Exploring Meaning in the Life of Chinese Breast Cancer Survivors

Spiritual needs of women with breast cancer: A structural equation model

PURPOSE

The purpose of this study was to develop a structural equation model (SEM) to explore the factors influencing the spiritual needs of breast cancer patients.

METHODS

A cross-sectional study was conducted in the breast surgery department of a tertiary hospital in China from September 2020 to December 2020; convenience sampling and questionnaires were used to facilitate sampling and data collection. A total of 220 female breast cancer patients were included in the study. The data were analysed using multiple linear regression and structural equation modelling.

RESULTS

Compared with patients with other diseases, patients with breast cancer have greater spiritual needs (76.16 ± 13.19). Multivariate analysis revealed that religious beliefs, education level, social support, and resilience are important factors affecting the mental health of women with cancer (p < 0.05). The structural equation model fit well (RMSEA = 0.056, χ2p = 0.002). Social support directly affected spiritual needs (β = 0.607, p < 0.001) and indirectly affected spiritual needs through resilience (β = 0.353, p < 0.001). Resilience directly affected spiritual needs (β = 0.386, p < 0.05). Education level indirectly affected spiritual needs through social support (β = 0.307, p < 0.001).

CONCLUSION

This study provides a theoretical basis for intervention measures to improve the spiritual needs of female breast cancer patients. Paying more attention to social support and resilience may help solve the problem of meeting the high spiritual needs of breast cancer patients. Further research is needed to develop interventions.

The mediating effect of perceived social support between family resilience and meaning in life in breast cancer patients

PURPOSE

The beneficial effects of family resilience and meaning in life on patients are established, but limited is known for the effect of perceived social support. We aim to investigate the impact of family resilience on the meaning of life among Chinese patients with breast cancer (BC) and to further detect whether perceived social support mediated this association.

METHODS

From February to June 2022, we conducted this cross-sectional study with 276 women who were diagnosed with BC in a tertial hospital in Guangdong province, China. The Chinese version of Meaning in Life Scale (C-MiLS) was used to measure the meaning in life. The Chinese version of the family resilience assessment scale (C-FRAS) and the perceived social support scale (PSSS) were adopted to obtain the family resilience and perceived social support, respectively. The mediating effect of perceived spousal support was estimated using the bootstrapped confidence interval (CI) via IBM SPSS AMOS 22.0.

RESULTS

The mean scores were 60.79 ± 11.63 for meaning in life, 82.08 ± 11.48 for family resilience, and 62.72 ± 12.19 for perceived social support, respectively. Our results indicated the positive correlations of meaning in life with family resilience (β = 0.822, P < 0.05) and perceived social support (β = 0.886, P < 0.05). The perceived social support exerted the mediating effect in the relationship between family resilience and meaning in life (β = 0.368 [95%CI, 0.274, 0.450], P < 0.001), accounting for 54.6% of the variance in meaning in life.

CONCLUSIONS

Our findings highlight that family resilience and perceived social support should be enhanced for BC patients to improve their meaning in life. In particular, the association between family resilience and meaning in life was positively mediated by perceived social support. Thus, interventions for improving family resilience and perceived social support might be useful in easing psychological distress and improving meaning in life in individuals with BC.

Psychological distress in adult women of reproductive age at different stages after breast cancer diagnosis: A qualitative study

AIM

To explore the actual experience of psychological distress of adult women of reproductive age at different stages after breast cancer diagnosis.

DESIGN

Qualitative.

METHODS

Eighty-one patients with breast cancer-related distress thermometer scores >4 were selected using a purposive sampling method. Patients were divided into newly diagnosed and 1-, 3-, 6-, 9- and 12-month groups according to time since diagnosis and then interviewed. A phenomenological approach was adopted to analyse interview content, and different themes were extracted.

RESULTS

Women exhibited different levels of psychological distress depending on the time since diagnosis, with newly diagnosed patients showing the highest distress. Within 1 year post-diagnosis, different events caused patients distress. Themes extracted at new diagnosis and 1-, 3-, 6-, 9- and 12 months post-diagnosis included sadness and disbelief, loss of control, optimistic but concerned, physical and mental exhaustion, difficulties returning to society and limited sexual intimacy, respectively; all groups expressed reproductive concerns.

CONCLUSION

Clinical nurses should focus on different psychologically distressing events to provide targeted interventions at distinct phases. For women of childbearing age, clinical nurses should pay particular attention to patients' marriage and reproductive concerns.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

During the year after a breast cancer diagnosis, patients of childbearing age experience events that cause psychological distress that differ depending on time since diagnosis. Nurses should focus on core stressful events and perform specific nursing interventions.

IMPACT

To provide holistic care, nurses should consider the psychological and emotional changes patients may undergo. For women of childbearing age, clinical nurses should pay particular attention to patients' marriage and fertility concerns, and be able to provide evidence-based professional guidance on reproductive preservation techniques.

REPORTING METHOD

The study was reported using the consolidated criteria for reporting qualitative research guidelines.

PATIENT OR PUBLIC CONTRIBUTION

Patients contributed to data collection through interviews.

The Farsi version of meaning of life in Iranian patients with cancer: A psychometric study

BACKGROUND

Having meaning in life is a protective factor for psychological well-being. Accurate assessment of this construct needs a valid and reliable tool.

PURPOSE

This study aims to evaluate the psychometric properties of the Farsi version of the meaning of life questionnaire in patients with cancer.

METHOD

In this cross-sectional study, after translating the questionnaire to Farsi, in a sample of 212 patients with cancer, feasibility, content and convergent validity, exploratory and confirmatory factor analysis, internal consistency, stability, and responsiveness were evaluated.

RESULTS

The results show that the content validity ratio of all ten items was greater than 0.49. Also, the modified Kappa coefficient of each item was greater than 0.6. The maximum likelihood exploratory factor analysis extracted one factor, which explains 76.13% of the total variance of the sample. Item nine was removed. The confirmatory factor analysis results show that the one-factor model had good fit indices. The Cronbach's alpha, McDonald's omega, composite reliability, MaxR, and intraclass correlation coefficient were 0.96, 0.96, 0.96, 0.96, and 0.98, respectively. The questionnaires had responsiveness and its response time was 3 s.

CONCLUSION AND POLICY SUMMARY

The nine-item Farsi version of the meaning of life questionnaire has good validity and reliability and responsiveness.

Association Between Primary Decision-Maker and Care Intensity Among Patients With Advanced Cancer in Mainland China

Purpose: In China, decisions regarding the treatment of seriously ill patients are usually made by family caregivers. This study aimed to explore the association between the primary decision-makers and the intensity of care given to patients with advanced cancer in China. Methods: We conducted a survey of family members and other caregivers representing 828 cancer patients who died between July 2013 and July 2016. The survey asked: "After the physician conveyed that the disease is incurable, what treatment did the patient and caregiver prefer?" and "Who was the primary decision-maker?" We compared the treatment intensity with locus of decision-making using multivariable logistic regression, adjusting for socio-demographic and clinical covariates informed. Results: Of the 792 patients in our sample, the majority were male (67·2%), 60 years or older (64·0%), married (82·2%), lived with family (98·2%), had medical insurance (94·8%), earned below-average income (53·5%), lived rurally (61·5%), had a gastrointestinal cancer diagnosis (50·8%), experienced moderate or severe pain (86·3%), never received palliative care (80·4%) and had caregivers as primary decision-makers (70·6%). We found that patients were more likely to receive intensive disease-modifying treatments when the primary decision-maker were their children (adjusted odds ratio [AOR] = 1·86, 95% CI:1·26-2·74), spouse (AOR = 2·04, 95% CI:1·26-3·30), or other caregivers (AOR = 3·46, 95% CI:1·24-9·69). Conclusions: When patients with advanced cancer in China did not make their own medical decisions, they were more likely to receive intensive disease-modifying treatments at the end-of-life. Actions should be taken to better understand and ensure that caregivers' decisions reflect the values and presence of patients.

Moderating effects of suicide resilience and meaning in life on the association between entrapment and suicidal ideation in Chinese patients with ovarian cancer: a cross-sectional study

BACKGROUND

Numerous studies have confirmed that patients with ovarian cancer have a relatively high risk of suicidality. Early identification of psychological factors related to suicidal ideation in patients with ovarian cancer may provide effective information for suicide prevention strategies. This study aimed to investigate whether and how suicide resilience and meaning in life moderate the relationship between entrapment and suicidal ideation in patients with ovarian cancer.

METHODS

This was a cross-sectional investigation was conducted in 505 Chinese patients with ovarian cancer. Patients completed a battery of self-reported questionnaires that included the General Information Questionnaire, and Chinese versions of the Entrapment Scale, Scale for Suicidal Ideation, Suicide Resilience Inventory-25, and Meaning in Life Scale. Descriptive statistics, Pearson' s chi-square, Pearson' s correlation, and hierarchical multiple linear regression analysis were performed.

RESULTS

In this study, the prevalence of suicidal ideation reported by patients with ovarian cancer was 32.07%. Patients' suicidal ideation could be explained by the following three predictors: entrapment × suicide resilience × meaning in life (β = -0.169, p < 0.001), entrapment × suicide resilience (β = -0.148, p < 0.001), and entrapment × meaning in life (β = -0.107, p = 0.005).

CONCLUSION

These findings suggest that ovarian cancer patients are prone to suicidal ideation when they feel a sense of entrapment. Enhancing patients' suicide resilience and meaning in life may be two targeted interventions to reduce suicidal ideation in ovarian cancer patients. In particular, considering both the protective effects of suicide resilience and meaning in life may yield better suicide prevention outcomes than considering only one of these factors.

Higher family and individual resilience and lower perceived stress alleviate psychological distress in female breast cancer survivors with fertility intention: a cross-sectional study

PURPOSE

The aim of this study was to explore how family resilience and individual resilience reduce perceived stress and psychological distress in young female breast cancer survivors with fertility intention.

METHODS

From June 2020 to June 2021, female breast cancer survivors were selected from the cancer centers of 10 tertiary Level A general hospitals in five cities of Sichuan Province. The survivors completed the Chinese versions of the Family Resilience Assessment Scale, Connor-Davidson Resilience Scale, Perceived Stress Scale, and a self-report distress thermometer. A multiple mediation effects test and structural equation modeling were used to explore the relationships among family resilience, individual resilience, perceived stress, and psychological distress.

RESULTS

The direct effect of family resilience on perceived stress was β = -0.320 (95% confidence interval -0.365, -0.271, P < 0.01). The direct effect of family resilience on psychological distress was β = -0.263 (95% confidence interval -0.363, -0.153, P < 0.001). The direct effect of family resilience on individual resilience was β = 0.593 (95% confidence interval 0.542-0.640, P < 0.001). The indirect effect of family resilience on psychological distress was β = -0.322 (95% confidence interval -0.373, -0.274, P < 0.001). Both perceived stress and individual resilience mediated the relationship between family resilience and psychological distress. Furthermore, a partial mediating effect of perceived stress and individual resilience on family resilience and psychological distress was observed.

CONCLUSION

Young female breast cancer survivors in China experience moderate levels of psychological distress.

A grounded theory of resilience experiences of women with gynecological cancer

PURPOSE

The present study aims to develop an explanatory framework to gain a deeper understanding of the resilience process in women diagnosed with gynecological cancers.

METHOD

Informed by Salutogenesis Model, a Straussian-grounded theory study was conducted. In-depth interviews were conducted with 20 women with gynecological cancer between January and August 2022. Data were analyzed using open, axial, selective coding, and constant comparative methods.

RESULTS

The core category encapsulated that most women defined resilience as having a dynamic process that could be promoted throughout the process. However, they expressed that they needed "individual resources for resilience" and "generated resources by the supportive interventions" to be resilient. They emphasized that these resources should make the process manageable, meaningful, and comprehensible to promote resilience. Furthermore, they defined in detail which components should be included in supportive interventions. They stated "some reflections of resilience on their cancer process" and "life gains from the process."

CONCLUSION

This study developed a grounded theory that provides a guideline for healthcare professionals on how women could be encouraged to have resilience and what is the importance of resilience on women's cancer process and their lives. Salutogenesis may help to understand the resilience process in women with gynecological cancer and provides direction for how healthcare professionals should shape their clinical interventions to promote the resilience process.

Post-traumatic growth among childhood cancer survivors: A qualitative meta-synthesis

PURPOSE

To conduct a meta-synthesis of qualitative studies on the post-traumatic growth experiences of childhood cancer survivors.

METHOD

Various databases, including PubMed, Cochrane Library, Web of Science, EMBASE, PsycInfo, ProQuest, Scopus, China National Knowledge Infrastructure (CNKI), Wanfang Data, China Science and Technology Journal Database (CSTJ), and China Biology Medicine (CBM) were used to retrieve qualitative studies on childhood cancer survivors who experienced post-traumatic growth.

RESULTS

Eight papers were included in this study, and similar fragments were combined to form eight categories, which were further combined into four synthesized findings: adjustment of cognitive system, enhancement of personal strength, improving relationships with others, resetting of life goals.

CONCLUSIONS

Post-traumatic growth was observed in some childhood cancer survivors. The potential resources and positive forces contributing to this growth are of great significance in the fight against cancer, in tapping into individual and social resources to help survivors grow, and in improving their survival rates and quality of life. It also provides a new perspective for healthcare providers regarding the relevant psychological interventions.

Meaning in life and its relationship with family cohesion: A survey of patients with palliative care in China

OBJECTIVE

Meaning in life (MIL) and family cohesion are important concerns for the palliative care population; however, evidence of the relationship between MIL and family cohesion is scarce. Therefore, this study aimed to examine the relationship between MIL and family cohesion and explore the factors that influence MIL among the palliative care population.

METHODS

In this cross-sectional study, 205 patients with advanced cancer were recruited from two palliative care units in China. Data were collected using the meaning in life scale (MiLS), the family cohesion subscale of the Family Adaptability and Cohesion Scale, second edition, Chinese version, and the Karnofsky Performance Status Scale (KPS). Multivariate linear regression models were used to examine the relationship between family cohesion and perceived MIL and identify the potential factors of participants' MiLS score.

RESULTS

The mean MiLS score was 100.90 (SD ​= ​9.17). The results showed that family cohesion (r ​= ​0.313, P ​< ​0.001) and KPS scores (r ​= ​0.311, P ​< ​0.001) were positively correlated with MiLS scores. Multivariate linear regression revealed that MIL was significantly influenced by family cohesion, KPS score, sex, religiosity, whether participants lived alone, and their medical insurance payment method (Adjust R ² ​= ​28.4%, F ​= ​6.281, P ​= ​0.013).

CONCLUSIONS

Our findings indicate a positive relationship between family cohesion and MIL, suggesting that clinicians should consider increasing patients' family cohesion as an approach to enhance perceived MIL.

Factors influencing death anxiety among Chinese patients with cancer: a cross-sectional study

OBJECTIVE

The purpose of this study was to investigate death anxiety status among Chinese patients with cancer and identify factors that affect death anxiety.

DESIGN

Cross-sectional study.

SETTING

Changsha, Hunan Province, China.

PARTICIPANTS

A total of 286 inpatients diagnosed with cancer were randomly recruited from a tertiary cancer centre and completed the questionnaires between January and June 2021.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the status of death anxiety. The secondary outcomes were the factors that affect death anxiety among Chinese patients with cancer.

METHODS

A total of 286 Chinese patients with cancer were recruited from a tertiary cancer hospital to complete the demographic and clinical characteristics questionnaire, Templer's Death Anxiety Scale, Acceptance and Action Questionnaire-second edition, and Meaning in Life Questionnaire from January to June 2021. Data were analysed using t-test, analysis of variance, Kruskal-Wallis H test, Pearson correlation analysis and multiple linear regression analysis.

RESULTS

On average, patients with cancer scored 7.72±4.17 for death anxiety, 25.71±9.69 for experiential avoidance and 45.19±8.22 for meaning in life. Ultimately, the statistically significant factors influencing death anxiety were education levels, insurance, pain scores, experiential avoidance and meaning in life. These factors explained 40.6% of the difference in death anxiety.

CONCLUSIONS

Patients with cancer in China experienced a high level of death anxiety. This study showed that experiential avoidance and meaning in life were important factors that affected death anxiety in patients with cancer. Further studies should be conducted to explore effective interventions to prevent experiential avoidance and increase meaning in life for patients with cancer. Attention should be paid to patients without insurance but with lower education levels and higher pain scores to ultimately relieve death anxiety and improve their quality of life.

Spiritual needs and their associated psychosocial factors among women with breast cancer: A cross-sectional study

AIMS

Guided by the biopsychosocial-spiritual model, this study aimed to evaluate the spiritual needs of Chinese women with breast cancer and explored factors associated with those spiritual needs.

DESIGN

This study has a cross-sectional design.

METHODS

This cross-sectional study involved 228 breast cancer patients in China, between May 2019 and July 2019. Data were collected using the general information form, the Spiritual Needs Scale, the Perceived Social Support Scale and the Hospital Anxiety and Depression Scale. Data were analysed by Spearman correlation analysis, univariate analysis and multiple linear regression, and a structural equation model (SEM) was constructed by maximum likelihood estimation.

RESULTS

There was a slightly higher average score for spiritual needs. Of the five dimensions of spiritual needs, those with the highest and lowest levels were 'meaning and purpose' and 'relationship with transcendence' respectively. Religion, time since confirmed diagnosis and education level were related to spiritual needs. The proposed model linking spiritual needs perceived social support, anxiety, and depression revealed a satisfactory fit to the data. Specifically, a higher level of social support predicted lower levels of anxiety and depression, which in turn predicted stronger spiritual needs.

CONCLUSIONS

The spiritual needs of breast cancer patients were associated with individual characteristics and psychosocial elements. Patients' spiritual needs should therefore be effectively evaluated, especially the needs of those who are not religious. Furthermore, comprehensive, needs-tailored interventions that incorporate spiritual, biological, psychological and social support should be formulated.

IMPACT

Nurses should become more aware of the spiritual needs of breast cancer patients, incorporate a spiritual focus into their care and develop comprehensive needs tailored to their characteristics as well as interventions based on biopsychosocial factors.

Exploring the meaning of life from the perspective of patients with depression: A phenomenological study

This study explored the perceptions of meaning of life for patients with depression. A qualitative phenomenology approach was used. Patients with depression (n = 20) were recruited until data saturation occurred. Findings revealed four themes all related to their value of: (1) accepting depression; (2) appreciating work (paid and non-paid); (3) embodying love and taking on responsibilities; (4) receiving spiritual comfort. Healthcare professionals could facilitate patients with depression to explore their meaning of life while enduring and transforming the emotional pain that accompanies depression, hence, perhaps, decreasing their suicidal ideations.

The quality and meaning of life of cancer patients in remission: socio-psychological aspects

The sense of the meaning of life is a subjectively felt, positive mental state. Suffering in chronic illness intensifies in a human being the sense of isolation and gives rise to emotions with that an individual often cannot cope. Such experiences are characteristic of the process of cancer remission. The sense of coherence strengthens the sense of coping with disease, which increases prospects of recovery. The article presents the results of the authors' research (103 respondents) on the quality and meaning of life of cancer patients in remission: socio-psychological aspects, indicators of the categories of «meaning of life», «responsibility», «consistency», and the latter is dominant at the stage of cancer remission in the studied cohorts. The survey was conducted on the basis of the methodology developed by the authors using the «Goal in Life» test (PIL) by J. K. Crumbaugh and J.J. Smith. Maholicka, as well as «The sense of coherence» by A. Antonovsky (SOC-29). The study showed that the group under survey had a fairly high level of indicators of the categories «meaning of life», «responsibility», «consistency», which did not depend on when the respondents were diagnosed with cancer, as well as the fact that the studied indicators reached higher values in women than in men. Interpersonal factors «meaning of life» and «responsibility» were identified as dominant in the study of the quality and meaning of life in relation to other socio-psychological factors.

Emerging From the "Ku:" Fluctuating in Adjusting With Breast Cancer-A Post-Traumatic Growth Theory Situated Within Chinese Culture

This purpose of the study was to construct a model (theory) to understand Chinese women's adjustment process in living with breast cancer. A constructivist grounded theory method was adopted in this study. A total of 24 women were recruited through purposive and theoretical sampling. Semi-structured, audio-recorded interviews were undertaken in Chinese and transcribed. Initial coding, focused coding, and theoretical coding approaches were used to identify subcategories and categories, and to construct the emergent theory. The basic social process these women used to deal with the breast cancer diagnosis was identified as: Emerging from the 'ku': Fluctuating in adjusting with breast cancer. Four categories were revealed following analysis: confronting challenges, orienting to reality, accommodating the illness, and transforming their lives, which encapsulated the main cognitive and emotional processes in which Chinese women engaged in their adjustment to living with their illness. The core process was influenced by a variety of contextual influences, which were identified as personal factors, social-environmental factors, and some specific cultural factors which emphasized positive changes. Chinese cultural values such as "Wuwei" coping strategies, familial primacy, and Chinese self-disclosure contribute to Chinese women's adjustment processes and post-traumatic growth experiences. Hence, there is a need to consider Chinese cultural features, in designing culturally tailored supportive programs in multi-cultural clinical settings.

Identifying End-of-Life Preferences Among Chinese Patients With Cancer Using the Heart to Heart Card Game

Background:

Understanding the preferences for end-of-life (EOL) care is imperative in providing quality care to patients with life-threatening illness. However, it is difficult for patients, families, and health-care providers to initiate EOL conversations in China. An easy-to-use tool that could help health-care providers initiate EOL discussions is the Heart to Heart Card Game (HHCG), originally designed for Chinese Americans.

Objective:

To evaluate the EOL preferences among Chinese patients with cancer using the HHCG.

Methods:

We conducted a descriptive study to assess EOL preferences using HHCG among patients at the oncology chemoradiotherapy department of a Chinese tertiary hospital.

Results:

We recruited 58 patients in total of which 40 (69%) patients completed HHCG. The most frequently selected card was “I want my family to get along,” followed by “I don’t want to be a burden to my family,” and “I want to maintain my dignity.” Among the 3 cards selected, social needs were rated as the most important (36.7%), followed by spiritual needs (35.8%), physical needs (20.0%), and financial needs (7.5%). The evaluation of the HHCG revealed that more than 70% of the participants highly valued HHCG.

Conclusion:

The HHCG can be used as a communication tool to encourage EOL discussions between cancer patients and health-care providers in China. Moreover, Chinese patients with cancer attach significant importance to their family and maintaining dignity at the EOL.

Exposure to violence in breast cancer patients: systematic review

RESULTS

The nine studies included were reviewed under two titles as descriptive and qualitative. Based on the results of six descriptive studies, it was determined that the majority of these studies focused on violence and abuse in childhood; depression is high among breast cancer patients exposed to violence; healing is unfavorably influenced among breast cancer patients exposed to spouse violence or abuse/violence in childhood; physical, emotional and functional welfare/comforts are restricted and quality of life is low during disease process; there is positive correlation between advanced-stage cancer and history of violence; they hesitate to ask the clinical staff for support. Although breast cancer women underreport the violence they have been exposed to, a study stated that 55% of women are exposed to violence after being diagnosed with breast cancer. Results of the three qualitative study revealed that violence is the field of "taboo" among breast cancer patients and they reconsider the "life", "relationship-origin stress", "social support" and "importance of breast for herself" over the disease process.

CONCLUSION

In conclusion, it is underlined that giving care becomes difficult, maintenance of treatment fails, and quality of life is decreased in breast cancer patients exposed to violence.