Oncologists' Experience of Delivering Bad News in Korea.

This study explored oncologists' experiences of delivering bad news to patients with cancer and their families. Nine oncologists recruited from three superior hospitals in Korea completed in-depth interviews. The results of thematic analyses identified four themes: precursors to bad news delivery, why it is difficult to deliver bad news, when it is more difficult to deliver bad news, and strategies of delivering bad news. The participants felt unprepared for the task and stressed because breaking bad news goes against their responsibility to do no harm and their professional objective to promote healing. Although they were unclear about best practices regarding communication styles, they individualized their communication style to meet the needs of their patients, who have an array of cultural, social, and spiritual backgrounds. Understanding oncologists' perceptions of bad news delivery can inform culturally appropriate interventions for alleviating their stress and improving patient-physician relationships in communication of bad news.

How do they grow out of their cancer experience? Korean adolescent and young adult cancer survivors' stories.

Objectives: Cancer experiences can bring positive as well as negative impacts. The current literature, however, focuses mainly on the negative impacts. This qualitative study examines Korean childhood cancer survivors' post-traumatic growth, which concerns how they respond positively to the cancer experience and how they change as a result of their experience.Design: In-person or telephone interviews were conducted with 31 adolescent and young adult survivors of childhood cancer post-treatment who were living in Korea.Results: Thematic analysis found that childhood cancer survivors experienced growth by feeling gratitude (being content with the present, making comparisons with worse situations), engaging in self-affirmation ('I am strong'; 'My example can help others'; 'I am ready for new challenges'), deepening faith (communicating with God, trusting God's direction), and finding the social meaning of cancer (becoming a self-advocate, mapping out a career path).Conclusions: The study findings can be used by psychosocial care professionals to support Korean cancer survivors to recognize post-traumatic growth and, thus, achieve improved well-being.

A photovoice study on the bereavement experience of mothers after the death of a child.

This study explored the bereavement experience of mothers after losing a child to cancer in Korea, using photovoice. The mothers took photos reflecting five subject areas they selected: (a) if I had one more day with my child, (b) memories with my child, (c) dreaming of my child's healthy future, (d) what gave me strength, and (e) fulfilling my child's wishes for the future. The findings show that mothers who lost a child to cancer need bereavement care to promote well-being. This study can help pediatric oncology providers develop bereavement interventions that address parental grief and improve quality of life.

A qualitative study on parents' concerns about adult children with intellectual disabilities amid the COVID-19 pandemic in South Korea.

BACKGROUND: This study aimed to understand parents' concerns about their adult child with intellectual disabilities due to the restriction of community-based services amid the COVID-19 pandemic in South Korea. METHODS: In-depth interviews were conducted face-to-face or by telephone with 19 parents of adult children with intellectual disabilities who had to stop using community-based services. RESULTS: Participants worried that their adult child was not aware of the seriousness of COVID-19, was more susceptible to the COVID-19 virus, could not recognize self-infection and could have fatal consequences of getting infected with COVID-19. They expected challenges in their adult child's life (losing a daily routine, being isolated, regression in skills, becoming bored, lacking physical activities and increased behavioural challenges) but also experienced adjustments and hopes. CONCLUSION: The study demonstrated parents' worry about their adult child becoming infected with COVID-19, highlighting the urgent need for community-based services to address psychosocial challenges during the pandemic.

A Photovoice Study: The life experiences of middle-aged adults with intellectual disabilities in Korea.

BACKGROUND: As adults with intellectual disabilities approach older adulthood, they face unique physical and psychosocial challenges. This study explored the lived experiences of middle-aged adults with intellectual disabilities living in their community. METHOD: Six sessions of Photovoice were conducted with a purposeful sample of six middle-aged adults with intellectual disabilities in South Korea. Participants were involved with the theme selection, taking photographs related to the themes, group discussion of photo stories and sharing Photovoice outcomes. RESULTS: Thematic analysis yielded 11 subthemes under the five major themes selected by the participants: health, free time, time in the centre, family and my future in old age. CONCLUSIONS: The study findings showed complex issues middle-aged adults with intellectual disabilities may face in later life, including bereavement and healthy lifestyle concerns. It is important to create a space for meaningful social support and social interactions without stigma.

Changes in Relationships in Bereaved Families: Perspectives of Mothers Who Lost a Child to Cancer.

The loss of a child greatly affects the dynamics of interpersonal relationships in bereaved families. This study explored the relationships in bereaved Korean families from the perspectives of mothers after the death of a child due to cancer. We conducted in-depth interviews with 15 bereaved mothers of a deceased child with childhood cancer. Thematic analysis identified 12 subthemes related to bereaved mothers' struggles in grief within three significant themes based on family relationships: (a) relationship with husband; (b) relationship with surviving child or children; and (c) relationships with extended family members. Findings highlight bereaved mothers' need to build supportive family relationships while acknowledging bereaved family members' different grieving styles and their own challenges in grieving the loss of a child.

Compassion satisfaction and compassion fatigue among medical social workers in Korea: the role of empathy.

Medical social workers are affected by their clients' suffering, which has an impact on social workers' professional quality of life. This study examined the role of empathy in relation to professional quality of life among medical social workers in South Korea. Using the Professional Quality of Life Scale and Interpersonal Reactivity Index, we found that empathic concern and personal distress were significant components of empathy and were correlated with professional quality of life. Empathic concern was positively associated with compassion satisfaction and negatively associated with burnout. Personal distress was correlated with all components of quality of life: compassion satisfaction, secondary traumatic stress, and burnout. Women had significantly higher levels of burnout than men; religious affiliation was associated with higher levels of compassion satisfaction; and longer years of employment was associated with higher levels of secondary traumatic stress. Medical social workers should be educated on and trained in how empathy can help them address compassion fatigue and promote compassion satisfaction.

Pediatric oncology social workers' experience of compassion fatigue.

Pediatric oncology social workers play an important role in supporting cancer patients and their families as they learn to talk about and cope with the physical and psychological impacts of cancer. As a result, social workers are particularly vulnerable to compassion fatigue and the associated psychological and physical impacts. The purpose of this qualitative study was to understand the experience of compassion fatigue among 27 pediatric oncology social workers. Four main themes emerged throughout the five focus groups: Conditions that contribute to compassion fatigue; the influence of compassion fatigue; coping strategies to alleviate compassion fatigue; and desire for systematic support to prevent compassion fatigue. Our study findings emphasize the importance of developing programs, policies and research geared toward the prevention of compassion fatigue, in addition to coping with symptoms. Further, this study brings attention to the importance of including pediatric oncology social workers in efforts to develop and implement systemic supports.

The effects of individual- and network-level factors on discussion of cancer experiences: Survivors of childhood cancer in Korea.

This study aimed to identify young adult Korean cancer survivors' individual- (psychological distress, stigma, sociodemographic variables, and cancer-related variables) and network-level factors (relationship type, social support type) that influence discussion of their cancer experiences. Sixty-eight survivors of childhood cancer who were recruited using snowball sampling nominated 245 individuals from their networks, including family and intimate partners (40%) and friends and acquaintances (60%), as people with whom they most frequently interacted. Results of multilevel modeling analysis indicated that higher levels of internalized shame were a prominent individual-level factor associated with a lack of discussion of cancer experiences. Relationship type and support type at the network-level were also significant correlates of discussion of cancer experiences. Programs for reducing the survivors' shame, improving illness identity, and providing professional training for building social relationships that are intimate and in which they could exchange reciprocal support may help Korean childhood cancer survivors to openly share their cancer experiences with others in their social network and to be successful in the journey of cancer survivorship.

Why did I get cancer? Perceptions of childhood cancer survivors in Korea.

This study explored whether and how childhood cancer survivors in Korea ask and resolve the question of what may have caused their cancer. Thirty-one childhood cancer survivors participated in in-depth interviews about their self-questioning process in this regard. The findings indicate that Korean childhood cancer survivors pondered this question alone due to the stigma attached to cancer in the family and society. Their answers included internal factors (doing "bad things," having unhealthy eating habits, engaging in magical thinking, having a stress-prone personality, or having a biological susceptibility) or external factors (stressors, random events, the environment, or medical conditions). How they perceived the cause of cancer had an impact on aspects of their current lives. Psychosocial care standards or guidelines are needed in regard to the provision of a safe environment in which Korean cancer survivors and their parents can share their perceptions and process their thoughts.

Experiences of Korean mothers of children with cancer: A Photovoice study.

Using Photovoice, a participatory action research methodology, we investigated Korean mothers' lives postdiagnosis of their child with cancer. Photovoice was used to understand the mothers' perceptions of how they have adapted to their children's illnesses. Five mothers of children with cancer participated in five sessions of the Photovoice project, during which they took and shared photographs and narratives about their experiences and joined weekly group discussions on their selected themes. The following themes and subthemes emerged: "What I would like to do (taking a break, socializing with friends, spending time with other family members, developing my career)," "My child and food (whatever my child wants to eat, love of family)," "My days for my child (doing what my child wants to do, being a playmate, changing for my child)," and "Power sources for me (family, courage of children, mom is strong, hope)." Having a child with cancer greatly affects the mother's social and work lives as well as emotional well-being. Services and programs such as respite care, parenting education, and psychological support are recommended based on the study findings.

The Experiences of Korean Young Adult Survivors of Childhood Cancer: A Photovoice Study.

Photovoice was used to understand the impact of childhood cancer on Korean young adult survivors. Seven survivors of childhood cancer (currently aged 20-27 years), diagnosed before the age of 19 and with cancer treatment completed, participated in five sessions. The participants took photographs that captured their group's weekly topics and participated in discussions about their feelings and experiences. Fifty-six photo images with narratives on the survivors' experiences were produced on these four participant-selected themes: Relationships With Others, Stigma, Overcoming Difficulties, and The Future This study on Korean childhood cancer survivors sheds light on their perspectives about the impact of cancer. Using an innovative methodology that takes the participants' point of view, this study contributes to the literature on young adult cancer survivors' quality of life and their psychosocial adjustment. The results can inform educational programs and increase public awareness by providing survivors' schoolteachers and peers with knowledge about childhood cancer.

Posttraumatic Growth Outcomes and Their Correlates Among Young Adult Survivors of Childhood Cancer.

OBJECTIVE: This study aims to identify and examine posttraumatic growth (PTG) experiences, and their correlates, among young adult survivors of childhood cancer. METHODS: 602 long-term childhood cancer survivors between the ages of 18 and 39 participated. Their demographic (age, gender, race/ethnicity, education, relationship status, employment, and income), cancer-related (diagnosis, current health problem, age at diagnosis, and years since diagnosis), and psychosocial (social support and optimism) PTG correlates were examined using descriptive, correlational, and regression analyses. RESULTS: PTG was significantly greater for females and nonwhite survivors, and for those diagnosed at older ages. Survivors diagnosed with solid/soft tissue tumors reported lower PTG. Optimism and social support were positively associated with PTG. CONCLUSION: Study findings highlight potential intervention opportunities for increasing PTG by facilitating discussion around growth experiences within an optimistic framework among a supportive network of family members and peers.

Postcancer experiences of childhood cancer survivors: how is posttraumatic stress related to posttraumatic growth?

Understanding posttraumatic growth (PTG) and the factors associated with PTG among cancer survivors is important to improve their quality of life. This study examined PTG among 225 Korean adolescents and young adults between 15 years and 39 years of age who survived childhood cancer (58.5% males and 41.5% females). We explored the relationships between PTG and several sociodemographic and medical variables, and whether the relationships between PTG and posttraumatic stress disorder (PTSD) symptoms were linear or curvilinear. The Posttraumatic Stress Diagnostic Scale (PDS) and the Posttraumatic Growth Inventory (PTGI) were used to assess PTSD symptoms and PTG, respectively. In addition to the effects of sociodemographic and medical variables, there were linear effects of PDS on PTGI (R(2) change = .03, p = .008). No evidence of a curvilinear relationship between PDS and PTGI was found. Higher PDS scores were associated with lower PTGI scores (ß = -.18). Older age (ß = .41) and shorter time since diagnosis (ß = -.42) were associated with greater PTGI. Understanding the factors that were associated with PTG among Korean adolescent and young adult survivors of cancer adds to the knowledge on PTG and may help develop services to promote PTG in this group.

Caregiving Stress Experienced by Parents of Adult Children with Intellectual Disabilities During COVID-19 in Korea.

Many of community supports and resources were shattered in the COVID-19 pandemic, leaving parents to navigate caring for their adult child with intellectual disabilities with little support. This study explored caregiving stress experienced by parents of adult children with intellectual disabilities during the COVID-19 pandemic in Korea. In-depth interviews were conducted with 19 parents of an adult child with intellectual disabilities. Thematic analysis yielded two themes: caregiving burden and deteriorating health. Parents bore the brunt of the caregiving burden, spending much of their time helping their adult child with daily activities and managing their challenging behaviors, leaving the caregivers struggling physically and mentally. The heightened caregiver burden and associated deteriorating health among these parents raise serious concerns, indicating a need for immediate support to alleviate these issues and help parents navigate caring for their adult child with intellectual disabilities during the COVID-19 pandemic.

Job-Seeking Experiences of Trans Adults in South Korea.

Being trans is stigmatized and can make it difficult to fit into the job market in South Korean society. This study explored trans individuals' job-seeking experience and the impact of gender identity on their career choices and development using a qualitative approach. In-depth interviews were conducted with 20 trans adults with job-seeking experiences who were recruited through purposive and snowball sampling in South Korea. Ten subthemes were identified in three overarching themes: (a) limiting myself in job search; (b) challenges in the job application and interview process; and (c) having a desire to build a meaningful career. Participants limited their choices for employment in favor of gender-neutral jobs or trans-inclusive work environments. In the job-seeking process, they faced challenges due to society's rigid binary gender roles and the negative stereotypes about trans identities. Despite stress and identity-related conflict, participants expressed a desire to overcome challenges, build a meaningful career, and flourish at work without compromising their gender identity. This study highlights the experiences of trans individuals in their job-seeking journey. Psychosocial interventions and career support services could help trans individuals in the job-seeking process by identifying their unique challenges to employment and providing assistance to cope with stigma and oppression.

Changes in life experiences of adults with intellectual disabilities in the COVID-19 pandemics in South Korea.

BACKGROUND: The COVID-19 pandemic has had a significant impact on adults with intellectual disabilities who are dependent on community services. OBJECTIVE: This study explored the experiences of adults with intellectual disabilities from their perspective during the COVID-19 pandemic in South Korea, where most community-based services were suspended. METHODS: We conducted in-depth interviews with 15 adults with intellectual disabilities who lost access to services during COVID-19 pandemic. Inductive thematic analysis was conducted. RESULTS: Five overarching themes emerged: changes in (a) daily life, (b) health behaviors, (c) family relationships, (d) social relationships, and (e) social participation. Most participants experienced the loss of daily routines and healthy behaviors, family conflicts, and social isolation, but they also developed new ways of adapting and finding a new normal. CONCLUSIONS: The findings offer valuable evidence of ways to develop and stabilize community-based services during a pandemic, with insights into the experiences of people with intellectual disabilities.

Self-portraits of families with young adult cancer survivors: using photovoice.

Photovoice is a participatory research methodology in which individuals photograph their everyday realities. The present study used photovoice to understand the impact of cancer on a sample of six young adult survivors of childhood cancer (YACS) and their family members. The themes of the YACS group included, in their own words, "lost childhood," "my culture," "health," "what keeps me going/sacrifices," and "who am I?" Those of the family group included "how cancer affected survivors' hopes and dreams?," "positive impact of cancer," "importance of information," "barriers to self-care," and "what we learned and what we can do." The family-based and participants-driven framework and photovoice produced some novel findings that call for YACS-targeted guidance and training on social relationships, independence, and career; support for the families from family-oriented cultures; and facilitation of family dialogue.

Caregiving behavior is associated with decreased mortality risk.

Traditional investigations of caregiving link it to increased caregiver morbidity and mortality, but do not disentangle the effects of providing care from those of being continuously exposed to an ailing loved one with serious health problems. We explored this possible confound in a national, longitudinal survey of elderly married individuals (N= 3,376). Results showed that spending at least 14 hr per week providing care to a spouse predicted decreased mortality for the caregiver, independently of behavioral and cognitive limitations of the care recipient (spouse), and of other demographic and health variables. These findings suggest that it may be premature to conclude that health risks for caregivers are due to providing active help. Indeed, under some circumstances, caregivers may actually benefit from providing care.

Cultural influences on the survivorship of families affected by childhood cancer: a case for using family systems theories.

This paper uses the family systems perspective to synthesize existing studies on the 3 components of Olson's (2000) Circumplex Model-family cohesion, flexibility, and communication-as they relate to family adaptation to cancer; and to extend the discussion to the cultural influences on these components. Family systems theory was found to be a useful framework for understanding the variance of positive and negative family adaptation in the survivorship of childhood cancer and the cultural impact on the family level variables.