A Decision Tree Model for Breast Reconstruction of Women with Breast Cancer: A Mixed Method Approach.

The number of breast reconstructions following mastectomy has increased significantly during the last decades, but women are experiencing a number of conflicts with breast reconstruction decisions. The aim of this study was to develop a decision tree model of breast reconstruction and to examine its predictability. Mixed method design using ethnographic decision tree modeling was used. In the qualitative stage, data were collected using individual and focus group interviews and analyzed to construct a decision tree model. In the quantitative stage, the questionnaire was developed questions based on the criteria identified in the qualitative stage. A total of 61 women with breast cancer participated in 2017. Five major criteria: recovery of body image; impact on recurrence; recommendations from others; financial resources; and confirmation by physicians. The model also included nine predictive pathways. It turns out that the model predicted 90% of decisions concerning whether or not to have breast reconstruction. The findings indicate that the five criteria play a key role in decision-making about whether or not to have breast reconstruction. Thus, more comprehensive issues, including these five criteria, need to be integrated into an intervention for women with breast cancer to make their best decision on breast reconstruction.

Illness Experiences of Adults with Spina Bifida: Protecting the Whole Self.

PURPOSE: To understand and describe the illness experiences of adults with spina bifida (SB) which is an incurable birth defect and chronic condition that must be managed throughout life. METHODS: A qualitative study using grounded theory was adopted. Data were collected through individual interviews with 16 adults with SB between 2016 and 2017 in South Korea. All interviews were audiotaped, and the transcribed data were analyzed using constant comparative analysis. RESULTS: The basic socio-psychological process that underlies the illness experiences of adults with SB was identified as protecting the whole self. This consists of three stages: strict self-concealment, attempting self-disclosure, and balancing between self-concealment and self-disclosure. These stages reveal a process of establishing a firm sense of self by freeing oneself from the shame and stigma of society. Three different patterns of living emerged as a result: living as a non-disabled person, living as a marginal person between non-disabled and disabled, and living as a disabled person. CONCLUSION: Adults with SB struggle to protect their whole self while managing their chronic conditions by having to constantly balance between self-concealment and self-disclosure. Intervention for adults with SB needs to be based on the stage of sociopsychological maturation. In the early stage, intervention needs to be focused on self-concealment to help establish a firm sense of self. On the other hand, in the later stage when psychological maturity occurs, an intervention that focuses on self-disclosure would be helpful so as not to be isolated from society.

Pain and Menopause Symptoms of Breast Cancer Patients with Adjuvant Hormonal Therapy in Korea: Secondary Analysis.

OBJECTIVE: The purpose of this study was to describe the prevalence and levels of pain and menopause symptoms of breast cancer patients with adjuvant hormonal therapy (HT). METHODS: A cross-sectional survey design was used. Secondary analysis was used from the primary data collected in 2013 from a total of 110 breast cancer patients receiving HT for more than 3 months, using questionnaires of the Korean version of brief pain inventory and the menopause rating scale. RESULTS: Mean age of the participants was 53.56. Most (88.2%) of the participants reported to have pain and almost (95.5%) of them reported to have menopause symptoms. More pain was reported in participants with aromatase inhibitor (AI) than those with tamoxifen. Adherence to HT showed a significant difference according to the rate of feeling increased pain (P = 0.001). Among the menopause symptoms, fatigue was the most common symptom (97.3%). Sweating/flush was significantly higher in tamoxifen group (P < 0.005), and joint and muscle complaints were higher in AI group (P < 005). CONCLUSIONS: The results of the study show that the prevalence and levels of pain and menopause symptoms among breast cancer patients receiving HT were high. Thus, oncology professionals need to provide appropriate interventions to relieve pain and menopause symptom to improve adherence to HT.

Correction to: Oncology practitioners' perspectives and practice patterns of post-treatment cancer survivorship care in the Asia-Pacific region: results from the STEP study.

It has been highlighted that the original manuscript [1] contains a typesetting error in the surname of Jesson Butcon. This was incorrectly captured as Jessica Butcon in the original manuscript which has since been updated.

An Emerging Integrated Middle-Range Theory on Asian Women's Leadership in Nursing.

INTRODUCTION: Asian cultures reflect patriarchal cultural values and attitudes, which likely have influenced women leaders in their countries differently from women in Western cultures. However, virtually no leadership theories have been developed to reflect the experiences and development of nursing leaders from Asian cultures. The purpose of this article is to present an emerging integrated middle-range theory on Asian women's leadership in nursing. METHODOLOGY: Using an integrative approach, the theory was developed based on three major sources: the leadership frames of Bolman and Deal, literature reviews, and exemplars/cases from five different countries. RESULTS: The theory includes two main domains (leadership frames and leadership contexts). The domain of leadership frames includes human resources/networks, structure/organization, national/international politics, and symbols. The domain of leadership contexts includes cultural contexts, sociopolitical contexts, and gendered contexts. DISCUSSION: This theory will help understand nursing leadership in Asian cultures and provide directions for future nurse leaders in this ever-changing globalized world.

Leadership in Nursing in Korea.

Nurses are the largest workforce that impacts the health of the people. As the life expectancy and the number of people with chronic diseases increases in Asia, it is important for Asian nursing professionals to play a pivotal role in improving health status and quality of life by demonstrating their leadership. This article focuses on nursing leadership in Korea. Leadership exemplars were described in detail to show how successful nursing leaders set goals and challenged to meet these goals, despite numerous obstacles that exist in male-oriented society of Korea. And three essential elements that future nurse leaders should consider were suggested. First, awareness was emphasized as the first step to becoming a leader. Clear awareness about women and nursing would help nursing leaders reduce or eliminate gender biases that can undermine nurses' achievements and limit their advancement. Second, challenge was stressed as nursing leaders must challenge and expand the horizon of nursing by facing their situations and problems with courage. Lastly, transformation was highlighted, as the ultimate role of a leader is to make the world better. Four leadership frames-structural frame, human resource frame, political frame, and symbolic frame-were introduced to help guide their leadership journey to change the world. The results of this study would help nurses innovate with excellent leadership by efficiently managing nursing resources and by helping nursing organizations to adjust to changing demands in health care.

Oncology practitioners' perspectives and practice patterns of post-treatment cancer survivorship care in the Asia-Pacific region: results from the STEP study.

BACKGROUND: Most efforts to advance cancer survivorship care have occurred in Western countries. There has been limited research towards gaining a comprehensive understanding of survivorship care provision in the Asia-Pacific region. This study aimed to establish the perceptions of responsibility, confidence, and frequency of survivorship care practices of oncology practitioners and examine their perspectives on factors that impede quality survivorship care. METHODS: A cross-sectional survey of hospital-based oncology practitioners in 10 Asia-Pacific countries was undertaken between May 2015-October 2016. The participating countries included Australia, Hong Kong, China, Japan, South Korea, Thailand, Singapore, India, Myanmar, and The Philippines. The survey was administered using paper-based or online questionnaires via specialist cancer care settings, educational meetings, and professional organisations. RESULTS: In total, 1501 oncology practitioners participated in the study. When comparing the subscales of responsibility perception, frequency and confidence, Australian practitioners had significantly higher ratings than practitioners in Hong Kong, Japan, Thailand, and Singapore (all p < 0.05). Surprisingly, practitioners working in Low- and Mid- Income Countries (LMICs) had higher levels of responsibility perception, confidence and frequencies of delivering survivorship care than those working in High-Income Countries (HICs) (p < 0.001), except for the responsibility perception of care coordination where no difference in scores was observed (p = 0.83). Physicians were more confident in delivering most of the survivorship care interventions compared to nurses and allied-health professionals. Perceived barriers to survivorship care were similar across the HICs and LMICs, with the most highly rated items for all practitioners being lack of time, dedicated educational resources for patients and family members, and evidence-based practice guidelines informing survivorship care. CONCLUSIONS: Different survivorship practices have been observed between HICs and LMICs, Australia and other countries and between the professional disciplines. Future service planning and research efforts should take these findings into account and overcome barriers identified in this study.

[Hermeneutic Phenomenological Study on Caring Experience of Spouses of Elderly People with Dementia at Home].

PURPOSE: This study aimed to understand and describe the caring experiences of spouses of elderly people with dementia. METHODS: The hermeneutic phenomenological method was used and participants were 12 spouses aged 65 and over who were taking care of their husbands or wives with dementia at home. Data were collected from individual in-depth interviews on participants' actual caring experiences. Additionally, novels, movies, and memoirs on elderly couples with partner who had dementia were included as data for the analysis. The qualitative data analysis software program was used to manage and process the collected qualitative data. Data were analyzed using hermeneutic phenomenological analysis based on four fundamental existentials including lived body, lived space, lived time, and lived others. RESULTS: Five essential themes emerged from the analysis: 1) body moving like an old machine, 2) swamp of despair filling with hope, 3) sweet time after bitterness, 4) disappointed elderly couple in the empty nest, and 5) unappreciation vs. empathetic feelings. These essential themes were comprehensively summarized as "the road leading to the maturation of life with dedication and hope while bearing the weight of caring based on the couple's relationship." CONCLUSION: The findings indicate that the nature of the caring experience of spouses of elderly individuals with dementia is filled with many dynamic and paradoxical dimensions. Thus, results of the study would help with developing interventions tailored specifically for elderly spouse caregivers to support their role adaptation and ultimately improving their quality of life.

[Hermeneutic Phenomenological Study on Caring Experience of the Mothers of Children with Epilepsy].

PURPOSE: The purpose of this study was to develop a deeper understanding of the experience of mothers caring for children with epilepsy. METHODS: Data were collected through individual in-depth interviews and observation from 12 mothers of children with epilepsy. Data were collected from December, 2014 to February, 2015 and analyzed using van Manen's hermeneutic phenomenological methodology to identify essential themes of their experience. RESULTS: The essential themes that fit into the context of the 4-existential grounds of time, body, other people, and space were: Lived time-ongoing influence of the past, living in insecure present, fearful future with no answer; Lived body-bonded body, burned out state; Lived other-burden but also support, shrunken down; Lived space-narrowed range of activity, widened horizon. CONCLUSION: The findings in this study show in-depth understanding of the hardships of mothers who are caring for children with epilepsy. The beauty and greatness of these mothers are revealed through the analysis of various phenomenological materials such as literary and artistic work reflecting socio-cultural context, as well as vivid care experiences of mothers of children with epilepsy. This will be helpful in increasing understanding of the nature of caregivers' experience for medical professionals dealing with patients and caregivers. Also it helps to improve the understanding of the disease among the general public, followed by a more warming and caring attitude towards patients and family members. Finally, it will enhance psychological well-being and overall quality of life of the epileptic children and their families.

[The Lived Experience of Patients with Heart Transplantation: A Phenomenological Study].

PURPOSE: The purpose of this study was to describe the lived experience of patients with heart transplantation in Korea. METHODS: Individual indepth interviews and a focus group interview were used to collect the data from nine patients who had heart transplantations in 2015. All interviews were audio-taped and verbatim transcripts were made for the analysis. Data were analyzed using Colaizzi's phenomenological method. RESULTS: Among the nine participants, eight were men. Mean age was 57.30 years. Six theme clusters emerged from the analysis. 'Joy of rebirth obtained by good luck' describes the pleasure and expectation of new life after narrow survival. 'Suffering from adverse drug effects' illustrates various psychosocial difficulties, such as low self-esteem, helplessness, alienation, and burnout, arising from the side effects of medications. 'Body and mind of being bewildered' illustrates disintegrated health and haunting fear of death. 'Alienation disconnected with society' describes isolated feeling of existence due to misunderstandings from society. 'Suffering overcome with gratitude and responsibility' includes overcoming experience through various social supports and suitable jobs. Finally, 'acceptance of suffering accompanied with new heart' illustrate changed perspective of life itself. CONCLUSION: The findings in this study provide deep understanding and insights of the lived experience of heart related illness for these patients and should help in the development of tailored-interventions for patients with heart transplantation.

Creating a Culture of Professional Development for Oncology Nursing in Asia.

The importance of professional development of oncology nursing in Asia is growing along with growth in the cancer burden and disparity in cancer incidence and mortality between more- and less-developed regions, the latter of which includes most Asian countries. This paper proposes ways to advance the oncology nursing in terms of education, practice, and research in Asia. It also describes major challenges expected in developing and implementing a unique professional role for oncology nurses in Asia. This study will provide insights for Asian oncology nurses in developing culturally sensitive oncology nursing practices with limited health care resources.

Tailoring communications to the evolving needs of patients throughout the cancer care trajectory: a qualitative exploration with breast cancer patients.

BACKGROUND: Doctor-patient communication is a crucial aspect of patient care. This study explored the communication experience of patients in a cancer consultation over the course of the cancer continuum. METHODS: In-depth interviews with seven breast cancer patients were carried out. RESULTS: Themes related to communication experiences across the five phases of cancer consultation, from diagnosis to recurrence, were identified. The most salient issue is that patients also perceived cancer as 'a disease of the mind', which is not adequately cared for in consultation. This highlights the notion that cancer care providers should provide appropriate care for the psychological dimensions of the cancer experience with an empathic and sincere attitude during consultations. To this end, non-verbal aspects of communication that convey caring, support, and respect seem important. Furthermore, patients perceived that the consultation time was far shorter then they needed and reported that they felt pressured for time. Moreover, the stance taken by patients and the needs and preferences of patients varied across the phases of the cancer trajectory. As patients progressed through the phases of their treatment, they assumed more active roles in the course of their care and the need for more detailed information and questioning increased. Thus, ensuring that patients have opportunities to ask questions in the consultation is important. CONCLUSION: Current findings suggest that the efficacy of communication varies depending on which phase patients are in and that effective communication should be tailored to these evolving needs and preferences of breast cancer patients. Also, patients perceived that the consultation did not adequately address their need for information related to their care or their emotional issues associated with the cancer experience. It is therefore important to address their needs by paying particular attention to non-verbal aspects of communication that convey empathy and respect toward patients, as well as allowing patients to ask questions.

[Decision Making Experience on Breast Reconstruction for Women with Breast Cancer].

PURPOSE: The purpose of this study was to explore decision making experiences of Korean women with breast cancer who underwent breast reconstruction with/after a mastectomy. METHODS: Data were collected during 2015-2016 through individual in-depth interviews with 10 women who had both mastectomy and breast reconstruction, and analyzed using phenomenological method to identify essential themes on experiences of making a decision to have breast reconstruction. RESULTS: Five theme clusters emerged. First, "expected loss of sexuality and discovery of autonomy" illustrates various aims of breast reconstruction. Second, "holding tight to the reputation of doctors amid uncertainty" specifies the importance of a trust relationship with their physician despite a lack of information. Third, "family members to step back in position" describes support or opposition from family members in the decision making process. Fourth, "bewilderment due to the paradox of appearance-oriented views" illustrates paradoxical environment, resulting in confusion and anger. Lastly, "decision to be made quickly with limited time to oneself" describes the crazy whirling process of decision making. CONCLUSION: Findings highlight aims, worries, barriers, and facilitators that women with breast cancer experience when making a decision about breast reconstruction. Deciding on breast reconstruction was not only a burden for women in a state of shock with a diagnosis of breast cancer, but also an opportunity to decide to integrate their body, femininity, and self which might be wounded from a mastectomy. These findings will help oncology professionals provide effective educational counselling before the operation to promote higher satisfaction after the operation.

[Factors Influencing Quality of Life during Chemotherapy for Colorectal Cancer Patients in South Korea].

PURPOSE: The purpose of this study was to investigate the levels of physical symptoms, anxiety, depression, and quality of life (QOL) during chemotherapy for colorectal cancer patients in South Korea and to identify factors influencing their QOL. METHODS: Data were collected from 144 colorectal cancer patients receiving chemotherapy during 2012 at one general hospital located in Seoul. Physical symptoms were measured by the M. D. Anderson Symptom Inventory-Gastrointestinal Cancer Module, and anxiety and depression were measured by the Hospital Anxiety Depression Scale. QOL was measured by the Functional Assessment of Cancer Therapy-Colorectal. Data were analyzed using descriptive statistics, t-test, one-way ANOVA, Scheffé post hoc test, Pearson correlation and stepwise multiple regression. RESULTS: Mean age of the participants was 56.6 and most of them were not employed. In terms of cancer stage, 38.2% were in stage 3, followed by stage 4 (34.7%). The most frequent symptom was lack of appetite, followed by sleep disturbance and fatigue. The mean score for anxiety was 5.40 with a prevalence of 23% and that of depression 8.85 with a prevalence of 64.6%. The mean score for quality of life was 81.93 out of 136 and 75.3% of the variance in QOL was explained by depression, symptoms, anxiety, treatment place, and occupational status. Depression was the strongest predictive factor. CONCLUSION: Oncology professionals need to pay special attention to relieving depression as well as physical symptoms to improve QOL during chemotherapy for colorectal cancer patients.

Unmet needs and quality of life of family caregivers of cancer patients in South Korea.

OBJECTIVE: The purpose of this study was to investigate the levels of unmet needs and quality of life (QOL) among family caregivers (FCs) of cancer patients and to characterize the relationship between unmet needs and QOL. METHODS: A descriptive correlation design was used. Data were collected by convenience sampling during 2013 from 191 FCs of cancer patients who visited an outpatient cancer center in a general hospital in Korea. The comprehensive needs assessment tool for cancer-caregivers and the Korean version of the Caregiver QOL Index-Cancer were used to measure unmet needs and QOL, respectively. RESULTS: FCs of cancer patients had a variety of unmet needs with prevalence ranged from 57.0% to 88.9%, depending on the domain. The domain with the highest prevalence of unmet needs was healthcare staff, followed by information/education. The mean QOL score was 74.62, with a possible range of 0-140. A negative correlation was found between unmet needs and QOL. Stepwise multiple regression analysis showed that unmet needs relating to health/psychological problems, practical support, family/social support, in addition to household income, cohabitation with the patient, and patient's age, explained 52.7% of the variance in QOL. The most influential factor was unmet needs relating to health/psychological problems, which accounted for 35.7% of the variance. CONCLUSIONS: The results of this study indicate that oncology professionals need to develop interventions to improve the QOL of FCs by focusing not only on information/educational needs of patient care but also on physical and psychological needs of FCs.

Psychosocial needs of low-income people with cancer in Korea.

PURPOSE: The purpose of the study was to investigate significant psychosocial needs of low-income people with cancer in Korea and the extent to which these needs are unmet and which factors influence them. METHODS: A descriptive study with a cross-sectional design was used. The data were collected by questionnaires from a convenience sample of 238 low-income people with cancer during 2009. A psychosocial needs inventory consisting of 7 categories with 48 items was used to identify significant psychosocial needs and unmet needs. Unmet psychosocial needs were defined to the needs that the participants reported as both important and unsatisfied. Influencing factors defined with multivariate regression analysis. RESULTS: "Health professionals" was the most important needs category, followed by "information. Among the 48 items, 37 were identified to be important or very important by more than 50% of the participants. All 37 important psychosocial needs were also identified to be unmet needs. "Emotional and spiritual" was the most unmet psychosocial needs category, followed by "practical matters" and "identity" categories. The most unmet need item was 'help with financial matters' (50.0%). The strongest influencing factor was 'no one to talk with'. CONCLUSION: Low-income people with cancer experience high levels of unmet needs across a wide range of psychosocial needs. They need to be supported not only for practical matters but also for emotional and spiritual areas. The results provide a first step towards a development of interventions tailored to meet psychosocial needs and expectations of low-income people with cancer.

[Structural equation modeling on quality of life in older adults with osteoarthritis].

PURPOSE: The aim of this study was to explore how individual factors, physiologic factors, symptoms, environmental factors, functional status and health perception predict the quality of life (QOL) for older adults with osteoarthritis and to provide guidelines for interventions and strategies to improve QOL in these patients. The conceptual model was based on the Wilson and Cleary's Model. METHODS: Data were analyzed using SPSS WIN 20.0 and AMOS 19.0 program. RESULTS: The proposed model was a good fit for the data based on the model fit indices. Based on the constructed model, individual factors, social support, functional status and health perception were founded to have direct effects on QOL. Symptom had a indirect effect on QOL. Social support had a significant effect on QOL, and this model explained 63.6% of the variance in QOL. CONCLUSION: The results of this study suggest that nursing strategies to increase QOL in this population should contain social support to promote QOL and manage functional limitations and health perception.

[Factors influencing quality of life in patients with breast cancer on hormone therapy].

PURPOSE: The purpose of the study was to identify degrees of pain, menopause symptoms, and quality of life, and to identify factors influencing quality of life of patients with breast cancer who were on hormone therapy. METHODS: A cross-sectional survey design was utilized. Data were collected using questionnaires from 110 patients with breast cancer who had been on hormone therapy for 3 months or more and were being treated at a university hospital in Seoul. Data were analyzed using χ²-test, t-test, ANOVA, Pearson correlation coefficient and multiple linear regression. RESULTS: Mean age of the participants was 53.56 (SD=6.67) and 54 (51.4%) had stage 0 or I at the time of diagnosis. Most of the participants reported having pain and menopause symptoms (88.2% and 95.5% respectively). The mean score for quality of life was 87.84±21.17. Pain, menopause symptoms and quality of life had strong correlations with each other (p<.005). Quality of life was explained by menopause symptoms (ß=-.71), economic status (ß=.20) and occupation (ß=.16). CONCLUSION: The results of the study suggest that menopause symptoms should be incorporated into oncologic nursing care to improve quality of life of patients with breast cancer on hormone therapy.

[Overcoming experiences of family members caring for elderly patients with dementia at home].

PURPOSE: The purpose of the study was to understand and describe the overcoming experiences of family members caring for elderly patients with dementia at home. METHODS: Data came from autobiographies on the overcoming experiences of caregiving from 31 participants, who had submitted the autobiographies to a public contest held by the Seoul Metropolitan Center for Dementia in 2012. Data were analyzed using qualitative content analysis. RESULTS: Four overcoming stages emerged from the analysis: confronting stage; challenging stage; integrating stage; and transcendental stage, representing transformation of experiences from frustration and suffering to happiness and new hope in life. The confronting stage illustrates severe negative feelings and exhaustion occurring after the diagnosis of dementia. The challenging stage signifies major driving forces in taking good care of their patients. It includes tender loving memories about the patients as well as family and social supports. The integrating stage shows genuine empathy for the patients' situation and the happiness of 'here and now', while the transcendental stage represents new hope in the future. CONCLUSION: Health professionals need to support caregivers to find true meaning of caring and happiness in everyday life, while providing specific information on dementia care and relieving various negative feelings.

Factors influencing health-promoting behaviors in Korean breast cancer survivors.

PURPOSE: The purpose of this study was to examine the relationships among internal health locus of control, depression, social support, and health-promoting behaviors in Korean breast cancer survivors and to identify factors influencing health-promoting behaviors. METHOD: A predictive design was used. The data were collected by questionnaires from a convenience sample of 258 breast cancer survivors in Korea during 2007. The data were analyzed using descriptive statistics, t-tests, one-way ANOVA, Pearson's correlation coefficients, and stepwise multiple regression. RESULTS: When differences of health-promoting lifestyle based on demographic and illness-related characteristics were examined, no significant differences were found except for undergoing chemotherapy. Internal health locus of control, depression, and social support were correlated significantly with the health-promoting lifestyle. As a result of stepwise multiple regression analysis, social support, depression, and chemotherapy were discovered to account for 34.98% of the variance in health-promoting lifestyle. The variable that most affected a health-promoting lifestyle was social support, followed by chemotherapy and depression. CONCLUSIONS: The results of the study clearly demonstrate the importance of social support and depression in explaining the occurrence of a health-promoting lifestyle among Korean breast cancer survivors.