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Objective: The goal of this study was to examine the knowledge, attitude, and practice on second cancer screening among cancer survivors. Methods: Three focus group interviews were conducted with thirteen disease-free stomach, colorectal, breast and thyroid cancer survivors. Recurrent issues were identified and then placed into thematic categories. Results: None of the study participants had heard SPC, and they could not differentiate SPC from ‘recurrence’ or ‘metastasis.’ Survivors believed that they had been cured, and they were not aware of their increased risk of SPC. Although they had high awareness of cancer screening, they could not make a distinction between ‘cancer screening’ and ‘routine surveillance test’ after cancer treatment. Survivors said that they would have had the screening for SPC if they had known about it. They preferred physicians as the most reliable source for screening information. Conclusion: Cancer survivors had limited knowledge about SPC, and lack of information was the main barrier for SPC screening. Practice implications: An educational intervention would help cancer survivors to understand their risk of SPC and the needs of screening after the first cancer. [Copyright &y& Elsevier]

Abstract: Context: No systematic or comprehensive attempts have yet been made to assess quality of death as an indicator of palliative care outcomes in Korea, and no validated instruments exist for the assessment of a good death in Koreans. Objectives: This study examined the validity and reliability of the Korean version of the Good Death Inventory (GDI), which was developed in Japan to evaluate the quality of death from the perspective of bereaved family members. Methods: Forward and backward translations and a pilot test were conducted. In a multicenter cross-sectional survey, a questionnaire packet, including the GDI, overall quality of life during the last week, and overall satisfaction with care, was mailed to bereaved family members (n =501) of patients who had died from cancer two to six months before the study. Descriptive analyses were performed, including response rate, mean, median, skewness, and kurtosis for each item. The reliability of the GDI was tested by Cronbach’s alpha. The dimensional structure was assessed using confirmatory factor analyses. Concurrent validity was tested by correlation with the overall quality of life and overall satisfaction with care. Results: Participants were able to complete the GDI, and the compliance rates were satisfactory. Cronbach’s alpha coefficient for internal consistency was 0.93 overall and ranged from 0.69 to 0.94 for subdomains. The hypothesized 18-factor model of a good death appeared to fit the data (goodness of fit index [GFI]=0.964; adjusted GFI index=0.960; normal fit index=0.952). The overall scores on the GDI correlated with patients’ quality of life (0.56; P <0.001) and overall satisfaction with care (0.44; P <0.001). Conclusion: The Korean version of the GDI is a reliable and valid measure of the comprehensive outcomes of palliative care from the perspective of bereaved Korean family members. [Copyright &y& Elsevier]

Abstract: Context: A reliable and valid measure of structure and process of end-of-life care is important for improving the outcomes of care. Objectives: This study examined the validity and reliability of the Korean version of Care Evaluation Scale (CES), which was developed in Japan to evaluate structure and process of palliative care from the perspective of bereaved family members. Methods: Standard forward-backward translation and a pilot test were conducted. A multicenter cross-sectional survey was conducted with bereaved family members (n =501) of patients who had died from cancer two to six months before the study. Descriptive analyses were performed. The reliability of the CES was tested by Cronbach''s alpha. The dimensional structure was assessed using confirmatory factor analyses. Concurrent and discriminant validity were tested by correlation with the overall satisfaction with care, patient''s overall quality of life (QoL), and family member''s own QoL as measured by the EQ-5D. Results: Participants could complete the CES readily, with low missing response rates. Cronbach''s alpha for internal consistency was 0.93 overall, and ranged from 0.88 to 0.94 for subdomains. The hypothesized 10 subscale model of the CES appeared to fit the data (goodness-of-fit index=0.854). The overall score of the CES moderately correlated with overall satisfaction with care (r =0.54, P <0.001), more weakly correlated with the patient''s QoL (r =0.32, P <0.001), but did not correlate with the family member''s QoL (r =0.03, P =0.548). Conclusion: The CES was found to be a reliable and a valid measure of the necessity for improvement in the structure and process of end-of-life care from bereaved family members'' perspectives. [Copyright &y& Elsevier]