Decision-making process for risk-reducing salpingo-oophorectomy among Korean women with hereditary breast cancer: A grounded theory study.

PURPOSE: To explore the decision-making process regarding Risk-Reducing Salpingo-Oophorectomy (RRSO) among women with hereditary breast cancer in Korea, with a focus on complex interpersonal interactions and sociocultural influences. METHOD: This qualitative, grounded theory study conducted semi-structured and in-depth interviews with 17 women with hereditary breast cancer between March and December 2021. Theoretical sampling and constant comparison were utilized for data analysis. RESULTS: The core concept identified was 'Navigating optimal trajectories for preserving myself,' encompassing four stages: (1) conflicting between cancer-free health and maintaining integrated self; (2) recognizing the decision-maker: myself vs. physician; (3) seeking meaningful information; and (4) evaluating decision results and prioritizing values. Women's conflict was influenced by the time given to decide, the timing of BRCA results, complexity of surgical choices, diverse perspectives, and the quality of information. This process often reiterated until RRSO was undertaken. CONCLUSION: Women with hereditary breast cancer grapple with conflicting decisions to preserve their integrated selves. The decision-making process is complex and subjective, influenced by physician-dominated decision-making culture, subjective meaningful information, individual values, and decisional circumstances. Supporting women in prioritizing their values and providing comprehensive information on the physical, emotional, relational, and social impacts of each option are crucial. Oncology nurses can play a vital role in bridging the gap between physician-dominated decision-making and patient autonomy by facilitating communication and supporting patient-centered care.

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.

"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 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.