Journal of Korean Academy of Nursing

Research Papers

Development and Evaluation of an App-Based Self-Management Program for Exercise Practice of Breast Cancer Survivors: A Non-Randomized Controlled Trial: Maeng, Suyoun , Yu, Jungok; J Korean Acad Nurs 2024;54(2):250-265. Published online May 31, 2024; DOI: https://doi.org/10.4040/jkan.23119

Purpose
This study aimed to develop an app-based self-management program based on the transtheoretical model (TTM) for breast cancer survivors’ exercise practice, as well as to investigate the program’s effects on the stage of change for exercise, exercise self-efficacy, exercise decisional balance, exercise amount, and body composition.
Methods
This non-randomized controlled study included 52 participants (26 in each of the experimental and control groups, respectively). An app-based self-management program based on the TTM was conducted with the experimental group for a 12-week period. The program comprised three components: individual coaching for each stage of change for exercise based on TTM, amount of exercise and body composition monitoring, and online self-help meetings.
Results
Compared with the control group, the experimental group had significantly higher stages of change for exercise (p < .001), exercise self-efficacy (p < .001), exercise decisional balance (p = .002), exercise amount (p < .001), and body composition (body weight [p = .006], body mass index [p = .005], and body fat percentage [p = .010]) immediately and four weeks after the intervention.
Conclusion
An appbased self-management program based on the TTM improves exercise behaviors in breast cancer survivors and provides physical benefits.

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Effects of a mobile health coaching intervention on symptom experience, self-management, and quality of life in breast cancer survivors: A quasi-experimental study
Jin-Hee Park, Sun Hyoung Bae, Yong Sik Jung, Min Hee Hur, Ji Young Kim, Su Jin Jung
Medicine.2025; 104(12): e41894. CrossRef

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Effects of the Advanced Practice Nurse-Led Psychoeducational Program for Colorectal Cancer Survivors: Kim, Hye Kyung , Yoo, Yang-Sook; J Korean Acad Nurs 2022;52(3):245-260. Published online June 30, 2022; DOI: https://doi.org/10.4040/jkan.21207

Abstract PDF

Purpose
This study aimed to investigate the effects of an advanced practice nurse-led psychoeducational program on distress, anxiety, depression, coping with cancer (CWC), health promotion behavior (HPB), and quality of life (QOL) among colorectal cancer survivors.
Methods
This study was designed as a quasi-experimental study with a non-equivalent control group pretest-posttest. The participants were survivors of colorectal cancer who underwent follow-up care. There were 39 survivors: 19 in the experimental group and 20 in the control group. The experimental group performed a psychoeducational program for 120 minutes per session, once a week for a total of six weeks, while the control group received routine education and counseling. Distress, anxiety, depression, CWC, HPB, and QOL were investigated before, immediately after, and 4 weeks after the intervention. The data were analyzed with SPSS/WIN ver. 24.0, using repeated measures ANOVA.
Results
There were significant interactions between time and group for distress and anxiety. In addition, CWC interacted with the total of CWC and interpersonal coping, and QOL interacted with the total of QOL and functional status. However, there were no significant differences in the depression or HPB scores.
Conclusion
Based on the results of this study, we expect that this program can be used as an effective intervention for colorectal cancer survivors.

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Kisook Kim, Hyohyeon Yoon
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Cristian-David Useche-Guerrero, María-de-los-Ángeles Merino-Godoy, Eva-María Barroso-Márquez, Emilia Isabel Martins Teixeira da Costa, Rafaela Camacho Bejarano, Francisco-Javier Gago-Valiente, Rizal Angelo Grande
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XiaoYing Zhang, HuangQin Liu, LiYing Lin, Huimin Xiao
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How should the healthcare system support cancer survivors? Survivors’ and health professionals’ expectations and perception on comprehensive cancer survivorship care in Korea: a qualitative study
Su Jung Lee, Dal-Lae Jin, Young Ae Kim, Hyun-Ju Seo, Seok-Jun Yoon
BMC Cancer.2023;[Epub] CrossRef
Cancer Survivorship Care and Roles of Oncology Nurses
Eun Young Park
Asian Oncology Nursing.2022; 22(3): 121. CrossRef

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Original Article

Mediation Effect of Self-Efficacy on the Relationship between Perceived Self-Management Support and Health-Related Quality of Life among Cancer Survivors: Bo Gyeong Lee, Tae Sook Lee, Soo Hyun Kim; J Korean Acad Nurs 2019;49(3):298-306. Published online January 15, 2019; DOI: https://doi.org/10.4040/jkan.2019.49.3.298

Abstract PDF

Abstract Purpose

This study aimed to examine the levels of perceived self-management support, self-efficacy for self-management, and health-related quality of life (HRQoL) in cancer survivors, and to identify the mediating effect of self-efficacy in the relationship between perceived self-management support and HRQoL.

Methods

This study used a descriptive correlational design. Two hundred and four cancer survivors who had completed treatment participated in the study. Measurements included the Patient Assessment of Chronic Illness Care Scale, the Korean version of the Cancer Survivors’ Self-Efficacy Scale, and the Medical Outcomes Study Short Form-36. Data were analyzed using descriptive statistics, Pearson's correlation coefficient analysis, and multiple regression analysis using Baron and Kenny's method for mediation.

Results

The mean score for perceived self-management support was 3.35 out of 5 points, self-efficacy was 7.26 out of 10 points, and HRQoL was 65.90 out of 100 points. Perceived self-management support was significantly positively correlated with self-efficacy (r=.29, p<.001) and HRQoL (r=.27, p<.001). Self-efficacy was also significantly correlated with HRQoL (r=.59, p<.001). Furthermore, self-efficacy (β=.55, p<.001) had a complete mediating effect on the relationship between perceived self-management support and HRQoL (Z=3.88, p<.001).

Conclusion

The impact of perceived self-management support on HRQoL in cancer survivors was mediated by self-efficacy for self-management. This suggests that strategies for enhancing self-efficacy in cancer survivors should be considered when developing self-management interventions for improving their HRQoL.

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Soo Hyun Kim, Yu Hyeon Choe, Jingyeong Choi, Ji Young Park, Eun Yi
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Mediating Effect of Self-Efficacy on the Relationship between Symptom Experience and Health-Related Quality of Life in Patients with Chronic Obstructive Pulmonary Disease
Enhee Jo, Ju-Young Park, Young Jun Jang
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Hye Jin Kim, Eunjoo Lee
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Trajectories of quality of life in breast cancer survivors during the first year after treatment: a longitudinal study
Jin-Hee Park, Yong Sik Jung, Ji Young Kim, Sun Hyoung Bae
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Soo Hyun Kim, Bo Gyeong Lee, Yu Hyeon Choe, Francesca Chiesi
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International Journal of Environmental Research and Public Health.2020; 17(20): 7532. CrossRef

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Review Article

Effects of Psychoeducational Intervention for Cancer Survivors: A Systematic Review and Meta-Analysis: Jin-Hee Park, Sun Hyoung Bae; J Korean Acad Nurs 2017;47(2):143-163. Published online April 28, 2017; DOI: https://doi.org/10.4040/jkan.2017.47.2.143

Abstract PDF Supplementary Material

Purpose

This study was a systematic review and meta-analysis designed to investigate effects of psychoeducational intervention for cancer survivors.

Methods

Ten databases were searched. Two reviewers independently performed the selection of the studies, data extraction and assessment. The risk of bias was assessed using Cochrane Collaboration's tool. To estimate the effect size, meta-analysis of the studies was performed using Comprehensive Meta-Analysis and RevMan programs.

Results

Of 18,781 publications identified, 35 met inclusion criteria, and 25 studies were used to estimate effect size of psychoeducational intervention. Effect sizes (standardized mean difference [SMD]) were heterogeneous and random effects models were used in the analyses. Psychoeducational intervention was effective for quality of life (n=2,410, ES=0.23; 95% CI: 0.09~0.37), coping and self-efficacy (n=179, ES=0.68; 95% CI: 0.26~1.11), anxiety (n=1,786, ES=-0.26; 95% CI: -0.37~-0.15), depression (n=1,910, ES=-0.28; 95% CI: -0.37~-0.18), and psychological distress (n=2,242, ES=-0.31; 95% CI: -0.46~-0.17). Subgroup analysis showed that counseling was the most effective intervention for quality of life, and behavioral therapy was an effective intervention for all positive and negative outcomes. Publication bias was not detected except for psychological distress.

Conclusion

Psychoeducational intervention appears to be effective in improving quality of life and coping and self-efficacy, and it is effective in reducing psychological symptoms in cancer survivors. Behavioral therapy, especially, is commonly effective in improving psychosocial outcomes. However, low-quality evidence, variability in the designs of existing studies, and publication bias suggest that additional high-quality trials should be conducted in the future.

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Original Articles

A Study on the Knowledge Structure of Cancer Survivors based on Social Network Analysis: Sun Young Kwon, Ka Ryeong Bae; J Korean Acad Nurs 2016;46(1):50-58. Published online February 29, 2016; DOI: https://doi.org/10.4040/jkan.2016.46.1.50

Abstract PDF

Purpose

The purpose of this study was to identify the knowledge structure of cancer survivors.

Methods

For data, 1099 articles were collected, with 365 keywords as a Noun phrase extracted from the articles and standardized for analyzing. Co-occurrence matrix were generated via a cosine similarity measure, and then the network analysis and visualization using PFNet and NodeXL were applied to visualize intellectual interchanges among keywords.

Results

According to the result of the content analysis and the cluster analysis of author keywords from cancer survivors articles, keywords such as 'quality of life', 'breast neoplasms', 'cancer survivors', 'neoplasms', 'exercise' had a high degree centrality. The 9 most important research topics concerning cancer survivors were 'cancer-related symptoms and nursing', 'cancer treatment-related issues', 'late effects', 'psychosocial issues', 'healthy living managements', 'social supports', 'palliative cares', 'research methodology', and 'research participants'.

Conclusion

Through this study, the knowledge structure of cancer survivors was identified. The 9 topics identified in this study can provide useful research direction for the development of nursing in cancer survivor research areas. The Network analysis used in this study will be useful for identifying the knowledge structure and identifying general views and current cancer survivor research trends.

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Posttraumatic Growth, Dyadic Adjustment, and Quality of Life in Breast Cancer Survivors and Their Husbands: Seunghee Song, Eunjung Ryu; J Korean Acad Nurs 2014;44(5):515-524. Published online October 31, 2014; DOI: https://doi.org/10.4040/jkan.2014.44.5.515

Abstract PDF

Purpose

The purpose of this study was to identify whether the couple perceived breast cancer as a traumatic event, to evaluate the association among posttraumatic growth, dyadic adjustment, and quality of life and to explore the predictors affecting quality of life of the couple.

Methods

A cross-sectional comparative survey design was utilized. Participants were 57 couples recruited from a national cancer center in Korea. Data were analyzed using paired t-test, McNemar test and independent t-test. On the basis of variables found to be significantly associated with quality of life, multiple regression was used to examine the simultaneous influence of multiple predictors.

Results

Breast cancers survivors and spouses perceived breast cancer as a traumatic event (43.9% and 24.6%, respectively). The global quality of life was explained by perception as trauma (β=-19.79) and posttraumatic growth (β=0.46) in survivors, and perception as trauma (β=-18.81) and dyadic adjustment (β=0.53) in spouses.

Conclusion

Results suggest that future research should use qualitative methods to evaluate why contemplating reasons for cancer contributed to posttraumatic growth, examine other potential predictors of quality of life such as dyadic adjustment and intimacy, and identify links between posttraumatic growth and other psychological outcomes such as distress and well-being, using prospective analyses.

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A Path Analysis on Factors Influencing Second Primary Cancer Screening Practices in Stomach, Colon, and Breast Cancer Survivors: Young Hee Yang; J Korean Acad Nurs 2014;44(2):139-148. Published online April 30, 2014; DOI: https://doi.org/10.4040/jkan.2014.44.2.139

Abstract PDF

Purpose

This study was conducted to identify the factors influencing second primary cancer (SPC) screening practice by examining the relationships of physical symptoms, knowledge and attitudes regarding SPC screening, perceived risk, primary cancer type, and demographic factors of cancer survivors.

Methods

Participants were 308 survivors of stomach, colon, or breast cancer recruited from 2 university hospitals in Korea. Data were collected using a questionnaire and analyzed using IBM SPSS 21.0 and AMOS 18.0.

Results

The proportion of participants taking all cancer screenings according to national guidelines was 40%. They had moderate knowledge and a relatively positive attitude regarding SPC screening and high cancer risk perception. The participants had taken fewer SPC screenings after than before cancer diagnosis. The factors influencing cancer risk perception were age, physical symptoms, knowledge regarding SPC and primary cancer type (stomach). The factors influencing SPC screening practice were age, gender, economic status, knowledge regarding SPC screening, and primary cancer types (colon).

Conclusion

It is important for clinical professionals to recognize that survivors of cancer are susceptible to another cancer. Education on SPC screening for these survivors should focus on communicating with and encouraging them to have regular cancer screenings.

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Late Effects, Social Adjustment, and Quality of Life in Adolescent Survivors of Childhood Leukemia: Sung Sil Hong, Ho Ran Park, Kwang Sung Kim, Sun Hee Choi; J Korean Acad Nurs 2014;44(1):55-63. Published online February 28, 2014; DOI: https://doi.org/10.4040/jkan.2014.44.1.55

Abstract PDF

Purpose

This study was conducted to examine the late effects, social adjustment, and quality of life in adolescents who had been completely treated for childhood leukemia and their parents.

Methods

Participants consisted of 41 pairs of adolescent survivors (13-18 years) and their parents. Parents checked for their child's physical late effects. The Korean Version of Post-Traumatic Symptoms for psychological late effects, social functioning questionnaire for social adjustment and the PedsQL 4.0 Generic Core Scales for quality of life were completed by adolescents and parents. Data were analyzed using SPSS.

Results

Twenty out of 41 adolescents had one or more physical late effects. Adolescents showed more serious psychological late effect than parents. Five children and seven parents had above cut-off scores and they were considered the high risk group for posttraumatic symptoms. Parent-reported scores were significantly higher than child-reported scores in terms of social adjustment and emotional functioning of quality of life. Low school functioning in adolescents was associated with physical late effects.

Conclusion

The results indicate that long-term and systematic management for childhood leukemia survivors affect positive social adjustment and can further improve quality of life.

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Symptom Experience and Quality of Life in Breast Cancer Survivors: Jin Hee Park, Eun-Young Jun, Mi-Young Kang, Yong-Sik Joung, Gu-Sang Kim; J Korean Acad Nurs 2009;39(5):613-621. Published online October 31, 2009; DOI: https://doi.org/10.4040/jkan.2009.39.5.613

Abstract PDF

Purpose

The purposes of this study were to evaluate symptom experience and quality of life (QOL) and to identify the predictors of QOL among breast cancer survivors.

Methods

A cross-sectional study was conducted on 200 disease-free breast cancer survivors at two hospitals between December 2007 and July 2008. Functional Assessment of Cancer Therapy Scale-B, Memorial Symptom Assessment Scale-short Form and The Linear Analogue Self Assessment Scale were used to assess symptom experience and QOL in these patients. Data were analyzed using the Pearson correlation, t-test, ANOVA, and stepwise multiple regression with SPSS/WIN 12.0.

Results

The mean score of QOL for breast cancer survivors was 95.81 (±18.02). The highest scores among physical and psychological symptoms were sexual interest and anxiety. Year since treatment completion was significantly associated with QOL in sociodemographic variables. Physical and psychological symptoms have a significant negative association with QOL. The results of the regression analyses showed that physical and psychological symptoms were statistically significant in predicting patients' QOL.

Conclusion

Symptom experience and QOL are essential variables that should be acknowledged when delivering health care to breast cancer survivors. More attention to the reduction and management of psychological distress could improve QOL among breast cancer survivors.

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