism. We believe that the results of this study provide basic data for developing nursing intervention programs aimed at reducing burnout amongst nurses in cancer wards.

Reliability and Validity of the Korean Version of the Cancer Stigma Scale

PURPOSE: In this study the reliability and validity of the Korean version of the Cancer Stigma Scale (KCSS) was evaluated. METHODS: The KCSS was formed through translation and modification of Cataldo Lung Cancer Stigma Scale. The KCSS, Psychological Symptom Inventory (PSI), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 (EORTC QLQ-C30) were administered to 247 men and women diagnosed with one of the five major cancers. Construct validity, item convergent and discriminant validity, concurrent validity, known-group validity, and internal consistency reliability of the KCSS were evaluated. RESULTS: Exploratory factor analysis supported the construct validity with a six-factor solution; that explained 65.7% of the total variance. The six-factor model was validated by confirmatory factor analysis (Q (χ2/df)= 2.28, GFI=.84, AGFI=.81, NFI=.80, TLI=.86, RMR=.03, and RMSEA=.07). Concurrent validity was demonstrated with the QLQ-C30 (global: r=-.44; functional: r=-.19; symptom: r=.42). The KCSS had known-group validity. Cronbach's alpha coefficient for the 24 items was .89. CONCLUSION: The results of this study suggest that the 24-item KCSS has relatively acceptable reliability and validity and can be used in clinical research to assess cancer stigma and its impacts on health-related quality of life in Korean cancer patients.

The Effects of Puerperium Maternal Anxiety, Marital Relationships, and Depression on Late Postpartum Depression

PURPOSE: This study aimed to determine the effects of puerperium maternal anxiety, quality of marital relationship, and postpartum blues on late postpartum depression. METHODS: Participants were 130 postpartum women who delivered healthy babies, and answered self-administered questionnaires, such as Edinburgh Postpartum Depression Scale (EPDS-K), Spielberger's State Anxiety Inventory, and Quality of Marital Relationships during the 1st week of delivery and 4–6 weeks postpartum. Data were analyzed using t–test, ANOVA, Spearman's rho correlation coefficient, and hierarchical stepwise multiple regression analysis. RESULTS: The point prevalence of postpartum depression (EPDS-K ≥10, cut-off score) was 23.1% at early postpartum and 16.9% at late postpartum. Predictors of late postpartum depression were early postpartum depression (β=0.86), the difference between early and late postpartum anxiety (β=0.19), and the difference between early and late Quality of Marital Relationships (β=−0.13) (F=70.52, p<0.001). The total vatiance explained was 76.5%. CONCLUSION: It is recommended that a maternal management system should be established at maternity hospitals to screen new mothers' depression and anxiety risks during the early postpartum stage.

Factors Influencing Changes in Quality of Life in Patients undergoing Hematopoietic Stem Cell Transplantation: A Longitudinal and Multilevel Analysis

PURPOSE: This study was a prospective longitudinal study to identify changes in quality of life in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). It was based on Roy's adaptation model. METHODS: The questionnaires were administered before HSCT, 30 and 100 days after HSCT. Of the 48 potentially eligible patients, 44 (91.7%) participated in the study and 40 (90.9%) completed the questionnaires at 100 days after HSCT. Multilevel analysis was applied to analyze changes in quality of life. RESULTS: Overall, quality of life showed a decreasing tendency from pre-HSCT to 100 days after HSCT. The adaptation level of participants was compensatory. Type of conditioning was the significant factor influencing quality of life before HSCT (beta00=79.92, p <.001; beta01= - 12.64, p <.001) and the change rate of quality of life (beta10= - 1.66, p =.020; beta11=2.88, p =.014). Symptom severity (beta20= - 1.81, p =.004), depression (beta30= - 0.58, p =.001), social dependency (beta40= - 0.35, p =.165), and loneliness (beta50= - 0.23, p =.065) had a negative effect on changes in quality of life. Symptom severity and depression were statistically significant factors influencing changes in quality of life. CONCLUSION: According to the results of this study, the development of nursing intervention is needed to improve quality of life in patients undergoing allogeneic hematopoietic stem cell transplantation in the early immune reconstruction period. The interventions should include programs to enhance coping capacity and programs to help control symptom severity and depression. Also these interventions need to be started from the beginning of HSCT and a multidisciplinary approach would be helpful.

Recognition of Patients, Families, Nurses, and Physicians about Clinical Decision-making and Biomedical Ethics

PURPOSE: To identify the recognition of patients, families, nurses, and physicians about clinical decision-making and biomedical ethics. METHODS: Data were collected from October 23 to 30, 2012 using the structured questionnaires. A total of 200 data were analyzed using SPSS 20.0 version. RESULTS: Response about 'who should receive the first notice of a cancer diagnosis?' was significant difference statistically. Cancer patients had preferences to be notified their diagnosis first. Patients responded the person who made decision of treatment options would be physician first and then themselves. Families, nurses, and physicians answered that decision-maker would be both of patient and family. All four groups answered that the person who made decision about care-giver after discharge was patient and their family. Nurses and physicians who didn't aware of the advanced directive were over 30.0%, and patients and family who didn't aware of that were over 60.0%. Lastly, the rate of positive answer about making attempt of advanced directive after legalization was over 80.0%. CONCLUSION: Patient's attitude about making decisions is different from family's attitude. Nurses and physicians have to put emphasis on the patient's autonomy & self-determination and family members' needs.

Comparison of Blended Practicum Combined E-learning between Cooperative and Individual Learning on Learning Outcomes / 한국간호교육학회지

PURPOSE: This study was conducted to compare blended practicum with clinical and lab combined e-learning between cooperative and individual group on learning outcomes. METHOD: A total of 63 junior Nursing students were recruited from C University in G city from May, 2012 to June, 2012. Ten hours lab practicum for two weeks was provided for both two groups during the period of adult nursing practicum. Prior to blended practicum, e-learning was conducted. For cooperative group, two hours off line team learning with a tutor for eight weeks was provided, in other hands, for individual group, any off line team learning was not provided and self study on line was not evaluated by the tutor. RESULTS: The result of ANCOVA showed that critical thinking and self directed learning were significantly improved in the individual group compared to the cooperative group (F=-18.15, p<.001; F=28.12, p<.001). In other hands, clinical competence was significantly higher in the cooperative group than in the individual group (F=16.61, p<.001). CONCLUSION: Through development of self-leaning facilitating online contents, the blended practicum combined e-learning could be effective in critical thinking, self-directed learning and clinical competence. Further studies about e-learning strategies of off-line learning are still needed.

Reliability and Validity of the Korean Version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire to Assess Chemotherapy-induced Peripheral Neuropathy

PURPOSE: This study was performed to assess the reliability and validity of the Korean version of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Chemotherapy-induced peripheral neuropathy 20 items (EORTC QLQ-CIPN20) in patients receiving neurotoxic chemotherapy. METHODS: A convenience sample of 249 Korean cancer patients, previously or currently, being treated with peripheral neurotoxic chemotherapeutic agents were asked to fill in the questionnaire. Collected data were analyzed using SPSS 21.0 and AMOS 21.0. Construct validity, known-group validity, concurrent validity, and internal consistency reliability of the Korean version of the QLQ-CIPN20 were evaluated. RESULTS: Factor analysis confirmed 3 dimensions of CIPN: sensory, motor, and autonomic. The factor loadings of the 20 items on the 3 subscales ranged from .38 to .85. The 3 subscale-model was validated by confirmatory factor analysis (GFI=.90, AGFI=.86, RMSR=.05, NFI=.87, and CFI=.94), and concurrent validity was demonstrated with the EORTC QLQ-C30. Furthermore, the QLQ-CIPN20 established known-group validity. The Cronbach's alpha coefficients for internal consistency of the subscales ranged from .73 to .89. CONCLUSION: The Korean version of the EORTC QLQ-CIPN20 showed satisfactory construct, concurrent, and known-group validity, as well as internal reliability.

Related Factors to Quality of Life among Hospitalized Cancer Patients Undergoing Chemotherapy

PURPOSE: The purpose of this study was to identify relationships between quality of sleep, symptom cluster, depression, environmental disorder, and quality of life among hospitalized cancer patients. METHODS: The subjects were 114 patients who underwent chemotherapy for colon cancer, gastric cancer, gynecologic cancer and breast cancer. They were recruited from the cancer center of a university hospital. Data were collected from August 4th to 30th, 2011. The questionnaires included the Korean sleep scale A (quality of sleep), MDASI-K (symptom cluster), the environmental sleep disturbing scale, Zung's depression scale, and the Korean version of EORTC QLQ-C30. The collected data was analyzed by t-test, ANOVA, multiple regression analysis using the SPSS 19.0 program. RESULTS: Functional QOL was negatively associated with symptom QOL (r=-.798, p<.001). Symptom cluster, depression, & spouse (46.3%) were the most powerful predictors for functional QOL (46.3%) and symptom QOL (53.4%). CONCLUSION: It is evident that oncology nurses need to evaluate two dimensions of quality of life for cancer patients, for example, functional and symptom QOL. We recommend nurses develop specific protocols for relieving physical symptoms and alleviating depression, and furthermore test the effectiveness of them.

A Structural Model for Psychosocial Adjustment in Patients with Early Breast Cancer

PURPOSE: This study was done to propose a structural model to explain and predict psychosocial adjustment in patients with early breast cancer and to test the model. The model was based on the Stress-Coping Model of Lazarus and Folkman (1984). METHODS: Data were collected from February 18 to March 18, 2009. For data analysis, 198 data sets were analyzed using SPSS/WIN12 and AMOS 7.0 version. RESULTS: Social support, uncertainty, symptom experience, and coping had statistically significant direct, indirect and total effects on psychosocial adjustment, and optimism had significant indirect and total effects on psychosocial adjustment. These variables explained 57% of total variance of the psychosocial adjustment in patients with early breast cancer. CONCLUSION: The results of the study indicate a need to enhance psychosocial adjustment of patients with early breast cancer by providing detailed structured information and various symptom alleviation programs to reduce perceived stresses such as uncertainty and symptom experience. They also suggest the need to establish support systems through participation of medical personnel and families in such programs, and to apply interventions strengthening coping methods to give the patients positive and optimistic beliefs.

Randomized Controlled Trial for Preventing Stomatitis and Discomfort among Acute Leukemic Patients / 종양간호학회지

PURPOSE: This study compared the effect of two oral care agents on preventing stomatitis and discomfort for acute leukemic patients. METHODS: A total of forty patients was enrolled and randomly assigned to sodium bicarbonate or chlorhexidine group. WHO oral toxicity scale was used for measuring stomatitis and Beck's subjective oral discomfort scale for evaluating oral comfort. Data was collected from August 2009 to February 2010. The data was analyzed using Chi-square test, Fisher's exact test, and Mann-Whitney test. RESULTS: Data analyzed was thirty five one. The incidence of stomatitis was 47.4%, 68.8% in sodium bicarbonate and chlohexidine group respectively. The onset of stomatitis was about the 10th and 9th day after chemotherapy initiation, and the duration was 8.0 and 8.67 day respectively. The severity of stomatitis was highest on the 21st day after chemotherapy initiation. There were no statistical differences in the status of stomatitis and the levels of oral comfort during treatment periods. CONCLUSION: Nurses should routinely assess oral cavity and encourage patients to do oral care actively from second to third week after chemotherapy initiation. Also sodium bicarbonate agent can be recommended to for preventing stomatitis.

Analysis of Research Papers Published by Three Nursing Journals to Suggest the Direction of Journal of Korean Oncology Nursing / 종양간호학회지

PURPOSE: The purpose of this study was to analyze the research papers published in three nursing journals to suggest the direction for Journal of Korean Oncology Nursing (JKON). METHODS: To compare JKON with Journal of Korean Academic Society of Nursing Education and Cancer Nursing, all the research papers published in those three journals, 2010 were reviewed using an analysis criteria developed by the researchers, focusing on type of research, characteristics of authors and subjects, research design, data collection and analysis methods, sample size estimation, and ethical considerations regarding data collection. RESULTS: JKON lacked research papers which were supported by research funds, produced by multidisciplinary teams, addressing cancer survivors or patients with metastatic cancers, and written in qualitative methodologies. However, JKON showed higher ratio of research papers than the other two journals which were adapted from thesis or dissertations, describing sample size estimation process precisely, and participating subjects diagnosed with various cancers. CONCLUSION: The study found out that JKON is presenting well the area of oncology nursing in Korea and also has several weak points that need to be improved. The study therefore suggested several recommendations for the JKON to take the professional and global leader roles.

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.