Psychometric evaluation of an adult post-COVID-19 symptom tool: a development and validation study.

The objective of this study was aimed to develop and validate an instrument for post-COVID-19 symptoms in adults. Data were collected from adults with a previous COVID-19 diagnosis in Taiwan. We developed the initial instrument through systematic review and expert feedback. Its validity was tested using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and criterion-related validity, while its reliability was tested using Cronbach's alpha. In total, 310 adults participated in this study. Examination of the EFA clearly classified a five-factor model with 24 items (Kaiser-Meyer-Olkin = 0.903; Bartlett's test of sphericity: X2 = 5242.956, df = 276, p < 0.01). The goodness of fit indices of the CFA were as follows: chi-square = 635.172 (p < 0.01), normed chi-square = 2.669, standardized root mean square residual = 0.077, root mean square error of approximation = 0.073, comparative fit index = 0.922, and Tuker and Lewis index = 0.910. The value of Cronbach's alpha coefficient for the total items was 0.941, and the values for the subscales ranged from 0.813 to 0.924. The instrument exhibited acceptable psychometric properties, proving it to be a valuable tool for evaluating post-COVID-19 symptoms in patients at hospitals.

Effects of a Moodle-based E-learning environment on E-collaborative learning, perceived satisfaction, and study achievement among nursing students: A cross-sectional study.

BACKGROUND: Studies suggest that e-learning environments (ELEMs) in nursing education may be more effective than traditional face-to-face teaching, as they lead to learning outcomes that equal or exceed those of face-to-face teaching. OBJECTIVES: To determine whether using ELEM for educational applications can significantly improve e-collaborative learning, perceived satisfaction, and study achievement among nursing students in a paediatric nursing course. DESIGN: Nonrandomized pretest-posttest quasi-experimental research design. SETTINGS: A medical college in northern Taiwan. PARTICIPANTS: Eighty-four students (52 in the non-ELEM group and 32 in the ELEM group) completed both the pretest and posttest. METHODS: Third-year nursing students were recruited and nonrandomly assigned to an experimental group (ELEM) and a nonexperimental group (non-ELEM) of their choice. Students in the former group received traditional classroom teaching without the use of Moodle-based ELEMs, while those in the latter completed the course through Moodle-based ELEMs and classroom lectures. RESULTS: Regarding perceived satisfaction, e-collaborative learning, and study achievement, the overall test results indicated a significant difference in the posttest between the two groups (F (1,82) = 10.622, P = 0.002), (F (1,82) = 9.481, P = 0.003), (F (1,82) = 59.301, P < 0.001, respectively). The explanatory power η2 reached 11.5 %, 10.4 %, and 42.0 %, respectively. CONCLUSION: The students who used Moodle-based ELEMs combined with classroom teaching showed significantly higher levels of e-collaborative learning, perceived satisfaction, and study achievement in the paediatric nursing course. ELEMs for educational purposes can serve as effective complementary learning tools for paediatric nursing courses.

Effects of video-recorded role-play and guided reflection on nursing student empathy, caring behavior and competence: A two-group pretest-posttest study.

AIM: The study examined the differences in nursing student empathy, caring behavior and competence between the experimental and control groups before and after educational intervention and to predict the factors affecting their core competencies. BACKGROUND: Educating nursing students in empathy and caring behaviors before entering clinical practice is challenging. DESIGN: We used a two-group pretest and post-test quasi-experimental design. METHODS: First-year nursing students from medical schools in Taiwan participated in our study. Data were collected between March and May 2022. The learning method used with the intervention group was role-playing with videos and guided reflection. The control group was exposed to traditional curriculum. Empathy, caring behavior and competence were measured using the Jefferson Scale of Empathy- Healthcare Providers, the Caring Behaviors Scale and the Nursing Student Competence Scale. RESULT: A total of 72 participants (40 in the experimental group and 32 in the control group) were included in the final statistical analysis. The response rate was 92%. Statistically significant differences in nursing student empathy, caring behavior and competence were observed between the experimental and control groups (p < .05). The η2 effect levels were 0.083, 0.223 and 0.270. Higher caring behavior scores were significantly associated with higher nursing student competence scores (ß = 0.81, 95% CI:0.66-0.97). CONCLUSIONS: Education based on video role-play and guided reflection improved empathy, caring behavior and nursing competence in first-year nursing students.

The Effect of Physical Activity on Body Constitution and Psychological Health in Older Adults: Evidence From an Analysis of a Biobank Research Database.

This study aims to describe the relationship between physical activity, suboptimal health status based on traditional Chinese medicine, and psychological health in older people in Taiwan. A total of 4,497 older individuals were selected from the Taiwan Biobank Research Database. Suboptimal health status was assessed using a body constitution questionnaire to measure yang deficiency, yin deficiency, and stasis. The results showed that older adults involved in physical activity had a lower likelihood of yang/yin deficiency and stasis constitutions than physically inactive people. Participants with yang deficiency or stasis constitutions had a higher likelihood of poor psychological health, whereas those with yin deficiency had a greater likelihood of depression. People involved in physical activity had a lower likelihood of depression than physically inactive people. Compared with male older adults, females had a lower percentage of physical activity habits, poorer body constitutions, and poorer psychological health.

Effects of naturalistic decision-making model-based oncofertility care education for nurses and patients with breast cancer: a cluster randomized controlled trial.

PURPOSE: This study examined the effects of an oncofertility education program on decisional conflict in nurses and patients with breast cancer. METHODS: A cluster randomized controlled trial was conducted with 84 nurses of five breast care units. Three units were randomly selected from the five as the nurse experimental group. Nurses at the experimental group accepted the oncofertility education based on the naturalistic decision-making (NDM) model, while those at the control group accepted the other non-oncofertility education. We also collected data from female patients before and after the nurses' educational training, respectively. The decisional conflict was measured using the Chinese version of the decisional conflict scale. RESULTS: Nurses in the experimental group had less decisional conflict after the oncofertility educational intervention than those in the control group. After the intervention, nurses with higher infertility knowledge scores had significantly lower decisional conflict. Single nurses had significantly higher decisional conflict than married nurses. A higher perceived barrier score was significantly associated with a higher decisional conflict score. Among patients with the same fertility intention scores, those in the experimental group had lower decisional conflict scores than those in the control group. CONCLUSIONS: Our work demonstrates that NDM-based oncofertility care education is feasible and acceptable to improve nurse and patient decisional conflict. Educational training based on the NDM model decreased the decisional conflict regarding oncofertility care. CLINICALTRIALS: gov Identifier: NCT04600869.

Psychometric evaluation of a nursing competence assessment tool among nursing students: a development and validation study.

BACKGROUND: Nursing competence refers to the core abilities that are required for fulfilling one's role as a nurse. A specific instrument comprehensively measuring competence among nursing students has not yet been developed. The purpose of the study was to develop and validate a nursing competence instrument for nursing students in bachelor training. METHODS: A descriptive and explorative study design was used. Data were collected from students at one medical college in Taiwan in 2020 and 2021. A total of 241 nursing students participated in this study. We developed the initial instrument through systematic review, expert evaluations, and pilot versions. Its validity was then tested using confirmatory factor analysis (CFA) and criterion-related validity, while its reliability was tested using Cronbach's alpha and test-retest analysis. RESULTS: The final fit indexes of CFA were as follows: chi-square = 860.1 (p < 0.01), normed chi-square = 2.24, SRMR = 0.04, RMSEA = 0.07, CFI = 0.94, and TLI = 0.94. Cronbach's alpha values for the subscales observed ranged from 0.91 to 0.98. The test-retest reliability coefficient for the Nurse Competence Scale was 0.515 (n = 30, p < 0.01). CONCLUSIONS: The instrument exhibited acceptable psychometric properties, thereby proving itself a valuable tool for evaluating nursing students' competence at bachelor training. Further assessments of its reliability, validity, and generality from mentors' and scholars' views in different contexts and cultures are recommended.

Determinants of health-seeking behavior toward Chinese or Western medicine in Taiwan: An analysis of biobank research database.

BACKGROUND AND PURPOSE: Health-seeking behavior has a direct impact on individual's health. A proper understanding of patients' demographics and health factors is essential in constructing high-quality health care services toward Chinese or Western medicine. The objective of this study was to understand the tendency among Taiwanese to opt for either Chinese or Western medicine when both services are available. MATERIALS AND METHODS: This study was based on the analysis of secondary data. A total of 13,151 individuals with an age of 30 years or more were selected from the Taiwan Biobank Research Database in Taiwan. Multiple logistic regression analysis was used to identify factors associated with health-seeking behaviors toward Chinese or Western medicine. RESULTS: Among all the participants, 50.8% showed a greater tendency to seek Western medicine treatment, while 10.4% showed a preference for Chinese medicine treatment. Main drivers for a Chinese medicine health-seeking behavior were women, hypotension, low income, normal HbA1c, normal total cholesterol, and yang deficiency. The preference for Western medicine treatment was associated mainly with men, an older age, a married status, lower income, a lower education, an abnormal cholesterol level, and the absence of stasis. CONCLUSION: Healthcare providers should understand the factors associated with health-seeking behavior and refer patients to their desired treatment.

Developing a web-based oncofertility tool for reproductive-age women with breast cancer based on social support framework.

PURPOSE: To develop electronic systems for oncofertility support, and to examine the comprehensibility, feasibility, usability, and effects on social support and preparation for decision-making. METHODS: The study steps were guided, tested, and utilized to (a) identify the requirements of a patient, (b) guide the development of support interventions, and (c) evaluate the quality of web-based oncofertility support. Alpha testing and beta testing were used to ensure the quality of the web-based oncofertility support tool. The effectiveness was evaluated using the Preparation for Decision-Making Scale and Social Support Questionnaire. RESULTS: At the alpha testing phase, the mean (± standard deviation) values of the comprehensibility and usability for reproductive-age women with breast cancer were 4.24 (± 0.47) and 4.42 (± 0.57); and the mean values of the acceptability and usability for healthcare providers were 4.04 (± 0.67) and 3.99 (± 0.66), respectively. At the beta testing phase, the mean values of the feasibility for patients and healthcare providers were 3.93 (± 0.67) and 4.17 (± 0.78), respectively. The corresponding mean Preparation for Decision-Making Scale scores were 3.78 ± 0.82 and 4.11 ± 0.93, respectively. The results of the Wilcoxon signed-rank test revealed that the informational and instrumental support scores improved significantly compared with the pre-test data (informational support: 8.94 ± 3.28 vs. 10.06 ± 1.91, p < 0.01; instrumental support: 7.44 ± 2.90 vs. 8.75 ± 2.57, p < 0.01). CONCLUSIONS: The oncofertility support website demonstrated acceptable comprehensibility, feasibility, and usability, in addition to informational and instrumental support. TRIAL REGISTRATION: Clinicaltrials.gov NCT05100498, https://clinicaltrials.gov/ct2/show/NCT05100498.

Development and Validity Testing of an Assessment Tool for Oncofertility Barriers in Multidisciplinary Healthcare Providers on the Breast Cancer Team.

BACKGROUND: Multidisciplinary healthcare providers, especially clinical nurses, lack a valid tool to assess the comprehensive barriers affecting oncofertility care in breast cancer treatment. PURPOSE: The aims of the research were to develop a self-assessment scale on oncofertility barriers and test its validity and reliability. METHODS: This was a methodological study. The initial 36 items of the developed Oncofertility Barrier Scale (OBS) were generated through qualitative study and a review of the literature. This scale was further refined using expert validity (n = 10), face validity (n = 10), and item analysis (n = 184). Exploratory factor analysis with principal axis factoring and direct oblimin rotation was used to determine the construct validity. The reliability of the OBS was evaluated using internal consistency and test-retest analyses. RESULTS: The mean item-level and scale-level content validity indices of the initial OBS were higher than .96. The data were shown to be feasible for the factor analysis, and a six-factor solution was chosen that accounted for approximately 57.6% of the total variance. These factors included (a) lack of information and education, (b) rigid thinking toward oncofertility care, (c) cancer patient stereotypes, (d) fertility risk, (e) insufficient support, and (f) interrupted oncofertility care. The Cronbach's alpha of the 27-item OBS was .91, and the test-retest reliability coefficient was .55. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The final version of the developed OBS has acceptable reliability, content validity, and construct validity. This scale is appropriate for use in research and clinical practice settings to identify the barriers to fertility cancer care that should be resolved by the breast cancer care team.

Oncofertility care: A qualitative study to understand personal perspectives and barriers in the multidisciplinary breast care team in Taiwan.

BACKGROUND: Previous studies indicate significant gaps exist in current practices and perceptions of oncofertility care. OBJECTIVES: We aim to understand the clinical experience regarding oncofertility care among health providers in a multidisciplinary breast care team. METHODS: A qualitative, descriptive study was conducted. Data were collected through in-depth interviews with 16 health care providers who worked in a hospital in Taipei. Verbatim transcriptions were analyzed using constant analysis methods. RESULTS: Health care providers' experiences regarding fertility care for reproductive-age women with breast cancer were divided into two themes: personal perspectives and barriers. Personal perspectives consisted of six subthemes including empathizing with the patient's suffering during the diagnosis and treatment, safety as a prerequisite, satisfying the women's needs, respecting the women's choice, questioning women's ability to raise children, and returning to family life. There were also six subthemes under barriers. These subthemes were poor communication among the multidisciplinary team, lack of initial screening, insufficient support in the women's families, treatment considerations, lack of evidence-based information regarding oncofertility, and non-follow-up protocol. CONCLUSION: Nurses should evaluate the fertility needs of women with cancer and identify potential gaps during oncofertility care. Education strategies and tactics should be improved in order to overcome difficulties arising from health care providers' personal perspectives and barriers to the provision of optimal fertility care in women with cancer.

Perceptions of Behavioral Awareness, Intention, and Readiness for Advance Care Planning: A Mixed-Method Study among Older Indigenous Patients with Late-Stage Cancers in Remote Areas of Eastern Taiwan.

The first Patient Right to Autonomy Act enacted in Asia in 2019 has enabled every Taiwanese citizen to plan for his/her end-of-life (EOL) in case of incompetency. Advance care planning (ACP) has been highly promoted for individuals with terminal, life-threatening illnesses, particularly in the mainstream society, and efforts have been made by the Taiwanese government to train health care providers in order to optimize patients' quality of dying. However, such advanced decisions and discussions regarding life-sustaining treatment and EOL care remain scarce among older ethnically minority patients. A multiple-case study employing a mixed-method (n = 9) was undertaken to explore indigenous patients' ACP perceptions. Both quantitative and qualitative information was obtained from indigenous patients, a minority group whose socio-economic and educational status are different from the general Taiwanese population. An initiative was made to describe ACP behavioral awareness, intention, and readiness of older terminal patients from four tribes with seven late-stage cancers in remote, mountainous areas of eastern Taiwan. Our findings showed that according to the Transtheoretical Model, terminal indigenous patients' ACP readiness was at a precontemplation stage. Their lack of fundamental ACP awareness, insufficient healthcare resources, life-sustaining value in a Christian faith context, and the prevalent health disparity in the remote communities have negatively affected indigenous patients' intention to participate in ACP. We provide suggestions to further promote ACP in this group and suggest that health information should be tailored at various readiness stages in order to overcome barriers and decrease ACP literacy discrepancies. This study calls attention to an understudied area of ACP behaviors, an overlooked need in EOL care for older cancer patients of unique cultural backgrounds, and the imperativeness to ensure cultural minority group's EOL care is consistent with patients' preferences.

Developing a Web-Based Shared Decision-Making Tool for Fertility Preservation Among Reproductive-Age Women With Breast Cancer: An Action Research Approach.

BACKGROUND: The pregnancy rate after cancer treatment for female survivors is lower than that of the general population. Future infertility is a significant concern for patients with breast cancer and is associated with a poor quality of life. Reproductive-age patients with breast cancer have safe options when choosing a type of fertility preservation method to be applied. Better information and support resources aimed at women to support their decision making are needed. OBJECTIVE: The objective of this study was to develop a web-based shared decision-making tool for helping patients with breast cancer make decisions on fertility preservation. METHODS: We used the action research cycle of observing, reflecting, planning, and acting to develop a web-based shared decision-making tool. The following four phrases were applied: (1) observe and reflect-collect and analyze the decision-making experiences of patients and health care providers; (2) reflect and plan-apply the initial results to create a paper design and modify the content; (3) plan and act-brainstorm about the web pages and modify the content; (4) act and observe-evaluate the effectiveness and refine the website's shared decision-making tool. Interviews, group meetings, and constant dialogue were conducted between the various participants at each step. Effectiveness was evaluated using the Preparation for Decision-Making scale. RESULTS: Five major parts were developed with the use of the action research approach. The Introduction (part 1) describes the severity of cancer treatment and infertility. Options (part 2) provides the knowledge of fertility preservation. The shared decision-making tool was designed as a step-by-step process (part 3) that involves the comparison of options, patient values, and preferences; their knowledge regarding infertility and options; and reaching a collective decision. Resources (part 4) provides information on the hospitals that provide such services, and References (part 5) lists all the literature cited in the website. The results show the web-based shared decision-making meets both patients' and health providers' needs and helps reproductive-age patients with breast cancer make decisions about fertility preservation. CONCLUSIONS: We have created the first web-based shared decision-making tool for making fertility preservation decisions in Taiwan. We believe female patients of reproductive age will find the tool useful and its use will become widespread, which should increase patient autonomy and improve communication about fertility preservation with clinicians. TRIAL REGISTRATION: Clinicaltrials.gov NCT04602910; https://clinicaltrials.gov/ct2/show/NCT04602910.

Evidenced-based practice of decision-making process in oncofertility care among registered nurses: A qualitative study.

AIM: The purpose of our study was to construct the context of the nursing action/role in oncofertility care. DESIGN: Qualitative research. METHODS: We applied grounded theory to guide the qualitative study. Data were collected through in-depth interviews with 12 nurses in Taipei. The data were collected from August 2018 to February 2019. RESULTS: The core theme that described the role of nurses' decision-making in oncofertility care focused on understanding oncofertility from the self to the other. Care roles or actions in oncofertility that involved the process of psychological cognition were divided into four dimensions: perceiving the patient's changes and needs, triggering the self's emotions, empathizing with patient's situations and introspective care roles. Nurses who had experienced the phase of empathizing with the patient's situations developed more diverse roles and had positive actions toward oncofertility care. Based on the psychological changes for oncofertility decision-making process, implementing contextual training in oncofertility could help nurses create more positive actions in oncofertility care.

Constitutions of Deficiency and Stasis of Traditional Chinese Medicine and Related Factors among Middle-Aged Women in Taiwan.

BACKGROUND: Traditional Chinese medicine (TCM) appears to be the common therapy in middle-aged women. The constitution serves as a guide for TCM treatment. However, little is known about the constitution and related factors in middle-aged women. The objectives of this study were to describe the yang-deficiency, yin-deficiency, and stasis constitutions in middle-aged women. Demographic and health factors related to yang deficiency, yin deficiency, and stasis were also examined. METHODS: A total of 1,000 women aged 40-65 years were selected from 2009 through 2018 using random sampling from the Taiwan Biobank Research Database in Taiwan. Yang-deficiency, yin-deficiency, and stasis were assessed using the body constitution questionnaire. Multiple logistic regression analysis was used to identify factors associated with constitution in deficiency or stasis. RESULTS: The proportions of middle-aged women who had the constitution in yang-deficiency, yin-deficiency, and stasis were 29.7%, 21.7%, and 17.7%, respectively. The result of binary logistic regression showed that current menstruation, abnormal spirometry, and education level were predictive factors of yang deficiency. Women with younger age, abnormal spirometry, or a vegetarian diet had a significantly associated yin deficiency. Younger age, abnormal spirometry, and coffee habit were predictors of stasis. CONCLUSIONS: Middle-aged women in Taiwan with abnormal spirometry had a higher risk for deficiency or stasis constitutions, especially for those younger than 56 years. Healthcare providers should learn patients' constitutions and provide appropriate advice, referring them to safe providers of their desired method.

Impact of Symptom and Social Support on Fertility Intention in Reproductive-Age Women With Breast Cancer.

This study describes the fertility intention and explores factors related to fertility intention in reproductive-age women with breast cancer in Taiwan. In this cross-sectional study, women of childbearing age who had been diagnosed with breast cancer completed a face-to-face survey that included demographic, disease, and symptom-related data, and social support and fertility intention information. The mean fertility intention score among the 223 participants was "medium" (M ± SD = 41.18 ± 12.62). Higher symptom severity, especially for distress, was related to lower fertility intention. Instrumental support from families and friends was positively associated with fertility intention score. Younger women had better fertility intention scores than older women. The Sobel test showed that age mediated menopause and fertility intention. The findings offer the evidence of the needs to control symptoms and provide sufficient instrumental support regarding fertility after completing chemotherapy.

Infertility-related knowledge in childbearing-age women with breast cancer after chemotherapy.

AIM: The purposes of this study were to describe the degree of knowledge and explore the factors associated with knowledge of infertility among women of childbearing age with breast cancer. METHODS: In this cross-sectional study, we recruited women of childbearing age with a diagnosis of breast cancer who had completed chemotherapy at a hospital in Taipei from 2015 through 2016. Face-to-face interviews were completed with 201 (62%) of 324 eligible women, asking about sociodemographic variables, disease and treatment characteristics, fertility intention, and infertility-related knowledge. RESULTS: The result showed one in 10 women had thought about becoming pregnant after completion of breast cancer chemotherapy. The mean score of infertility knowledge among participants was low, especially for general knowledge. Women with higher levels of education had better knowledge scores. Fertility intention score, especially for the domain of the pregnant risk, was negatively associated with infertility knowledge score. CONCLUSION: Women with breast cancer lacked knowledge about infertility and underestimated the possibility of infertility. We suggest future patient education on infertility after cancer treatment and about reproductive technology in oncologic practice before treatment begins.

Meta-analysis: Exercise intervention for sleep problems in cancer patients.

BACKGROUND: Sleep problems cause physical and mental distress and may influence the survival of cancer patients. OBJECTIVES: This study aimed to explore the efficacy of exercise intervention to improve sleep in cancer patients. METHODS: Published papers from 1980 to 2018 were searched. RESULTS: The major findings included (a) exercise intervention had small positive effects on enhancing total subjective sleep quality (TSSQ; g = 0.38, 95% CI = 0.21-0.54) and objective sleep onset latency (g = 0.21, 95% CI = 0.01-0.41). (b) The characteristics in subgroups in regarding the small to large effects of an exercise programme on sleep were identified. First, the groups of a home-based exercise and a supervised exercise combined with a home-based exercise had a medium effect on TSSQ than the usual group. Second, interventions with aerobic exercise, especially the 4- to 8-week programmes and those with weekly volume of 80-149 min per week for cancer patients with ongoing or completed treatment also had a medium to large positive effect on TSSQ. Finally, patients with breast cancer and haematologic malignancies contributed a small effect in this meta-analysis. CONCLUSIONS: Maintaining regular aerobic exercises, even of different durations and weekly volumes, benefits patient sleep quality.

Oncofertility to Evidence-Based Practice: Changes in Fertility Intention and Symptom Burden in Reproductive-Age Women With Breast Cancer.

BACKGROUND: Infertility is negatively related to the quality of life in reproductive-age women with breast cancer. The nurses who care for these patients lack a comprehensive understanding of the changes in fertility intention that patients undergo from the time of cancer diagnosis, throughout treatment, and after treatment. A fertility intention assessment is the first step in discerning the patient's ideas toward future pregnancy. AIMS: This study examined the changes in fertility intention and symptom burden in reproductive-age women with breast cancer before, during, and after treatment. We also explored predictors of fertility intention among the women. METHODS: The study was guided by the theory of planned behavior. A longitudinal and observational study was conducted with 151 women with breast cancer who were treated at a teaching hospital in Taipei. The participants were interviewed using a structured questionnaire before, during, and after chemotherapy from July 2016 to March 2018. Fertility intention was assessed using the Fertility Intention Scale. The M.D. Anderson Symptom Inventory-Taiwanese version was used to measure the symptom burden. The generalized linear mixed model was used for multivariate analysis. RESULTS: Patients had significantly lower scores for fertility intention after treatment than before treatment. The study patients had substantially worse symptom burden during treatment than before or after treatment. Symptom burden scores, especially for symptom interference, correlated significantly with fertility intention. A higher Fertility Intention Scale score was significantly associated with younger age. LINKING EVIDENCE TO ACTION: Fertility intention decreased over time in women with breast cancer. Understanding fertility intention and controlling symptom burden throughout the course of treatment and beyond might help nurses provide better care for preserving fertility and maintaining fertility options for these women with breast cancer.

Development and Validation of a Fertility Intention Scale in Breast Cancer Survivors.

BACKGROUND: Evidence indicates that breast cancer survivors with reproductive concerns have a poorer quality of life than survivors without fertility concerns. There is a lack of reliable and valid assessments of fertility intention among breast cancer survivors. PURPOSE: The aim of this study was to develop and validate the Fertility Intention Scale (FIS) that is sensitive to the fertility intention of women with breast cancer. METHODS: A literature review and a qualitative study were conducted to generate the items in the scale. Content validity was evaluated by 15 experts, and face validity was assessed by 10 patients with cancer. Factor analysis was used to assess construct validity, and criterion validity was evaluated using two percentile items of fertility willingness. We developed and examined the validity and reliability of the FIS using a sample of 178 patients with breast cancer who had completed chemotherapy. RESULTS: The Cronbach's alpha calculated for the FIS (15 items) was .88. The factor analysis performed for the construct validity of the scale identified four factors that accounted for approximately 68.72% of the total variance. These four factors were pregnancy risk, disease control, social support, and happiness. There was a significant correlation between the total FIS and the level of desiring fertility preservation or pregnancy. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The FIS has acceptable reliability, content validity, and construct validity. This scale is appropriate for use in research and clinical practice settings to evaluate the risk-benefit perceptions of pregnancy in patients with breast cancer.

Incidence and lifetime risk of uterine corpus cancer in Taiwanese women from 1991 to 2010.

OBJECTIVE: Although uterine corpus cancer has been the most common malignancy of the female genital tract in many countries, the lifetime risk of this cancer has not yet been determined among Taiwanese women. The purpose of the study was to describe the change in incidence and the lifetime risk of uterine corpus cancer over a 20-year period from 1991 to 2010 in Taiwan. MATERIALS AND METHODS: We conducted a population-based registry study using the released database (available online) from the Taiwan Cancer Registry. RESULTS: A total of 15,542 women newly diagnosed with uterine corpus cancer were included in this study. The total number of this cancer increased by 5.7-fold from 1991 to 2010. The annual age-specific rate nearly doubled during the past decade (2001-2010) when compared with the previous decade (1991-2000). Incidence rates were highest in women aged 50-59 years, and increasing incidence rates were observed in each age strata starting from 40 years to 85 years and more, after the year 2000. The lifetime risk of being diagnosed with uterine corpus cancer was 0.39% in 1991-1995, 0.54% in 1996-2000, 0.73% in 2001-2005, and 1.12% in 2006-2010 among Taiwanese women. CONCLUSION: According to the observed changes in incidence rate, the burden of uterine corpus cancer in the general female population is expected to increase in the near future. From a public-health perspective, care providers should develop strategies for the prevention, early detection, and intervention to reduce the rapidly increasing incidence of uterine corpus cancer in Taiwan.