Psychosocial barriers and facilitators for cascade genetic testing in hereditary breast and ovarian cancer: a scoping review.

Despite increased awareness and availability of genetic testing for hereditary breast and ovarian cancer (HBOC) syndrome for over 20 years, there is still significant underuse of cascade genetic testing among at-risk relatives. This scoping review synthesized evidence regarding psychosocial barriers and facilitators of family communication and/or uptake of cascade genetic testing in relatives from HBOC families. Search terms included 'hereditary breast and ovarian cancer' and 'cascade genetic testing' for studies published from 2012-2022. Through searching common databases, and manual search of references, 480 studies were identified after excluding duplications. Each article was reviewed by two researchers independently and 20 studies were included in the final analysis. CASP, RoBANS 2.0, RoB 2.0, and MMAT were used to assess the quality of included studies. A convergent data synthesis method was used to integrate evidence from quantitative and narrative data into categories and subcategories. Evidence points to 3 categories and 12 subcategories of psychosocial barriers and facilitators for cascade testing: (1) facilitators (belief in health protection and prevention; family closeness; decisional empowerment; family support, sense of responsibility; self-efficacy; supportive health professionals); (2) bidirectional concepts (information; perception of genetic/cancer consequences; negative emotions and attitude); and (3) barriers (negative reactions from family and negative family dynamics). Healthcare providers need to systematically evaluate these psychosocial factors, strengthen facilitators and alleviate barriers to promote informed decision-making for communication of genetic test results and uptake of genetic testing. Bidirectional factors merit special consideration and tailored approaches, as they can potentially have a positive or negative influence on family communication and uptake of genetic testing.

Effectiveness of a Participatory Program for Improving the Cardiovascular and Cerebrovascular Health of Older Farmers in Rural Korea.

BACKGROUND: The aim of this study was to evaluate the effectiveness of a participatory approach to the cardiovascular and cerebrovascular (CCV) health of older farmers in rural Korea. METHODS: A nonequivalent control group pretest-posttest design was used. Participants included 58 farmers aged ≥ 60 years who were assigned to either an experimental group (n = 28) or a comparative group (n = 30). The experimental group took part in the participatory program for CCV health, while the comparative group received a conventional lecture program for CCV health. The two groups, from pretest to posttest, were compared using the generalized estimating equation (GEE) method. RESULTS: The participatory program showed a greater effect over time than the conventional lecture program for health empowerment (Χ2 = 7.92, p = 0.005) and self-efficacy in managing CCV health (Χ2 = 5.94, p = 0.015). The average rate of implemented improvements after 3 months was 88.9%, showing that the participatory program was successful. CONCLUSIONS: The participatory program for CCV health was an effective intervention for the empowerment and self-efficacy of older farmers in managing their own CCV health. Therefore, we recommend replacing lectures with participatory methods in CCV health programs for older farmers.

Challenges and Learning Needs of Nurse-Patients' Family Communication: Focus Group Interviews With Intensive Care Unit Nurses in South Korea.

Intensive care unit (ICU) nurses are expected to facilitate effective day-to-day communication with patients and family members at the bedside. To date, communication training for ICU health care professionals has targeted mainly intensivists-in-training, but there is limited data on communication experience and needs to be evaluated among ICU nurses. This qualitative study used focus group interviews to explore daily communication experiences with patients' families and communication training needs and preferences among ICU nurses in South Korea. Five focus group interviews were conducted with 27 ICU nurses (4-6 nurses per group). The results of inductive qualitative content analysis highlighted four main categories: "Perceived difficulties during communication," "burden from working conditions," "endeavors to promote communication skills," and "strategies for cultivating effective communication." Regarding suggestions for future communication training, nurses preferred interactive learning with peer-support over traditional methods (e.g., lectures). Nurses also suggested that communication training for ICU nurses should include learning skills appropriate for difficult situations (e.g., angry family members). Findings from this study can serve as a framework for stakeholders in ICU care and healthcare education (e.g., hospital and nursing administrators, nurse educators) when designing communication training to support ICU nurses with their practical knowledge and communication skills.

"Struggling to Accept the New Breast as Part of My Body" - The Challenge of Immediate Breast Reconstruction in Women With Breast Cancer.

BACKGROUND: Women have difficulties in making decisions and experiences an unexpectedly long recovery period after immediate breast reconstruction. There are still many limitations in understanding the overall changes in life experienced by women with breast cancer before and after immediate breast reconstruction. OBJECTIVE: This study aimed to explore the challenges experienced by women with breast cancer undergoing immediate breast reconstruction and how they coped with these problems. METHODS: Strauss and Corbin's grounded theory design was used. In-depth face-to-face individual interviews were undertaken with 11 women with breast cancer from 4 hospitals in Korea. Data collection and analysis were conducted simultaneously, using the constant comparative method. RESULTS: The core category was "struggling to accept the new breast as part of my body." "Decision making regarding immediate breast reconstruction" was the initial step, followed by "facing the changed breasts after surgery." The challenge of "living with the new breasts" slowly merged into "making up my mind to accept my breasts with gratitude." CONCLUSION: Women with breast cancer undergoing immediate breast reconstruction struggled to accept the new breast as part of their body, and some reached a measure of closure and acceptance with gratitude. IMPLICATION FOR PRACTICE: Nurses can apply findings by recognizing the experiences, perceptions, and needs of women; providing patients with sufficient information on the whole process; and offering continuous supportive care to facilitate the coping process. In addition, nurses should consider a variety of approaches that help women to integrate their changed bodies into their self-concept and self-image and restore a sense of normality.

An Exploration of Contextual Aspects that Influence Cardiovascular Disease Risks Perceived by Workers in a Small-Medium-Sized Workplace.

Contextual factors are associated with risks of cardiovascular disease (CVD) perceived by personnel employed in small-medium-sized workplaces. In an ecological model, data collection and analysis were undertaken, stratified by intrapersonal, interpersonal, and organizational contexts of blue-collar workers. Data were collected in face-to-face (n = 36) and focus group (n = 4) interviews and subjected to qualitative content analysis, to generate three main themes, 10 generic categories and 18 sub-categories. At the intrapersonal level, "physical burden", "burn out due to overtime work", "no time to take care of health because of family responsibility", and "lack of recognition and knowledge of CVD risks" were derived from the individual interviews. At the interpersonal level, "stress of possible job losses", "dislike of stigmatization of unhealthy persons", "smoking and drinking to reduce relationship stress", and "unhealthy work environment" differed by level of risk perception. "Preferred economic value" and "lack of understanding about importance of CVD management of an employer" emerged at the organizational level. Factors that influence CVD risks among workers in small-medium-sized business were present at the multiple levels. Therefore, healthcare providers in the field of occupational health should consider CVD risks in the context of blue-collar workers and organizational level for health-promotion programs.

The pregnancy experience of Korean mothers with a prenatal fetal diagnosis of congenital heart disease.

BACKGROUND: Prenatal diagnosis of fetal congenital heart disease (CHD) is becoming widely available but there is a lack of understanding on such expectant mothers' experiences during pregnancy. This was the first study to investigate the pregnancy experience of Korean mothers with a prenatal fetal diagnosis of CHD. METHODS: In-depth interviews were conducted with 12 mothers regarding their child's prenatal diagnosis of CHD and the adaptive processes during pregnancy. The data were transcribed and analyzed according to the grounded theory framework. RESULTS: When the diagnosis of fetal CHD was suspected, mothers desperately sought accurate information regarding CHD while hoping in vain for a misdiagnosis. When the definitive diagnosis was made, most pregnant women experienced psychological trauma and pain, framed in the stigma and burden of having an imperfect child. Provision of accurate health advice and emotional support by a multidisciplinary counseling team was crucial at this phase, forming recognition that CHD could be treated. When fetal movements were felt, mothers came to acknowledge the fetus as an independent being, and made their best efforts to protect the fetus from harmful external influences using traditional TaeKyo mindset and practices, which in turn, were helpful in restructuring the meaning of the pregnancy. CONCLUSIONS: Mothers went through a dynamic process of adapting to the unexpected diagnosis of CHD, which was closely linked to being able to believe that their child could be treated. Early counseling with precise information on CHD, continuous provision of clear explanations on prognosis, sufficient emotional support, and well-designed prenatal education programs are the keys to an optimal outcome.

The influence of marital intimacy on urinary and sexual symptom experience among patients with prostate cancer: a cross-sectional study.

BACKGROUND: Little is known about the influence of how patients with prostate cancer perceive emotional support from their spouses on their treatment-related symptoms. AIMS: To explore the influence of marital intimacy on urinary and sexual symptoms. METHODS: The research participants were 42 men diagnosed with prostate cancer recruited from a convenience sample from a university hospital in South Korea. The Expanded Prostate Cancer Index Composite, the Korean Marital Intimacy Scale, and the Hospital Anxiety and Depression Scale were used to measure variables of interest. RESULTS: In the hierarchical multiple regression analysis, higher marital intimacy was associated with more favorable symptom in the urinary domain. In the sexual domain, none of the models were significant, and no influence was found for marital intimacy. CONCLUSIONS: Marital intimacy, measured as perceived emotional support from spouses, was found to positively influence only the experience of urinary symptoms among South Korean men with prostate cancer.