Healthcare providers' experiences in providing sexual health care to breast cancer survivors: A mixed-methods systematic review.

AIMS: To analyse healthcare providers' (HCPs) experiences in sexual health care through the mixed-methods systematic review (MMSR). BACKGROUND: Sexual health for breast cancer survivors (BCSs) is becoming increasingly important as survivors live longer. HCPs are critical in providing sexual health care. DESIGN: A mixed-methods systematic review. METHODS: Literature searches were conducted in databases MEDLINE, CINAHL, Psychology & Behavioral Sciences Collection, Web of Science, Cochrane Library, Scopus, ClinicalTrials.gov and reference lists were searched from inception to 30 December 2022. Two independent reviewers extracted and analysed the data using the JBI guidelines for MMSR. RESULTS: After screening for 2849 citations, 19 studies were eligible for MMSR, involving 2068 HCPs. Most HCPs believe that sexual health care is their responsibility. However, sexual health was not adequately addressed. A lack of knowledge was the most significant barrier to providing sexual health care. Moreover, HCPs would like to acquire more knowledge and felt that current sexual healthcare training was inadequate. CONCLUSIONS: Findings suggest that HCPs did not frequently address sexual health in BCSs and that lack of knowledge was the most common barrier. Healthcare session administrators should allocate resources for sexual healthcare training that offer multiple formats, accessible content and convenience. They should also be multifaceted and proactive, meet the diverse needs of BCS at different stages and focus on effective communication. RELEVANCE TO CLINICAL PRACTICE: This study highlights the importance of addressing sexual health in BCSs and the need for HCPs to receive training in this area. Training should be multifaceted, proactive and meet the diverse needs of BCSs at different stages, with a focus on effective communication. By addressing this issue, HCPs will be better equipped to support the sexual health needs of BCSs, ultimately improving their overall well-being and quality of life. PROSPERO Registration Number: CRD42022327018 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=327018).

Dissociative Trait as a Mediator of Problematic Internet Use in Children with attention-deficit/hyperactivity Disorder and Learning Disabilities.

PURPOSE: This study used data from a national birth cohort study to investigate the duration of internet use at the age of 12 years among children diagnosed with attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), intellectual disabilities (IDs) and learning disabilities (LDs) at the age of five and a half years (66 months) to understand whether an ADHD, ASD, ID and LD diagnosis in childhood increases the risk of problematic internet use (PIU) in adolescence. Furthermore, the pathway relationship of dissociative absorptive trait with PIU and these diagnoses was also investigated. METHODS: The 5.5- and 12-year-old Taiwan Birth Cohort Study dataset was used (N = 17,694). RESULTS: More boys were diagnosed with LDs, IDs, ADHD and ASD; however, girls were at increased likelihood of PIU. ID and ASD diagnoses were not associated with increasing PIU likelihood. However, children who had been diagnosed with LDs and ADHD, along with higher dissociative absorptive trait, had an indirectly increased likelihood of PIU in adolescence. CONCLUSIONS: Dissociative absorption was found to be a mediating factor between childhood diagnosis and PIU and can be used as a screening indicator in prevention programs to reduce the duration and severity of PIU in children diagnosed with ADHD and LDs. Furthermore, with the increased prevalence of smartphone usage in adolescents, education policy-makers should pay greater attention to the issue of PIU in female adolescents.

[A Brief Introduction to Mixed Methods Systematic Review (MMSR)].

Systematic reviews provide important empirical evidence for healthcare providers to make the best clinical decisions. While qualitative research provides subjective information on the human experience, quantitative research may be used to provide quantified evaluations of interventions. To overcome the lack of objectivity in qualitative research and of context considerations in quantitative research, recent efforts have focused on developing mixed-method approaches that combine meta-analysis (quantitative systematic reviews) and meta-synthesis (qualitative systematic reviews). This new idea may help conceptualize studied phenomena more thoroughly. However, the typology remains inconsistent and the currently proposed approaches lack unified guidance and principles. In this paper, "mixed methods systematic review", a term promoted by the Joanna Briggs Institute, is used to indicate the newly developed systematic review. The use of systematic review in quantitative research and in qualitative research and the use of mixed methods systematic review are introduced chronologically, with an emphasis on procedures, examples, and quality appraisal tools. The concepts and concrete procedures for integrating results from different research method are presented for researchers and healthcare providers to allow them to better understand this approach and explore related phenomena more thoroughly.

Resilience among women with breast cancer surviving longer than five years: The relationship with illness perception and body image.

PURPOSE: This study aimed to investigate the correlations and identify the relationships between the resilience, perception of illness and body image of women with breast cancer in the 5-year-or-above survivorship. METHODS: We used convenient sampling to recruit from an outpatient department 106 women with breast cancer. The inclusion criteria were participants aged >20 years currently in a stable condition and were able to understand the Chinese language. Those women with mental health illness were excluded. All participants completed questionnaires on the following: demographic information, revision of illness perception (IPQ-R), body image scale (BIS), Eysenck personality questionnaire (EPQ), and resilience scale (RS). We conducted the structural equation modeling (SEM) to explore the factor structure. RESULTS: SEM results showed a good fit to the data (comparative fit index = 0.97, Tucker-Lewis index = 0.94). Findings F indicated the existence of significant relationships between resilience and either illness perception or body image. Personality had a direct association with illness perception (ß = 0.73, P < 0.05). Body image had an indirect effect on the relationship between resilience and illness perception (coefficient = -2.52; 95% bootstrapping CI = -31.36, -0.62). CONCLUSIONS: Results indicated that illness perception is a crucial predictor for better resilience as mediated through body image. To provide adequate information to women with breast cancer can improve their perception of breast cancer more positively. Hence, their body image and their way of coping with survival life turn better.

The synergistic interaction between urbanicity and maternal education affecting childcare pressure related to autism spectrum disorder in two national birth cohort studies.

To gain a holistic approach for parental help-seeking behavior and ASD diagnosis, this study aimed to use two national birth cohort study datasets to investigate the pathway relationship between personal and social/environmental factors, including maternal perceived childcare pressure, maternal level of education, urbanization at age 3, and the chance of receiving a autism spectrum disorder (ASD) diagnosis at when children are aged 5.5 years (2.5 years later). The 2003 Taiwan Birth Cohort Pilot Study (TBCS-p; N = 1618) and 2005 Taiwan Birth Cohort Study (TBCS; N = 19,183) datasets were used. The TBCS-p and TBCS both showed similar prevalence of ASD (0.3-0.4%). Children with ASD characteristics, as measured using the Modified Checklist of Autism in Toddlers, had 8.27-18.20 times increased likelihood of receiving ASD diagnosis [TBCS confidence interval (CF) of 5.32-12.86; TBCS-p CF of 2.03-163.46]. Pathway analysis showed that, although having a mother with higher education or who lived in a city decreased the chance for ASD diagnosis, the interactive effect of a maternal higher level of education and living in a city led to an increased likelihood for ASD diagnosis. Additionally, mothers who perceived a higher level of childcare pressure were also more likely to seek medical assistance and diagnosis. Access to healthcare (living in the city), maternal level of awareness (level of education), and perceived childcare pressure are all factors that influence help-seeking behavior and diagnosis. Therefore, medical professionals should pay special attention to the developmental condition of children in underserved backgrounds and rural areas to prevent delayed diagnosis.

Air pollution during the perinatal period and neurodevelopment in children: A national population study in Taiwan.

AIM: To evaluate the association between ambient particulate matter no larger than 2.5 µm in diameter (PM2.5 ) during the prenatal and postnatal periods and infant neurodevelopmental parameters. METHOD: We conducted a population-based birth cohort study using the Taiwan Birth Cohort Study. Participants were assessed for developmental conditions through home interviews at 6 months and 18 months of age. Exposure to PM2.5 of mothers and infants during perinatal periods was estimated using hybrid kriging/land-use regression. The exposure was linked to each participant by home address. Logistic regression was then conducted to determine the risk of neurodevelopmental delay in relation to PM2.5 . RESULTS: A total of 17 683 term singletons without congenital malformations were included in the final analysis. PM2.5 during the second trimester was associated with increased risks of delays in gross motor neurodevelopmental milestones (adjusted odds ratio [aOR] 1.09 per 10 µg/m3 increase in exposure to PM2.5 ). Delayed fine motor development was also found to be related to exposure to PM2.5 in the second and third trimesters (aOR 1.06), as was personal-social skill (aOR 1.11 for the second trimester and 1.06 for the third). These neurodevelopmental parameters were unrelated to postnatal PM2.5 exposure. INTERPRETATION: Exposure to ambient PM2.5 during pregnancy was significantly related to delay in gross motor, fine motor, and personal-social development in this population-based study. WHAT THIS PAPER ADDS: Prenatal exposure to higher PM2.5 was associated with increased risk of delayed early neurodevelopment. The critical period for delayed gross motor development was the second trimester. The critical period for fine motor and personal-social development was the second and third trimesters.

Families with high-risk characteristics and diagnoses of attention-deficit/hyperactivity disorder, autism spectrum disorder, intellectual disability, and learning disability in children: A national birth cohort study.

Background: A national birth cohort study was used to investigate whether high-risk family factors at 1.5-year-olds can increase the risk of attention-deficit/hyperactivity disorder (ADHD) diagnosis when children reach 5.5 years. The pathway relationship of high-risk family factors, children's developmental conditions, risk of autism spectrum disorder (ASD), and diagnosis of intellectual disability (ID), learning disability (LD), and ASD was also investigated. Methods: The 1.5-, 3- and 5.5-year-old Taiwan Birth Cohort Study (TBCS) dataset was used (N = 19,185). The high-risk familial factor was measured using five questions assessing whether parents are currently unmarried, unemployed, do not have any social insurance, perceive a "very heavy" economic childcare burden, and at least one of the parents has a disability certification. Developmental conditions were assessed using the Taiwan Birth Cohort Study-Developmental Instrument (TBCS-DI), and ASD risk was measured using the Modified Checklist of Autism in Toddlers. Data on ADHD, ID, LD, and ASD diagnoses were collected at age 5.5. The odds ratio model investigated whether children from families with high-risk factors at 1.5-years were at increased risk of ADHD, ID, LD, or ASD diagnosis at 5.5-years, compared to those children from families without such risks. Structural equation modeling investigated the logistic regression pathway relationship of high-risk familial characteristics, children's developmental conditions, autism screening, and diagnosis. Results: In the national birth cohort dataset of 19,185 children, 2070 (10.8%) met at least one of the high-risk familial factors. Children who met one high-risk familial factor had a 1.21-fold increased risk for ADHD diagnosis, 1.36-fold increased risk for LD diagnosis, and 1.80-fold increased risk for ASD diagnosis, compared to children from families without risks. High-risk familial factors directly increased the risk of ADHD and ID diagnosis, and indirectly increased the risk of ADHD, ID, LD, and ASD diagnosis through the mediating factor of children's development. Conclusions: Children who met more high-risk familial characteristics were at higher risk of ADHD, ID, LD, and ASD diagnosis. Development at three years was predictive of diagnosis at 5.5 years. Thus, developmental screening at age three is vital for interventions. Preventive, family-focused, and/or child-rearing services for at-risk families are important for improving outcomes for these children and their families.

[Metamorphosis of Nurses: The Development and Breakthroughs of Advanced Practice Registered Nurses].

BACKGROUND: The introduction and development of the advanced practice registered nurse (APRN) is a global trend in nursing. However, the development of APRNs in Taiwan remains uncertain and lacks necessary consensus. PURPOSE: This research study aimed to explore the views and suggestions of nursing experts in industry, government, and academia regarding the development of APRNs (clinical nurse specialists, case managers, certified clinical registered nurse anesthetists, and certified nurse-midwives) in Taiwan. METHODS: Data were collected from March to August 2017. Sixty-four experts participated in one of six focus group discussions held in northern, central, and southern Taiwan. These group discussions were recorded and transcribed verbatim with the consent of the participants. Content analysis was used to analyze the transcribed data. RESULTS: The comments and suggestions raised during the discussions were categorized into four major themes: professional development of necessity, core competencies, accreditation, and future promotion-related issues. Each theme was further divided into several subthemes. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The opinions of relevant experts regarding the current status of development of the roles, practical scope, and management and suggestions for APRNs were summarized to facilitate the future development of APRNs in Taiwan in terms of education, core competencies, certification, and practical scope. Furthermore, the results may be referenced in the establishment of a nursing consensus model and as a basis for promoting APRNs.

The Effect of Advance Care Planning Intervention on Hospitalization Among Nursing Home Residents: A Systematic Review and Meta-Analysis.

OBJECTIVE: To evaluate the effect of advance care planning (ACP) interventions on the hospitalization of nursing home residents. DESIGN: Systematic review and meta-analysis. SETTING AND PARTICIPANTS: Nursing homes and nursing home residents. METHODS: A literature search was systematically conducted in 6 electronic databases (Embase, Ovid MEDLINE, Cochrane Library, CINAHL, AgeLine, and the Psychology & Behavioral Sciences Collection), in addition to hand searches and reference list checking; the articles retrieved were those published from 1990 to November 2021. The eligible studies were randomized controlled trials, controlled trials, and pre-post intervention studies describing original data on the effect of ACP on hospitalization of nursing home residents; these studies had to be written in English. Two independent reviewers appraised the quality of the studies and extracted the relevant data using the Joanna Briggs Institute abstraction form and critical appraisal tools. A study protocol was registered in PROSPERO (CRD42022301648). RESULTS: The initial search yielded 744 studies. Nine studies involving a total of 57,180 residents were included in the review. The findings showed that the ACP reduced the likelihood of hospitalization [relative risk (RR) 0.54, 95% CI 0.47-0.63; I2 = 0%)], it had no effect on emergency department (ED) visits (RR 0.60, 95% CI 0.31-1.42; I2 = 99), hospice enrollment (RR 0.98, 95% CI 0.88-1.10; I2 = 0%), mortality (RR 0.83, 95% CI 0.68-1.00; I2 = 4%), and satisfaction with care (standardized mean difference: -0.04, 95% CI -0.14 to -0.06; I2 = 0%). CONCLUSION AND IMPLICATIONS: ACP reduced hospitalizations but did not affect the secondary outcomes, namely, ED visits, hospice enrollment, mortality, and satisfaction with care. These findings suggest that policy makers should support the implementation of ACP programs in nursing homes. More robust studies are needed to determine the effects of ACP on ED visits, hospice enrollment, mortality, and satisfaction with care.

The Self-Absorptive Trait of Dissociative Experience and Problematic Internet Use: A National Birth Cohort Study.

Functional and excessive use of internet are hard to distinguish from each other, and internet use can affect adolescents' development of self-identity. The aim of our study was to investigate the associated relationships between the risk and protective factors for internet use, including parental monitoring, the absorptive dissociative trait, having been bullied, exercise, self-perceived depressive mood, and happiness of 12-year-old adolescents. The Taiwan Birth Cohort Study dataset, which used a national household probability sampling method and included 17,694 12-year-old adolescents, was used for this study. Our results showed that 5.3% of adolescents reported spending more than five hours online during school days. Additionally, adolescents that spent more than five hours online during school days tended to have a higher absorptive trait, perceived less care from mothers, were more likely to have been bullied, and expressed a higher level of depressed mood, which led to a lower level of perceived happiness. Adolescents that spent more than five hours online during school days, compared to those that spent less than an hour online, were more likely to have been bullied, which effected their level of happiness, showing that they may be a group of higher concern. Therefore, spending more than five hours per day online maybe a clinical prevention indicator for problematic internet use.

[Cross-Disciplinary Research in Nursing: Competency and Practice].

Cross-disciplinarity is a current trend in healthcare. With the advancement of science and technology, the expansion of care fields, and the complexity of health problems, cross-disciplinary research has been increasingly emphasized in nursing studies in order to introduce technology into patient care, expand the scope of healthcare research, and improve quality of care. The term cross-disciplinary research typically covers multidisciplinary, interdisciplinary, and transdisciplinary studies. Each of these types of studies differ in terms of connotation, level of research problem addressed, and degree of interaction involved. The main purpose of this article is to describe the significance of cross-disciplinary research in nursing and to distinguish the types and nature of cross-disciplinary studies. Furthermore, reflections and recommendations on cross-disciplinary nursing research are also proposed. The development of cross-disciplinary nursing research is phased in nature and requires the creation of a cross-disciplinary research center and excellent leadership. Conducting cross-disciplinary nursing research is challenging and affected by uncertainty. Researchers may select the type of cross-disciplinary research that best addresses the complexity and commonality of the research problem being addressed. In addition, researchers may expand, communicate, and interact with other disciplines to improve their interdisciplinary research capabilities and opportunities.

Two-stage window screening and development trajectories in early identification of autism spectrum disorder among Han Chinese children.

OBJECTIVE: An understanding of the trajectory and norm of development in children is needed in order to understand the concept of the spectrum in the diagnosis of autism spectrum disorder (ASD). Children's developmental growth trajectory was measured from six to 66 months in the Taiwan Birth Cohort Study dataset (N = 11,145). Additionally, over 4 years of follow-up, the negative predictive value of using the Parental Concern Checklist and Taiwan Birth Cohort Study Developmental Instrument was also investigated as the first stage of screening in a two-stage window screening method for ASD diagnosis. RESULTS: The growth trajectory showed that children's language development began to increase at 18 months, and peaked at 36 months. On the other hand, social development showed steady growth from 18 to 66 months. The increase in the trajectory of children's language development prior to age three, when compared with other developmental dimensions, may increase the difficulty of diagnosing ASD. The two-stage window screening method can be used in settings where the screening sample is large, such as in community or primary care settings, and has been found to be time- and cost-efficient. Better understanding of children's developmental trajectory can enhance detection and intervention for ASD.

Recalled Parental Gender Preference in Chinese Culture: A Taiwan Birth Cohort Study.

Chinese culture has long favored sons over daughters. With the development of reproductive technology, the methods can be used not only in facilitation of conception, but also in sex-selective termination of pregnancies. Therefore, this study aimed to investigate: (1) the rate of pregnant expectancy/planning of children; (2) whether the Chinese cultural influence of son preference still exists, and factors effecting sex preference; and (3) whether artificial reproductive technology plays a role in parents giving birth to a child of their preferred sex. We used the Taiwan Birth Cohort Study dataset at six-months, which included 21,248 babies born in 2005. More mothers than fathers reported this pregnancy as unexpected (29.0% vs. 20.5%). Over half of the parents showed no preference for the sex of their child (mothers: 52.6%, fathers: 55.8%). However, among those who showed a preference, significantly more preferred sons than daughters (son preference, mothers: 24.8%, fathers: 24.3%; daughter preference, mothers: 22.5%, fathers: 19.9%). Additionally, structural equation modeling found that parents who had planned their pregnancy were more likely to prefer sons and less likely to prefer daughters. Parents who used artificial reproductive technology for conception were more likely to prefer and conceive sons. A preference for male children still exists in Taiwan, contributing to the high sex ratio at birth of 110 in our 2005 birth cohort. However, over half of the parents reported being neutral in the preference of the gender of their offspring. This suggests that Taiwan is moving toward a more gender-equitable society.

Relationships between internet use, deliberate self-harm, and happiness in adolescents: A Taiwan birth cohort pilot study.

The potential risk of internet use on adolescents' self-harm is a major concern. Vulnerable adolescents who are susceptible to bullying are also susceptible to the negative influence of the internet. In this study, the pathway associations were investigated between the risk factors of deliberate self-harm, experience of being bullied, internet use, and protective factors of maternal monitoring on perceived happiness of 12- and 13-year-old adolescents in the Taiwan Birth Cohort Pilot Study dataset (n = 1,457). The Chinese Oxford Happiness Questionnaire was used to measure the adolescents' self-perceived levels of happiness, in two dimensions of social adaptation status and psychological well-being. Our results show that 354 (24.3%) of the 12-year-olds reported having been bullied, and 289 (19.8%) of the 13-year-olds reported this. Seventy-nine (5.4%) of 13-year-olds reported deliberate self-harm in the past year. Results of a structural equation model showed that those who had been bullied at age 12 years were at greater risk of deliberate self-harm at age 13 years. A negative association was found between duration of internet use and perceived level of happiness. Adolescents who spent >5 h online during days off school were at higher risk of deliberate self-harm, and perceived a lower level of happiness. Therefore, spending >5 h online during days off school could be used as an indicator in future preventive action programs to screen out those at a high risk of excessive internet use, deliberate self-harm, and psychological well-being and social adjustment issues.

Measurement of Social Communication, Emotion and Cognitive Development from 6 Months to 8 Years Old: In a Taiwan Birth Cohort Study.

This study aimed to investigate (1) the reliability and validity of the Taiwan Birth Cohort Study-Developmental Instrument (TBCS-DI) 8-year-old scale; (2) the pathway relationship among the cognitive, emotional and social-communication dimensions of the TBCS-DI 8-year-old scale; (3) the predictive validity and association of the TBCS-DI dimensions at 6, 18, 36, and 66 months, with the dimensions of the 8-year-old scale. The Taiwan Birth Cohort Study dataset of 19,516 children followed from 6 months to the age of eight was used. The TBCS-DI 8-year-old scale showed good reliability and validity. A recursive relationship of emotion as the basis, affecting cognition and later social communication was found. Children's 18-month development was able to predict the development of children at 8 years, implying that 18 months may be a critical age for screening and intervention. Clinical intervention should also take into consideration the cultural disparity of emotional development in Asian countries.

The impermanent effect of waste incineration on children's development from 6 months to 8 years: A Taiwan Birth Cohort Study.

Incineration is a solution to waste problems; however, it has adverse effects on human health. Our study aimed to investigate the direct and indirect effects of living near an incinerator and breastfeeding on children's development at 6, 18, 36 and 66 months, and 8 years of age. The Taiwan Birth Cohort Study dataset used included randomized community data on 19,519 children from 6 months to 8 years old. The Taiwan Birth Cohort Study Developmental Instrument was used to measure children's development at different developmental ages. The results of our study showed that living within 3 km of an incinerator had a negative effect on children's 6-month development, however the effect dissipated after 18 months. Having been breastfed and living in the city had a more persistent and pervasive positive effect on children's development. Conversely, living in the city had an adverse effect on children's social-communication and emotional development when they were 8 years old; possibly due to the Chinese cultural characteristic of collectivism. Further follow-up of the long-term interactive effects of proximity to an incinerator and breastfeeding on children's development and health is needed.

Assessing Related Factors of Intention to Perpetrate Dating Violence among University Students Using the Theory of Planned Behavior.

Dating violence (DV) is a major public health problem among youth. The majority of DV studies in Taiwan involve the assessment of DV without the use of a robust psychological framework to guide research accuracy. Therefore, the purpose of this study was to utilize the Theory of Planned Behavior (TPB) to assess intention and other salient factors related to DV among university students. A two-phase, mixed-method design study was conducted among university students from seven universities in Taiwan, aged 18 to 24 years. In Phase I, questionnaires used were specifically developed based on the TPB, consisting of both direct and indirect measures related to DV. In Phase Ⅱ, questionnaire evaluation and related factors were examined through a two-step process of structural equation modelling (SEM) to test the TPB model. The results of this study found that perceived behavioral control, subjective norm, and attitude toward DV on behavioral intention accounting for 37.5% of the total variance. Among the related factors, attitude toward the behavior was the strongest (ß = 0.48, p < 0.001), followed by perceived behavioral control (ß = 0.19, p < 0.05). Findings from this study could expand the knowledge base in this important area and might help prevent DV.

The Psychometric Properties of the Chinese Oxford Happiness Questionnaire in Taiwanese Adolescents: Taiwan Birth Cohort Study.

The application of the eight-item Oxford Happiness Questionnaire has rarely been investigated cross-culturally. This study examined the psychometric properties and use of the eight-item Oxford Happiness Questionnaire in Taiwan, using a national birth cohort dataset of 12 year olds as a sample. The dataset of 12-year-old children in the Taiwan Birth Cohort Pilot Study, which included 17,694 adolescents, was used for this study. The eight-item Oxford Happiness Questionnaire was double-translated into Mandarin Chinese. Item analysis, exploratory factor analysis, and structural equation modeling for construct validity were conducted. The four-point Likert scale for the eight-item Chinese Oxford Happiness Questionnaire showed good inter-item correlation. Having deleted the item "mentally alert", the remaining seven items were separated into two dimensions of social adaptation status (SAS) and psychological well-being (PWB), resulting in Cronbach's alpha scores of 0.63 and 0.55, respectively. The two dimensions showed good construct validity. The differences in the language and cultural connotations of being "mentally alert" are discussed. Furthermore, being of a collective culture, the two dimensions of SAS and PWB were found in Chinese adolescents, allowing distinction between social- and individual-oriented happiness. Our study showed that the seven-item Oxford Happiness Questionnaire has a scale that is easy to use and comprehend, with good psychometric properties for use with Chinese adolescents.

A qualitative exploration of the fear of recurrence among Taiwanese breast cancer survivors.

OBJECTIVE: Fear of cancer recurrence (FCR) is the most commonly reported problem and unmet need among breast cancer survivors. The aim of this qualitative study was to explore the experience of recurrence fears among Taiwanese breast cancer survivors. METHODS: Three focus groups were included in this study. A purposive sampling technique was used to recruit 11 recurrence-free women at least 20 years of age from southern Taiwan who were diagnosed with breast cancer within the previous 2 years. Data were analysed and interpreted using content analysis. RESULTS: Three themes reflecting the experience of FCR were extracted from the transcript analyses: "Trapped in insecurity," "Suffering in silence," and "Pretending as if nothing happened." Participants endured a complex set of circumstances akin to silently walking the survival tightrope. Breast cancer survivors were still insecure and suffering, rather than celebrating survival, after the completion of treatment. Fear of cancer recurrence silently dominated their lives. CONCLUSIONS: An avoidance mindset and an unspoken FCR leave survivors insecure, resulting in a silent survival journey. These difficult thoughts and feelings that may impact the reconstruction of post-cancer life should be acknowledged. The development of appropriate survivorship care programs and emotional resilience regarding recurrence is needed for Taiwanese breast cancer survivors.