Factors affecting advance care planning in older adults with cancer.

INTRODUCTION: Advance care planning (ACP) has been widely endorsed and recommended for its many potential benefits, including improved end-of-life (EOL) care, enhanced satisfaction with care, and reduced anxiety and depression. However, little is known about the ACP completion rates and factors affecting ACP among older adults with cancer. This study's purpose was to examine biological, psychological, and social factors affecting ACP in this population. MATERIALS AND METHODS: Data from the 2002 to 2016 waves of exit interviews from the national longitudinal Health and Retirement Study were analyzed. The sample included 1088 decedents, aged 55 and over, who had a diagnosis of cancer. The exit interviews were completed by a proxy respondent (usually the next of kin of the decedents). ACP outcomes included: having EOL care discussion, durable power of attorney (DPOA), and advance directives (ADs). Multiple logistic regression models were conducted to examine the relationships between predictor variables and each of the three ACP outcome variables. RESULTS: Approximately 65% of the sample had ever discussed EOL care, 61.9% had an assigned DPOA, and 54.1% had ADs. Regression results showed that higher age, Black race, high school and above education, being widowed/never married, higher multimorbidity, and more limitations in activities of daily living and instrumental activities of daily living were significantly associated with the three ACP variables. Surprisingly, Black race was associated with higher odds of ever discussing EOL care and having ADs; high school and above education was associated with lower odds of all three ACP components. DISCUSSION: The majority of participants in this study had discussed EOL care, had an assigned DPOA, and had ADs. However, most participants were White/Caucasian and had completed high school education. Future research that includes more diverse and minoritized participants is needed. Also, the contrasting association of Black race and higher educational status with ACP outcomes warrant further exploration in future studies.

Religious/spiritual struggles and whole person functioning among Colombian university students: Longitudinal evidence of mutual influence.

This prospective study examined the primary, secondary and complex conceptual models of religious/spiritual struggles with 18 indicators of whole person functioning across five domains: psychological well-being, psychological distress, social well-being, physical well-being and character. We used three waves of longitudinal data (Wave 1: August/September 2021, Wave 2: October/November 2021, Wave 3: February 2022) from Colombian university students (N = 2878, Mage = 20.88 ± 4.05 years). Adjusting for covariates assessed in Wave 1, our primary analysis applied the analytic templates for outcome-wide and lagged exposure-wide designs to estimate two sets of lagged linear regression models. Religious/spiritual struggles in Wave 2 were associated with a small-to-medium-sized decline in subsequent functioning on 17/18 indicators in Wave 3, and worse functioning on 16/18 indicators in Wave 2 was associated with very small-to-medium-sized increases in subsequent religious/spiritual struggles in Wave 3. The results provided evidence in favour of the complex conceptual model for 16/18 indicators of whole person functioning. Our findings extend existing evidence on the reciprocal association between religious/spiritual struggles and individual functioning to a wide range of indicators, reinforcing the need for practitioners to consider the dynamic interplay between religious/spiritual struggles and individual functioning as they work with younger populations.

Do Forgiveness Campaign Activities Improve Forgiveness, Mental Health, and Flourishing?

Objectives: To evaluate the effectiveness of a forgiveness public health intervention at promoting forgiveness, mental health, and flourishing. Methods: Colombian students (N = 2,878) at a private, nonreligious university were exposed to a 4-week forgiveness community campaign and were assessed pre- and post-campaign. Results: Forgiveness, mental health, and flourishing outcomes showed improvements after the campaign. On average, participants reported engaging in 7.18 (SD = 3.99) of the 16 types of campaign activities. The number of types of campaign activities that participants engaged in evidenced a positive linear association with forgiveness, although some activities were more popular than others and some activities were more strongly associated with increased forgiveness. For depression, anxiety, and flourishing, engaging in more activities was generally associated with greater improvements, but the patterns were less consistent relative to forgiveness. Conclusion: This forgiveness public health intervention effectively promoted forgiveness, mental health, and flourishing. Effective campaigns in diverse communities involve promoting mental and physical health through forgiveness. However, recent conflict may hinder acceptance, necessitating political capital for leadership advocating forgiveness initiatives.

Associations of religious and existential variables with psychosocial factors and biomarkers of cardiovascular risk in bereavement.

Bereavement increases in prevalence as people age and is associated with multiple psychological and health risks, including cardiovascular risk. Religious and existential variables may play an important role in the health impacts of bereavement. Theorized pathways linking religious and existential variables with health have suggested these associations are due to intermediary psychosocial variables, but have not been tested in bereavement. This research empirically tested these pathways in a bereaved population. In N = 73 adults within 1 year of bereavement (mean age = 64.36), this study examined associations between (1) religious and existential characteristics (religious and spiritual struggles, intrinsic religiosity, and existential quest) and intermediary psychosocial variables (depression, loneliness, and difficulties in emotion regulation), and between (2) intermediary psychosocial variables and bereavement-relevant health outcomes (self-reported health, change in health since last year, grief severity, and cardiovascular biomarkers). Cardiovascular biomarkers (heart rate, heart rate variability, and blood pressure) were collected before, during, and after a laboratory grief recall emotion elicitation. Anticipated associations between self-reported religious and existential characteristics and intermediary variables, and between intermediary variables and self-reported bereavement-relevant outcomes, were consistently observed. However, associations between intermediary variables and cardiovascular biomarkers were largely unobserved. This study examined the role of religious and existential variables in whole-person health after bereavement and is among the first to include biomarkers of cardiovascular risk. Results suggest that although religious and existential variables are associated with important bereavement-related outcomes, these associations may be "skin-deep," and extensions to cardiovascular functioning should be re-examined.

The multilevel correlates, contributions, and consequences of leader humility in humanitarian aid work.

Objective: Leader humility has been linked to many positive outcomes but not examined in humanitarian aid work. Three studies examined the multilevel correlates, contributions, and consequences of leader humility in Medair-a large, multinational, faith-based aid organization. Study 1 examined correlates of leader humility in a sample of 308 workers and 167 leaders. Study 2 explored multilevel contributions of leader humility in 96 teams comprised of 189 workers. Study 3 utilized a subsample (50 workers, 34 leaders) to explore consequences of Time 1 leader and team humility on outcomes 6 months later. Method: Participants completed measures of humility (general, relational, team), leader and team attributions (e.g., effectiveness, cohesion, and growth-mindedness), organizational outcomes (e.g., job engagement and satisfaction; worker and team performance), and psychological outcomes (e.g., depression, anxiety, compassion satisfaction, and flourishing). Results: Leader and team humility contributed to multilevel positive attributions about leaders (as effective and impactful), teams (as cohesive, psychologically safe, and growth-minded), and oneself (as humble), and those attributions contributed to organizational and psychological outcomes. Teams' shared attributions of their leader's humility contributed to higher worker job satisfaction and team performance. Longitudinally, for workers and leaders, leader and team humility were associated with some positive organizational and psychological outcomes over time. Conclusion: In humanitarian organizations, leader humility seems to act as an attributional and motivational social contagion that affects aid personnel's positive attributions about their leaders, teams, and themselves. In turn, these multilevel positive attributions contribute to several positive team, organizational, and psychological outcomes among workers and leaders.

Development and Initial Validation of the Persevering Hope Scale: Measuring Wait-Power in Four Independent Samples.

Hope has been conceptualized as agency and pathways to achieve goals. However, this goal-directed conceptualization does not encapsulate all situations in which hope may be beneficial. To address the dispositional motivation to endure when a desired goal seems unattainable, unlikely, or even impossible (i.e., goal-transcendent hope), we provide initial psychometric evidence for the new Persevering Hope Scale (PHS). We developed and refined the PHS with undergraduates at a public college (Study 1) and replicated our findings in a community adult sample (Study 2). We replicated and extended these findings using longitudinal data with undergraduates at a faith-based college (Study 3) and a community sample of chronically ill adults (Study 4), and examined measurement invariance (Study 5). Scores on the PHS demonstrated robust evidence of estimated internal consistency and of criterion-related, convergent/discriminant, and incremental validity. Estimated temporal stability was modest. Partial scalar invariance was evidenced across samples, and full scalar invariance was evidenced across gender, race/ethnicity, and time. These preliminary findings suggest that the PHS is a psychometrically sound measure of persevering hope. Its use can broaden the current body of literature on trait hope to include goal-transcendent hope and advance research on the nature and benefits of this important construct.

Knowledge, beliefs, and misconceptions about palliative care among older adults with cancer.

INTRODUCTION: Older adults with cancer have high symptom burden and unmet needs and may benefit from palliative care (PC). However, little is known about their knowledge and understanding of PC. This study examined the knowledge, beliefs, and misconceptions about PC in older adults with cancer in the United States. MATERIALS AND METHODS: We used data from National Cancer Institute's 2018 wave of the Health Information National Trends Survey (HINTS). A total of 370 individuals aged 65 and older with a diagnosis of cancer were included in this study. The outcomes included PC knowledge, goals, and misconceptions. The main predictors included general health status, chronic conditions, functional limitations, and types of cancer. RESULTS: About two thirds of the sample (65.31%) did not have any knowledge of PC. Among those who had some knowledge, they had good understanding of PC goals, but also had many misconceptions about PC. Multiple regression analysis showed that older age (p < .001), racial minority (p = .021), and lower education (p = .001) was associated with lacking knowledge of PC. Individuals with some functional limitations tended to have better understanding and fewer misconceptions of PC. DISCUSSION: The knowledge about PC is low in older adults with cancer in the US. Educational interventions need to be implemented to increase knowledge and reduce the misconceptions about PC in this population. Increasing knowledge of PC may ultimately lead to increased access to PC and improve the quality of life in this population.

Associations of dispositional forgivingness with facets of well-being among Colombian adults: A longitudinal outcome-wide analysis.

Many studies have reported evidence suggesting that dispositional forgivingness has positive implications for different domains of well-being. However, relatively few methodologically rigorous studies have been conducted in the Global South, particularly in post-conflict settings where forgiveness could play an important role in supporting individual well-being. In this three-wave cohort study of predominantly young adult Colombians (n = 1575), we examined the associations of dispositional forgivingness with 20 well-being outcomes across several domains of well-being: psychological distress, psychological well-being, physical health, social well-being, and character strengths/virtues. Using an outcome-wide analytic design that included extensive control for potential confounding and reverse causation by adjusting for a range of covariates assessed in Wave 1 (2017), we found that dispositional forgivingness assessed in Wave 2 (2018) was at least modestly associated with improvements in one or more facet of each well-being domain assessed approximately 1 year later in Wave 3 (2019). Associations tended to be stronger for outcomes in the domains of psychological distress, psychological well-being, social well-being, and character strengths/virtues compared to the physical health domain. These longitudinal findings suggest that dispositional forgivingness might promote individual well-being in societies with a long history of ongoing civil unrest, conflict, and war.

Identifying pathways to religious service attendance among older adults: A lagged exposure-wide analysis.

We used prospective data (spanning 8 years) from a national sample of older U.S. adults aged > 50 years (the Health and Retirement Study, N = 13,771) to evaluate potential factors that lead to subsequent religious service attendance. We applied a lagged exposure-wide epidemiologic design and evaluated 60 candidate predictors of regular subsequent religious service attendance. Candidate predictors were drawn from the following domains: health behaviors, physical health, psychological well-being, psychological distress, social factors, and work. After rigorous adjustment for a rich set of potential confounders, we observed modest evidence that changes in some indices of physical health, psychological well-being, psychological distress, and social functioning predicted regular religious service attendance four years later. Our findings suggest that there may be opportunities to support more regular religious service attendance among older adults who positively self-identify with a religious/spiritual tradition (e.g., aid services for those with functional limitations, psychological interventions to increase hope), which could have downstream benefits for various dimensions of well-being in the later years of life.

Perceived posttraumatic growth after interpersonal trauma and subsequent well-being among young Colombian adults: A longitudinal analysis.

Research has shown that people sometimes report self-perceived growth as a result of dealing with a potentially traumatic event, but relatively few methodologically rigorous studies have examined whether perceived posttraumatic growth is associated with improved subsequent well-being across a wide range of outcomes. In this three-wave longitudinal study of Colombian emerging adults (n = 636), we examined the associations of perceived posttraumatic growth with 17 well-being outcomes across domains of psychological well-being (i.e., self-rated mental health, meaning in life, sense of purpose, happiness, life satisfaction), psychological distress (i.e., anxiety symptoms, depression symptoms, subjective suffering), social well-being (i.e., content with relationships, satisfying relationships, loneliness), physical well-being (i.e., self-rated physical health, sleep quality), and character strengths (i.e., state hope, trait forgivingness, orientation to promote good, delayed gratification). Using an outcome-wide analytic design that adjusted for a range of covariates assessed in Wave 1, we found that overall perceived posttraumatic growth assessed in Wave 2 was robustly associated with improvements in one or more facet of each well-being domain (15/17 outcomes in total) assessed approximately six months later in Wave 3. Our findings suggest that perceived posttraumatic growth may contribute to individual well-being over the longer-term.

Spiritually incorporating couple therapy in practice: Christian-accommodated couple therapy as an illustration.

Spiritually incorporating couple therapy (SICT)-couple therapy that incorporates spiritual interventions-has a growing research base. Information is limited on how spiritual interventions are used in practice; thus we studied treatment-as-usual (TAU). SICT is treatment that, at a couple's request, sometimes draws upon spiritual resources when addressing relational issues. We tracked 65 couples from 29 couple therapists (who advertised as spiritually incorporating therapists) over 402 sessions of SICT. Couple spirituality predicted use of spiritual interventions more than did therapist spirituality. The most used spiritual interventions included silent prayer for the couple, discussions of hope and forgiveness, and encouragement to consult their heart. In SICT, therapists used evidence-based couple therapy approaches. SICT should (a) treat highly religious couples in high distress as being at risk for early drop out; (b) follow couples' leads in using spiritual methods; and (c) draw on evidence-based couple and spiritual practices. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Suffering, psychological distress, and well-being in Indonesia: A prospective cohort study.

Research on the subjective experience of suffering has typically focussed on older clinical samples living in Western, educated, industrialised, rich, and democratic (WEIRD) countries. To further extend the existing body of empirical research on suffering to less WEIRD contexts, we use three waves of data (Wave 1: December 2020; Wave 2: January 2021; Wave 3: February 2021) from a sample of nonclinical Indonesian adults (n = 594) to examine associations between suffering, two indices of psychological distress, and 10 facets of well-being. In our primary analysis, we estimated a series of multiple regression models that adjusted for a range of sociodemographic characteristics, financial and material stability, religious/spiritual factors, prior values of overall suffering, and prior values of each outcome assessed in Wave 1. Results indicated that overall suffering assessed in Wave 2 was associated with an increase in both indices of psychological distress and a decrease in eight facets of well-being assessed in Wave 3. Using a similar analytic approach, results from a secondary analysis indicated that higher scores on both indices of psychological distress and lower scores on seven of the well-being facets assessed in Wave 2 were associated with worse subsequent overall suffering assessed in Wave 3. These findings contribute to empirical literature on the implications of suffering for well-being.

More spiritual than religious: Concurrent and longitudinal relations with personality traits, mystical experiences, and other individual characteristics.

People who self-identify as predominantly spiritual constitute a considerable and well-established part of the religious landscape in North America and Europe. Thus, further research is needed to document predictors, correlates, and outcomes associated with self-identifying primarily as a spiritual person. In the following set of studies, we contribute to some of these areas using data from German and United States adults. Study 1 (n = 3,491) used cross-sectional data to compare four religious/spiritual (R/S) self-identity groups-more religious than spiritual (MRTS), more spiritual than religious (MSTR), equally religious and spiritual (ERAS), and neither religious nor spiritual (NRNS)-on sociodemographic characteristics and a range of criterion variables (i.e., Big Five personality traits, psychological well-being, generativity, mystical experiences, religious schemata). In Study 2 (n = 751), we applied the analytic template for outcome-wide longitudinal designs to examine associations of the four R/S self-identifications with a range of subsequent outcomes (assessed approximately 3 years later) that were largely comparable to the criterion variables assessed in Study 1. The cross-sectional and longitudinal findings from these complementary studies provide further evidence of differences between these four categories of R/S self-identification, including strong evidence in both studies of an association between the MSTR self-identity and mysticism.

Recollections of Childhood Sexual Abuse: Complexities of Religious Coping and Muslim Religious and Psychological Adjustment in Afghanistan.

Religious coping is a double-edged sword. Clarification of the psychological benefits for positive religious coping requires statistical controls for negative religious coping and vice versa. This study sought to further explore the complexities of Muslim religious coping by extending the analysis to Afghans who coped with the sufferings associated with recollections of childhood and adolescent sexual abuse. Two hundred Dari Persian-speaking Afghan university students (122 identified having experience of childhood sexual abuse) self-reported on variables that measure religious orientation, religious coping, Muslim experiential religiousness, mental health, and child abuse. Results showed that negative religious coping interfered with the possibly beneficial effects of positive religious coping on mental health and child abuse. After controlling for negative religious coping, the associations of positive religious coping became obvious. In addition, Muslim spirituality moderated the associations of religious coping with mental health outcomes and child abuse: for people with higher Muslim spirituality, positive religious coping associated with better mental health, and negative religious coping associated with less child abuse. Implications for religious coping and combating trauma in a religious context are discussed.

Are mindful people more risk-averse? Effects of trait and state mindfulness on risk preference in decision-making.

The current research investigated whether various aspects of mindfulness were differentially associated with risk preference in decision-making. In Studies 1 and 2, attention and present-focus aspects of trait mindfulness were associated with lower risk preference in making monetary gains. In Study 3, participants completed either a mindfulness training or listened to a comparable control recording. Compared to the control condition, subjects in the mindfulness condition were more risk-averse in making choices for monetary gains. The attention and present-focus aspects of state mindfulness mediated this connection. Study 4 introduced a loss framing, where attention and present-focus no longer associated with lower risk preference, but awareness and acceptance aspects of trait mindfulness associated with higher risk preference in avoiding monetary losses. The results suggest that different aspects of mindfulness have potential for mitigating risk preference, but such potential is limited depending on the framing of a decision context.

Effects of organizational commitment, job satisfaction and workplace violence on turnover intention of emergency nurses: A cross-sectional study.

AIMS: To describe turnover intention of emergency nurses and clarify the effects of organizational commitment, job satisfaction and workplace violence on turnover intention. BACKGROUND: Research has showed the predictors of turnover intention differed among nurses of different specialties. However, research on turnover intention has mostly focused on general nurses rather than emergency nurses. DESIGN: A descriptive, cross-sectional study was conducted. METHODS: A self-administered questionnaire was used to collect data from 415 emergency nurses in Beijing, China, using convenience sampling. Path analysis was used to test the relationships between organizational commitment, job satisfaction, workplace violence and turnover intention. RESULTS: Most emergency nurses (90.2%) had a high level or very high level of turnover intention. Contrary to previous studies, organizational commitment had a significant direct positive effect on workplace violence. It also had a direct positive effect on job satisfaction and a negative effect on turnover intention. Workplace violence had a negative effect on job satisfaction and a positive effect on turnover intention. Job satisfaction had a direct negative effect on turnover intention. CONCLUSION: To reduce turnover intention in the emergency department, measures should be taken to reduce workplace violence and increase nurses' job satisfaction, especially those with high organizational commitment.

Amanah and Muslim Identity: Relationships with Religious and Psychological Adjustment in Malaysia.

Amanah refers to the accountability of Muslims to their community. In Malaysian Muslim university students (N = 209), an Amanah Scale predicted a stronger sense of identity along with more adaptive religious and psychosocial functioning. Multiple regression analyses identified Accountability to Society as especially influential, but Accountability to Allah exhibited at least some problematic implications. Amanah mediated Identity linkages with some measures of religious and psychological adjustment, but also suppressed Identity relationships with greater self-knowledge and lower anxiety. These data confirmed the importance of communal commitments in Muslim mental health, suggested that accountability may have limited liabilities as well as more obvious psychosocial advantages, and identified possible complexities in the assessment of Accountability to Allah.

Psychometric properties of the Chinese version of the chemotherapy-induced taste alteration scale.

PURPOSE: The chemotherapy-induced taste alteration scale (CiTAS) is a reliable and valid instrument to comprehensively assess patients' taste alterations in an easy way. We aimed to translate it and test its psychometric properties among Chinese cancer patients undergoing chemotherapy. METHOD: A convenience sample of 227 cancer patients were recruited in a tertiary cancer hospital in Beijing. The Chinese version of the CiTAS (C-CiTAS) was developed via rigorous translation methods. An exploratory structural equation model (ESEM) was used to test its construct validity. Correlations between the C-CiTAS scores and the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 scores were calculated for convergent validity. The overall taste alterations scale (OTAS) score was used to test its discriminant validity. Reliabilities were also examined. RESULTS: The majority of patients undergoing chemotherapy experienced minor to mild taste alterations. The current factor analysis results using the ESEM supported the original factor solution of the CiTAS, and no item of the CiTAS was dropped. The C-CiTAS demonstrated good construct validity, convergent validity and discriminant validity. The Cronbach's alphas of the C-CiTAS were 0.900 for the overall scale and from 0.570 to 0.857 for the four subscales. Its test-retest reliability was 0.815 (p < 0.01). CONCLUSIONS: The Chinese version of the CiTAS is a reliable and valid instrument to evaluate cancer patients' Chemotherapy-induced taste alterations in China.

The Role of Affect on Physical Health Over Time: A Cross-Lagged Panel Analysis Over 20 Years.

BACKGROUND: While previous studies have investigated the interplay between affect and health (1) over an extended period of time, (2) in a representative population, and (3) while modelling positive and negative affect simultaneously, no single study has done all three at once. METHODS: The present study accomplishes this by sampling adults from the Midlife Development in the US study who completed affect (Mroczek & Kolarz, 1998) and health measures (chronic conditions, Charlson, Szatrowski, Peterson, & Gold, 1994; functional limitations, McHorney, Ware, Lu, & Sherbourne, 1994; self-reported health) measured three times over 20 years. We ran three (one per health metric) random-intercept cross-lagged panel models, where positive and negative affect were modelled simultaneously. RESULTS: Results indicated that positive and negative affect significantly predicted future heath (functional limitations/self-reported health) and that this relationship was reciprocal (i.e. health measures predicted future affect). However, there were no significant cross-lagged relations between affect and chronic conditions. CONCLUSION: Our results suggest that both positive and negative affect play an equal role in predicting future health for functional limitations and self-reported health as well as highlight the bi-directionality of this relationship. Additionally, the degree to which affect predicts future health may be moderated by the type of health outcome.

Self-Compassion and Cultural Values: A Cross-Cultural Study of Self-Compassion Using a Multitrait-Multimethod (MTMM) Analytical Procedure.

Self-compassion is natural, trainable and multi-faceted human capacity. To date there has been little research into the role of culture in influencing the conceptual structure of the underlying construct, the relative importance of different facets of self-compassion, nor its relationships to cultural values. This study employed a cross-cultural design, with 4,124 participants from 11 purposively sampled datasets drawn from different countries. We aimed to assess the relevance of positive and negative items when building the self-compassion construct, the convergence among the self-compassion components, and the possible influence of cultural values. Each dataset comprised undergraduate students who completed the "Self-Compassion Scale" (SCS). We used a confirmatory factor analysis (CFA) approach to the multitrait-multimethod (MTMM) model, separating the variability into self-compassion components (self-kindness, common humanity, mindfulness), method (positive and negative valence), and error (uniqueness). The normative scores of the Values Survey Module (VSM) in each country, according to the cultural dimensions of individualism, masculinity, power distance, long-term orientation, uncertainty avoidance, and indulgence, were considered. We used Spearman coefficients (r s) to assess the degree of association between the cultural values and the variance coming from the positive and negative items to explain self-compassion traits, as well as the variance shared among the self-compassion traits, after removing the method effects produced by the item valence. The CFA applied to the MTMM model provided acceptable fit in all the samples. Positive items made a greater contribution to capturing the traits comprising self-compassion when the long-term orientation cultural value was higher (r s = 0.62; p = 0.042). Negative items did not make significant contributions to building the construct when the individualism cultural value was higher, but moderate effects were found (r s = 0.40; p = 0.228). The level of common variance among the self-compassion trait factors was inversely related to the indulgence cultural value (r s = -0.65; p = 0.030). The extent to which the positive and negative items contribute to explain self-compassion, and that different self-compassion facets might be regarded as reflecting a broader construct, might differ across cultural backgrounds.