Beyond death and dying: how Chinese spouses navigate the final days with their loved ones suffering from terminal cancer.

While advances in biomedicine exist for cancer, its diagnosis and treatment still bring the threat of mortality to the forefront of spouses' lives. Family conflict is largely due to unmet expectations that generate a lot of physical and emotional distress for spouses, as the primary surrogates. Moreover, older individuals in Hong Kong tend to lack control of where they die and who is present at the end of their lives. Deeper understanding of Chinese spouses' perspectives is needed to generate new insights, particularly in how spouses cope with caregiving. The aim of the study was to explore the Chinese spousal experience with their dying loved ones suffering from terminal cancer. A qualitative study using interpretive description was conducted. Spousal caregivers were purposively recruited through a hospice unit of two regional hospitals in Hong Kong, China. Documentary sources were used as secondary data. Fifteen individuals, consisting of seven men and eight women, participated in individual interviews. The overarching theme was a socially constructed "we" experience of confronting mortality, characterized by five subthemes: (a) balancing end-of-life tension between cure and comfort, (b) prioritizing the family goals and concerns, (c) de-medicalizing caregiving, (d) working for mutuality, and (e) creating a legacy of love. The study suggests that clinicians might consider harnessing the capacity of spouses to help work through confronting experiences of mortality and transforming events for goals that go beyond death. This places a major emphasis on salutary strategies surrounding transitions from curative to palliative care.

The association of peer pressure and peer affiliation with the health risk behaviors of secondary school students in Hong Kong.

OBJECTIVE: The aim of this study was to explore the relationship between peer pressure and the health risk behaviors of secondary school students. STUDY DESIGN: Cross-sectional study using a self-completed questionnaire. METHODS: Secondary school students in Year 3 were the target population of this study. Information was solicited from students on their perceptions of peer pressure using a questionnaire employing the Peer Pressure Inventory and their involvement in risk behaviors using a modified global school-based student health survey. RESULTS: A total of 840 secondary students from Hong Kong completed the questionnaires. The prevalence of secondary students who had ever smoked was 6.4%, consumed alcohol 39.2%, ever used drugs 0.5%, were sexually active 3.9%, and involved in bullying 20.5%. A higher proportion of secondary students involved in risk behaviors were affiliated with peers who were involved in the same activities: smoking (48.9%), drinking alcohol (86.5%), using drugs (18.2%), engaged in sexual activity (34.5%), and bullying (82.6%). The perception of peer conformity and peer involvement was found to be significantly correlated with the students' health risk behaviors, particularly with regard to smoking, drinking alcohol, and bullying. A logistic regression analysis showed that having friends who are involved in the same risk behaviors is the single most important factor associated with the participation of secondary students in those specific risk behaviors. CONCLUSIONS: The results of this study provided a better understanding of the association between peer pressure and the adoption of health behaviors. The development of effective peer-led prevention programs to reduce the uptake of health risk behaviors should therefore be promoted to prevent adolescents from developing serious health problems.

Spouses' experience of caregiving for cancer patients: a literature review.

BACKGROUND: The spouse is generally the primary informal caregiver for cancer patients. Many studies have explored the experience of caregiving for cancer patients, but it is unclear whether there are gender differences in the spousal caring experience for cancer patients. AIM: This review describes the recent published research on the stress process of spousal caregiving experience for cancer patients, and aims to identify any gender differences in the caregiving experience. METHODS: Electronic, manual and author's searches were conducted. Articles included were published in English and Chinese, from January 2000 to March 2012. Study population is couples coping with cancer. Focus is on caregiving experience for spouse with cancer, and findings include both male and female spousal caregivers in quantitative studies. The databases searched included MEDLINE, CINAHL, Science Citation Index Expanded, Scopus, PsycINFO and the China Academic Journal Full-text Database. The key search terms used were 'cancer' or 'oncology' or 'carcinoma' AND 'caregiver' or 'caregiving' or 'carer' AND 'gender differences' or 'gender' AND 'spouse' or 'couple' or 'partner'. Spousal caregiving experiences of cancer patients were explored by adopting the 'stress process' of the Cancer Family Caregiving Experience Model from the gender perspective. RESULTS: Twenty-five articles were identified and included in this review. It was revealed that female spousal caregivers perceived higher level negative experience in caregiving, such as lower mental health, lower physical health, poorer health-related quality of life, lower life satisfaction and decreased marital satisfaction than male spousal caregivers. However, female spousal caregivers are more likely to experience personal growth than male spousal caregivers. CONCLUSION: This review identified that female spousal caregivers for cancer patients had higher levels of negative experience in caregiving. A better understanding of the spousal caregiving experience will provide healthcare professionals with the information needed to develop interventions to support and prepare spousal caregivers to care for their loved ones with cancer.

Household smoking practices of parents with young children, and predictors of poor household smoking practices.

OBJECTIVES: Household smoking practices of parents have a major impact on the health of their young children. This study examined the characteristics and household smoking practices of parents with children aged 4-5 years, and identified the predictive factors of poor household smoking practices among Chinese parents in Hong Kong. STUDY DESIGN: Cross-sectional survey. METHODS: Smoking parents with young children from a 1997 birth cohort were re-contacted for a telephone interview to assess their household smoking practices. RESULTS: Among 1149 smoking parents from 1049 families, 898 (85.6%) parents smoked at home. Of these, 339 (37.8%) parents reported smoking at home but not near (i.e. within 3 metres) their children, and 559 (62.2%) reported that they smoked at home without any restrictions. Logistic regression revealed that the predictors of poor household smoking practices were: smoking mother [odds ratio (OR) 4.92, P<0.001]; children born with normal birth weight (OR 2.62, P<0.05); having more than one child (OR 1.70, P=0.01); being a daily smoker (OR 18.96, P<0.0001); smoking >or= 11 cigarettes per day (OR 3.10, P<0.0001); having a higher Fagerstorm nicotine dependence score (OR 4.57-4.86, P<0.01); and having a smoking partner (OR 2.78, P<0.05). CONCLUSIONS: A high proportion of smoking parents with young children display poor smoking practices at home. It is of the utmost importance that community education and smoking cessation services are targeted at these smoking parents to promote smoke-free families.

Pregnant women's decisions on antenatal HIV screening in Hong Kong.

Identification of HIV-infected pregnant women by antenatal screening is crucial to prevent mother-to-child transmission. In Hong Kong, little is known about women's opinions about the screening test. This cross-sectional study examines the decisions of Hong Kong Chinese pregnant women to undergo antenatal HIV screening and the reasons for their choices. Among 191 pregnant women studied, 147 (77.0%) indicated that they would opt for antenatal HIV screening if offered. Of those, 113 (76.9%) would do so for 'the health of their newborns' and 93 (63.3%) for 'their own health'. Fourteen (7.3%) would decline the test, because they have 'one stable sexual partner' (n=9, 64.3%) and believe that 'HIV infection was not their concern' (n=8, 57.1%). Women with a lower educational attainment (adjusted OR=3.77; 95% C.I., 1.12-12.67, p=0.03) were likely to choose antenatal HIV screening. Results of this study are predictive of pregnant women's responses to Hong Kong's newly enacted antenatal HIV screening programme.

Exposure to and actions against passive smoking in non-smoking pregnant women in Guangzhou, China.

BACKGROUND: The objective was to describe the extent of passive smoking exposure and preventive actions against passive smoking in non-smoking pregnant women and to analyze factors associated with preventive actions. METHODS: This was a cross-sectional survey on 1449 never-smoking pregnant women who made their first prenatal visit to the Women and Children's Hospital of Guangzhou, China during 1996-97. RESULTS: 60.2% (95% Confidence Interval 57.7%-62.7%) of the never-smoking pregnant women had a husband who currently smoked. Women with smoking husbands (n=872) were more exposed to ETS than those with non-smoking husbands (n=577) at home (71% vs. 33%), in public places (77% vs. 66%) and at work (60% vs. 50% of working women), and they took less actions against passive smoking in public places. Women with better education and knowledge on smoking and passive smoking had stronger preventive actions. CONCLUSIONS: Non-smoking pregnant women in China are often exposed to passive smoking and their preventive actions are weak. Passive smoking is an important obstetric and public health problem in developing countries and deserves urgent international attention.

An action research study into the development of nurses as reflective practitioners.

This study adopted an action research approach in addressing the question: How could nurses be prepared to be reflective practitioners? The study took place among a group of registered nurses who enrolled in the first year of their degree studies at the Hong Kong Polytechnic University. The methods of data collection included observation, interview, students' written material, and teacher reflection. The experience of this study suggested that teachers and students should be partners in the promotion of reflective learning among students. As teachers reflected on their teaching arrangement and the progress of student learning, students could accordingly be offered appropriate guidance. Throughout the span of their studies, students learned to gradually develop different perspectives in viewing professional nursing practice. The reconceptualization of nursing practice helped students challenge taken-for-granted views and eventually reconstruct their conception of nursing.