Posttraumatic growth and demoralization after cancer: The effects of patients' meaning-making.

OBJECTIVE: It is common for patients to experience positive and negative psychological changes (e.g., posttraumatic growth or demoralization) after being diagnosed with cancer. Although demoralization and posttraumatic growth are both related to meaning-making, little attention has been paid to the associations among these concepts. The current study investigated the relationship between demoralization, posttraumatic growth, and meaning-making (focusing on sense-making and benefit-finding during the experience of illness) in cancer patients. METHOD: Some 200 cancer patients (with lung cancer, lymphoma, or leukemia) at the MacKay Memorial Hospital in New Taipei completed the Demoralization Scale-Mandarin Version (DS-MV), the Chinese Posttraumatic Growth Inventory (CPTGI), and a self-designed questionnaire for assessing sense-making and benefit-finding. RESULTS: Demoralization was negatively correlated with posttraumatic growth, sense-making, benefit-finding, and time-since-diagnosis. Multiple regression analysis showed that meaning-making had different effects on demoralization and posttraumatic growth. The interactions of sense-making with either benefit-finding or time-since-diagnosis significantly predicted demoralization. Individuals with relatively higher sense-making and benefit-finding or shorter time-since-diagnosis experienced less demoralization. SIGNIFICANCE OF RESULTS: The suffering of cancer may turn on the psychological process of demoralization, posttraumatic growth, and meaning-making in patients. Cancer patients who evidenced higher posttraumatic growth experienced less demoralization. Trying to identify positive changes in the experience of cancer may be a powerful way to increase posttraumatic growth. As time goes by, patients experienced less demoralization. Facilitating sense-making can have similar effects. Cancer patients with less benefit-finding experience higher demoralization, but sense-making buffers this effect.

Development and Validity and Reliability of an Instrument to Assess Patient's Spiritual Well-Being.

Background: Spiritual care is not limited to palliative care or end-of-life care. The spiritual well-being of patients also needs to be taken into account in the multidisciplinary healthcare system of whole person care. For medical institutions providing spiritual care, it is necessary to develop a tool for clinical spiritual care providers to assess patient's spiritual well-being of. Aim: The purpose of this study was to construct a questionnaire that would allow spiritual care providers or pastors to assess the spiritual well-being of patients. Methods: The study combined qualitative and quantitative research methods. Qualitative research used in-depth interviews or focus groups with patients and family members to obtain textual data. The text was analyzed by Colaizzi analysis. The researchers constructed the Patient's Spiritual Well-Being Scale (PtSpWBS) from the themes obtained through qualitative analysis. Through the participation of 661 patients, quantitative research was conducted to analyze the reliability, validity and component analysis of the PtSpWBS. Results: Through qualitative research, it was found the spiritual needs of patients had two domains, namely spiritual awareness and spiritual dynamics. Based on this result, a 15-question PtSpWBS was designed. Cronbach's alpha was used to check the reliability of the PtSpWBS, and the internal consistency was calculated with a Cronbach's alpha value of 0.899. The Bartlett's Test of Sphericity of the PtSpWBS reached a significant difference (p<0.0001), and the KMO value of sampling appropriateness was 0.900. The three components were spiritual health, religion connection, and spiritual awareness. A PtSpWBS score ≦ 41 indicated the patient had poor spiritual well-being. Conclusion: The study constructed the PtSpWBS for clinical spiritual care providers to evaluate spiritual well-being of patients; this questionnaire has good reliability and validity. The PtSpWBS can be truly used by departments that specialize in providing spiritual care in medical institutions to conduct spiritual well-being assessment.

Development and Evaluation of Psychometric Properties Regarding the Whole Person Health Scale for Employees of Hospital to Emphasize the Importance of Health Awareness of the Workers in the Hospital.

(1) Background: Whole person health (WPH) is important among employees in hospitals. It will affect their performance and attitude toward patient care and organization. This project was designed to develop and assess the validity and reliability of utilizing the Whole Person Health Scale for Employees of a Hospital (WPHS-EH) to determine overall employee health. (2) Methods: A mixed-methods focus group and cross-sectional survey was adopted. Employees held six focus groups, with 62 employees from different departments in medical center in Taiwan. After analyzing the interview content, five experts tested its validity, and the 14-item WPHS-EH scale was analyzed. This was followed by an additional 900 participants questionnaire survey, response rate: 94.9%. Descriptive statistics, Cronbach's alpha, exploratory factor analysis (EFA), and items analysis were used. Additionally, the scale was implemented to conducted confirmatory factor analysis (CFA) test for validity. (3) Results: Three dimensions were extracted from the questionnaires by EFA: "hospital circumstance and system", "professional and interpersonal interaction" and "workload and harm". The Cronbach's alpha of the WPHS-EH scale was 0.82, while the three sub-dimensions were all significantly correlated with total scores. CFA confirmed the scale construct validity, with a good model fit. (4) Conclusions: The WPHS-EH is a reliable measurement tool to assess the effects of hospitals' Whole Person Health among employees. The intent of the WPHS-EH was to provide a reliable scale to analyze the work environment for hospital staff and useful information to healthcare administrators interested in improving the staff's whole person health.