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Fate control has been often misconceptualized as a superstitious belief and overlooked in health psychology. It is not known how this cultural belief might impact the well-being of Chinese people living with HIV. This study examined the protective role of fate control for well-being and the potential mediation effect of resilience. Participants in this study were rural patients who contracted HIV via commercial blood donation. In this cross-sectional survey, 250 participants completed measures of fate control, well-being, and resilience. The results showed that fate control and resilience were positively associated with well-being. Resilience mediated the association between fate control and well-being. Our findings provide insight into the adaptive function of fate control as a cognitive defensive mechanism and highlight the need to incorporate this cultural belief in developing culturally sensitive intervention programs for resilience enhancement tailored for this understudied population infected with HIV living in rural China. [ABSTRACT FROM PUBLISHER]

Social work educators are concerned about how best to equip social work students with the ability to self-reflect, because this is a core professional competence. The present study employed both quantitative and qualitative means to evaluate a course which set out to foster reflexivity among social work undergraduates. A quasi-experimental design was employed to examine the effectiveness of the course. Data were collected at pre-course, post-course, and 6 months after completion. We found that, over time, students in the experimental group gained more insight. The students disclosed in focus group interviews that the course had enhanced their understanding toward self, family, and society. The implications for social work education are discussed. [ABSTRACT FROM AUTHOR]

Background: This paper reports the development and validation of the Chinese Significant Wish Fulfillment Scale (CSWFS), a new multidimensional scale for assessing the perceived importance and level of fulfillment of wishes of older adults.Methods: Three studies were involved. Study 1 developed a 26-item pool on wish fulfillment through in-depth interviews with 22 older adults. Study 2 reduced the pool to 23 items through validation with a new sample of 315 older adults and examined the internal reliability. Study 3 involved a confirmatory factor analysis (CFA) and examined the test-retest reliability and the convergent validity of the scale with the construct of regret.Results: A five-factor structure model of 23 items was identified through exploratory factor analysis, which accounted for 51.67% of variance. As informed by the CFA in Study 3, a five-factor 22-item model was the best fit. Internal reliability and test-retest reliability was found to be good. Convergent validity was examined through correlation with the construct of future regret. The correlation, though statistically significant, was small.Conclusion: CSWFS demonstrates good psychometric properties, but the construct might be slightly different from that of future regrets. Probably, CSWFS addresses a construct that is under-explored but is of importance to older adults and especially to the Chinese community. [ABSTRACT FROM AUTHOR]

This study presents an exploration of significant coping strategies for Chinese widowers' healthy adjustment to conjugal loss. The informants, 17 Chinese widowers, were asked to share strategies they have adopted to achieve healthy adjustment to spousal loss. The results reveal that loss-orientation coping, consisting of: 1) emotion-focused coping; 2) social coping; and 3) meaning-focused coping, was the key strategy in dealing with challenges posed by the past. Restoration-orientation coping, consisting of: 1) problem-focused coping; 2) social coping; 3) future-focused coping and 4) meaning-focused coping; was the key to managing challenges posed by present and future needs. It is hoped that insights from this study will inform social workers' practice with Chinese widowers experiencing poor adjustment to conjugal loss. [ABSTRACT FROM AUTHOR]

In an exploratory, phenomenological study of seven Chinese widows in Hong Kong, five major themes are identified: relationship with the deceased, relationship with others, grief reactions, coping and emotional expression. This paper focuses on the first theme: the widows' relationship with the deceased husband along a timeline from the time of diagnosis to after death. The experiences in the final days with the deceased were frequently referred to when the informants talked about this theme. This paper aims to give added voice, based on the experience of Chinese widows, to the possible role of hospice and palliative care on influencing the bereavement experience. Issues of awareness and acceptance of death, the supportive environment and support for family carers, the moment of death, creation of legacies, and sensitivity towards cultural embedded practices, are discussed. It is hoped that the experiences of these bereaved widows will stimulate new research to elucidate and verify the findings reported in this paper. [ABSTRACT FROM AUTHOR]

This study reports the results of a survey on death preparation, death-related beliefs, and death anxiety in a Hong Kong sample. Respondents (N = 285) recruited from the community were asked if they have prepared for themselves a life insurance, a will, and a resting place (e.g. burial site, columbarium, etc.). Questions about their death-related cultural beliefs and anxiety were also asked. Results indicated that respondents who have thought of preparing for their own deaths but not yet acted out (contemplators) held stronger traditional cultural beliefs about death than respondents who have either done the preparations (planners) or never thought of the idea (non-contemplators). Contemplators also reported higher death anxiety. Despite limitations of the study's design, the current results suggest the beliefs in cultural taboo may play a role in the preparation for one's death. [ABSTRACT FROM AUTHOR]

This systematic review examined the role of social environment in pre-death grief experiences of dementia caregivers. Ninety-three Chinese and English articles were included from a comprehensive search of empirical studies using nine databases. Six social environment domains were generated: the person with dementia, dyadic relationship, family members and the wider community, health and social care services, place of care, and social-cultural contexts. A complex interplay between caregivers and their social environments that aggravate and attenuate pre-death grief experiences is evident. Research has focused mainly on the effects of people with dementia and dyadic relationships and has paid modest attention to the effects of family, relatives, and health and social care services. Caregivers' experiences with their friends, fellow caregivers, the wider community, and social-cultural norms are influential but understudied. Future research could adopt a systems thinking approach with sociological perspectives to generate a comprehensive and nuanced understanding of pre-death grief experiences.

The death of a family member affects not only individual family members but also their relationships and interactions. Grief has been studied mostly as an intrapersonal experience. Adopting the family perspective, this systematic scoping review focused on parent-child relationships in widowed families so as to identify what is already known on this topic and the research gaps for future study. The review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Four databases (Web of Science, Psycinfo, PubMed, and CINAHL Plus) were searched. Search terms were combinations of two concepts: (1) loss of a parent (20 terms) and (2) parent-child (eight terms). 5,419 studies were identified during the search, of which 36 studies were included in the review following two rounds of screening. Four research themes emerged, and the aggregated findings were identified: (a) The surviving parent and children are likely to become closer following the loss of a parent, while other relevant factors need to be taken into account; (b) Better parent-child relationships play a protective role in children's adjustment to loss; (c) The surviving parent and children's adjustment to loss are interdependent; (d) Through parenting, communication style, coping strategy, and other attributes, the surviving parent can influence their children's adjustment. Gender and age differences were identified in parent-child relationships. The findings further justify the importance of a family perspective when conducting research and practice on bereavement. Several research gaps were identified. Existing studies paid insufficient attention to children's agency and bidirectional relationships, and the interaction process and its role underlying parent-child bidirectional causality. A conceptual framework of parent-child relationships in widowed families is proposed based on these findings., (© 2020 Family Process Institute.)

Objective: This study aimed to develop an assessment tool measuring comprehensive interdisciplinary competence in end-of-life care (EoLC) and investigate its content, construct validity, reliability, and their correlates., Method: Items of the Comprehensive End-of-Life Care Competence Scale (CECCS) were developed according to a comprehensive core competence framework in EoLC and refined by a multi-disciplinary panel of experts. The psychometric properties were further tested through region-wide surveys of self-administered questionnaires completed by health and social care professionals in Hong Kong., Results: Participants comprised social workers, nurses, physicians, and allied health care professionals (445 participants in 2016, 410 in 2017, and 523 in 2018). Factor analysis validated the construct of the questionnaire which encompassed 26 items describing EoLC core competences in seven domains with satisfactory internal reliability (confirmatory factor analysis: χ2/df = 3.12, GFI = 0.85, TLI = 0.93, CFI = 0.94, RMSEA = 0.07; Cronbach's alphas ranged from 0.89 to 0.97): overarching value & knowledge, communication skills, symptom management, psychosocial and community care, end-of-life decision-making, bereavement care, and self-care. Higher perceived levels in these competences were correlated with a higher level of job meaningfulness and satisfaction (r ranged from 0.17 to 0.39, p < 0.01) and correlated with lower perceived stress (r ranged from -0.11 to -0.28, p < 0.05). Regression analysis found that age and work involvement in EoLC were positively associated with the perceived competences in all domains; professionals working in hospices reported higher levels of competence than workers in other settings; social workers showed lower perceived competences in symptom management, but higher levels in bereavement care than other health care professionals., Significance of Results: The validity and internal reliability of CECCS were demonstrated. The levels of perceived competences working in EoLC were significantly associated with professionals' job-related well-being. Practically, there is still room for improvement in comprehensive competences among health and social care workers in Hong Kong.

Background: Though grief, anxiety, and depression often co-occur, existing evidence mostly focus on any two of them at a time. Our study examined the relationships among the three clusters of symptoms., Methods: A Chinese community sample of 101 bereaved individuals participated at T1. We utilized Bayesian Structural Equation Modelling (BSEM) to conduct cross-lagged analyses on three-wave panel data (T1 at one-month post-loss, T2 at four-months, and T3 at seven-months)., Results: BSEM findings confirmed the presence of distinctive developmental paths for complicated grief (CG), anxiety, and depressive symptoms. Three simplex models showed that anxiety, CG symptoms, and depressive symptoms maintained high consistency. In cross-lagged models, anxiety at T1 was a significant predictor of depressive symptoms (standardized estimate B=0.386*) and CG symptoms (standardized estimate B=0.300*) at T2. The remaining positive directions (0.338*, 0.256*) in the final model suggest the important role of anxiety at early bereavement, while at a later stage, T2 CG contributed to depressive symptoms at T3 (0.356*)., Limitations: In addition to attrition, the overall sample size was limited. Data were based on self-report. Future research with repeated measures and Bayesian informative priors would be more useful to establish relational patterns of symptoms., Conclusions: In our models, the reduction in anxiety symptoms contributed to the development of depressive and CG symptoms, and these results should be replicated. Theories of mechanisms underlying post-loss anxiety can be explored as a potential means of reducing later symptoms., (Copyright © 2020. Published by Elsevier B.V.)

This study aimed to delineate changes in the patterns of prolonged grief severity in widowed adults following group bereavement interventions and to identify the predictive factors impacting these patterns. We performed a secondary analysis of data from a randomized trial of 125 Chinese widowed older adults who participated in either LOGBI or DPGBI. Self-ratings of prolonged grief symptoms via Inventory of Complicated Grief (ICG) were subjected to latent class growth analysis to identify subgroups according to symptomatic changes among baseline, post-treatment, and 8-week follow-up. Multinomial regression analysis examined whether participant classification could be predicted by demographics, loss-related characteristics, and the relationship with the deceased and baseline symptom severity. In the results, intervention sample comprised 96 completers with an attendance greater than 60%. A three-class categorization yielded the best model fit for changes in prolonged grief severity for both randomized and intervention samples: improved class (41.6% in the randomized sample, 42.8% in the intervention sample), partial responded class (48.1%/45.5%), and relapse class (10.3%/11.8%). Older widowed adults experiencing a high level of grief at baseline and bereavement following chronic illness had an elevated risk of symptomatic relapse after the completion of intervention. These findings indicated that Chinese widowed adults experienced different changing patterns of prolonged grief severity following group bereavement interventions. Practically, widowed adults with a higher risk of symptomatic relapse might need more intensive or longer term intervention or follow-up support., (© 2020 John Wiley & Sons, Ltd.)

Given the severe mental health consequences that may ensue after bereavement, it is crucial to better understand malleable cognitive factors that are associated with poorer bereavement outcomes. Grief rumination (i.e., repetitive thinking about the causes and consequences of a loss) is a malleable cognitive process that is concurrently and longitudinally associated with postloss mental health problems. To assess grief rumination, the English and Dutch Utrecht Grief Rumination Scale (UGRS) were recently developed. The current study examined the reliability and validity of a Chinese version of the UGRS. Three hundred and ninety-three Chinese adults (56% women) bereaved on average 16.88 months ago filled out online questionnaires assessing demographic and loss-related characteristics, grief rumination (UGRS), trait rumination, trait mindfulness, and anxiety, depressive, and prolonged grief symptoms. Confirmatory factor analyses showed that a second-order five-factor hierarchical model provided the most optimal factor structure for the Chinese UGRS. UGRS total scale and subscale scores demonstrated acceptable internal consistency. Grief rumination had a moderate positive association with trait rumination and a low negative association with trait mindfulness, providing convergent and discriminant validity evidence. Test-criterion validity evidence was also provided. UGRS scores could distinguish bereaved groups with different relationships with the deceased. Moreover, grief rumination was associated with symptoms of anxiety, depression, and prolonged grief even after controlling for demographic and loss-related variables, trait rumination, and trait mindfulness. The Chinese UGRS appears a valid and reliable instrument to assess grief rumination in Chinese bereaved individuals., (© 2018 John Wiley & Sons, Ltd.)

Objective: An advance directive (AD) is a document that allows mentally competent individuals to make healthcare decisions about their condition that they might no longer be able to make in the future. This study aimed to explore the perceptions of AD decision-making of various stakeholders in the Chinese palliative care setting., Methods: Patients with life-limiting diseases, family members, health professionals, and hospital volunteers were recruited in the palliative care unit of two hospitals in Hong Kong by purposive sampling on age and sex. Qualitative semi-structured individual interviews were conducted., Results: A total of 96 participants, including 24 participants from each group, completed the study. Most participants were willing to discuss AD but had not heard about it before the interview. Patients regarded the decisions made in the AD as a way to reduce their future sufferings, while they also considered the welfare of their family. Family members were concerned about the psychological burden when discussing about the AD. Health professionals emphasized the logistic and process of the AD. Hospital volunteers pointed out the impact of Chinese culture on AD acceptance and the lack of AD promotion in the community., Conclusions: The findings of the study indicated the need for more promotion of AD in the society. It is important to consider the opinion of a patient's family during AD discussions in a Chinese culture. Health professionals may need to identify the best timing for the discussion of AD with patients and their families., Competing Interests: There is no conflicts of interest.

Background: Professional caregivers bereave after patients' deaths. Such bereavement can exert considerable influences on huge numbers of professional caregivers and their clients. No study, however, has synthesized scattered evidence on the core process of such bereavement, and no corresponding model exists., Aim: To systematically review and synthesize the experience of bereavement after patients' deaths, and in particular, its core process, in professional caregivers' own descriptions in existing literature, and to propose an integrated model on that basis., Design: A review was conducted following Enhancing Transparency in Reporting the Synthesis of Qualitative Research Statement (ENTREQ)., Data Source: CINAHL Plus, PubMed, PsycINFO, Scopus, Embase, and Web of Science were searched in April 2018 with keywords as combinations of "professional caregiver" and "bereavement". References of eligible studies from pre-planned searches were manually screened., Review Methods: Full-text and English-written qualitative studies published in peer-reviewed journals in or after 1980 were included. Their qualities were assessed by two of the authors independently. Meta-ethnography was employed to synthesize findings from previous studies., Results: Twenty-three studies met the inclusion criteria, the majority conducted in Western and developed regions of the world. Three core concepts were identified in the core professional bereavement process: (1) perceived nature of patients' deaths; (2) bereavement reactions; (3) accumulated changes. Each concept consists of both a personal dimension and a professional dimension. Risk and protective factors and coping methods were unveiled to influence the core process. An integrated, process-oriented and multi-dimensional model was proposed on the basis of these findings., Conclusions: Patients' deaths are significant events for professional caregivers, and they bring both personal and professional, both temporal and long-lasting impacts. Professional bereavement is distinctive from familial bereavement and deserves serious attention for its own sake. Attention, acknowledgment, and in-time support must be given to professional caregivers when they encounter patients' deaths., (Copyright © 2018. Published by Elsevier Ltd.)

Compared to cancers at other sites, lung cancer often results in greater psychosocial distress to both the patients and their caregivers, due to the poor prognosis and survival rate, as well as the heavy symptom burden. In recent years, making protocols of proposed or on-going studies publicly available via clinical trial registries and/or peer-reviewed journals has benefited health sciences with timely communication of the latest research trends and improved transparency in reporting. However, such practice is yet to be a common sight in evidence-informed social work. Hence, this paper discusses the value of publishing protocols in social work research and presents the protocol of a randomized controlled trial that compares the effectiveness of integrative body-mind-spirit intervention with cognitive behavioral therapy for enhancing quality of life of patients with lung cancer and their family caregivers. The data collection process was still on-going at the time of manuscript submission.

This study is an exploratory study that aims to examine the mediating role of dual process coping in the relationship between risk factors and bereavement outcomes. A total of 178 Hong Kong Chinese bereaved older adults reported their bereavement-related information, dual process coping (Dual Coping Inventory, DCI), complicated grief (Inventory of Complicated Grief; ICG), depression (Geriatric Depression Scale, GDS) and loneliness (De Jong Gierveld Loneliness Scale, DJG) in face-to-face structured interviews. Results suggested that subjective traumatic death predicted complicated grief, depression, and loneliness via loss-orientated (LO) coping, whereas having lost a spouse rather than having lost a parent predicted loneliness via restoration-orientated (RO) coping. Future interventions may reconsider the use of LO coping and explore alternatives for traumatized bereaved older adults, and encourage RO coping for those experiencing spousal loss., (Copyright © 2017. Published by Elsevier B.V.)

The rationale, development, and validation of the Bereavement Guilt Scale (BGS) are described in this article. The BGS was based on a theoretically developed, multidimensional conceptualization of guilt. Part 1 describes the generation of the item pool, derived from in-depth interviews, and review of the scientific literature. Part 2 details statistical analyses for further item selection (Sample 1, N = 273). Part 3 covers the psychometric properties of the emergent-BGS (Sample 2, N = 600, and Sample 3, N = 479). Confirmatory factor analysis indicated that a five-factor model fit the data best. Correlations of BGS scores with depression, anxiety, self-esteem, self-forgiveness, and mode of death were consistent with theoretical predictions, supporting the construct validity of the measure. The internal consistency and test-retest reliability were also supported. Thus, initial testing or examination suggests that the BGS is a valid tool to assess multiple components of bereavement guilt. Further psychometric testing across cultures is recommended.

Background: Patients with cancer and their spouses usually both suffer, but the dyadic effects have not been thoroughly investigated. This study examined the dyadic effects of psychological distress on sleep disturbance in Chinese couples affected by cancer., Methods: Patients with cancer and their spouses (N = 135) participated in this study. The Hospital Anxiety and Depression Scale and Pittsburgh Sleep Quality Index were used to measure anxiety, depression, and sleep disturbance., Results: There were significant patient-spouse associations on anxiety (r = 0.48, P < .01), depression (r = 0.55, P < .01), and sleep disturbance (r = 0.30, P < .01). Analyses using the actor-partner interdependence model showed that anxiety had significant actor effects, rather than partner effects, on sleep disturbance in both patients and their spouses, but depression had both actor and partner effects. In addition to providing evidence for the concordance in distress and sleep disturbance in patients with cancer and their spouses, the findings indicate a mutual influence of depression on sleep disturbance among the couples., Conclusions: Clinicians and health care providers are suggested to integrate depression management as a component of sleep therapies and involve both patients and their spouses in treatment programs., (Copyright © 2016 John Wiley & Sons, Ltd.)

Stigma towards people with HIV (PHIV) can affect their family members. In this study of 68 HIV seronegative participants in China whose spouse died of AIDS, 35.3% reported prolonged grief. Stigma beliefs towards PHIV (i.e., belief that PHIV's death leaves the deceased, the family and society better off) predicted grief symptoms. Social campaigns to combat stigma and grief therapy to reconstruct the meaning of HIV-related death may be helpful to reduce suffering in HIV bereaved., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Thirty-four quantitative and 9 qualitative studies are reviewed to indicate current understanding of the nature and impact of guilt in bereavement. This overview suggests that guilt is especially prevalent among some vulnerable subgroups, and it is associated with maladaptive health outcomes. Being male, longer bereavement time, and good end-of life experience seem to be associated with less guilt feelings. However, definition ambiguity, measurement difficulties, and cultural insensitivity are evident in studies. Therefore, a multidimensional conceptualization of guilt and a structural model to guide future investigation of this phenomenon in the bereavement context is proposed.

Presence of growth after traumatic events was introduced to the academic community about a decade ago (Tedeschi & Calhoun, 1995). From the conventionally neglected perspective of Chinese widowers, this paper reports seventeen Chinese widowers' views on growth after conjugal loss. Findings seem to suggest that Chinese widowers would define growth as human learning, a definition probably influenced by Confucian teachings. Furthermore, contrary to claims made by Tedeschi and Calhoun (2004), it was found that growth may occur for some individuals without the presence of distress if the individuals have either a stable philosophy of life and death or optimism to buffer their distress or a sense of responsibility to suppress their distress.

Aims and Objectives: The paper discusses the application of the Eastern body-mind-spirit approach in healthcare practice., Background: Traumas, sufferings and losses may induce immense distress in patients and their families, as well as apathy and exhaustion in healthcare workers. Over-specialization and compartmentalization of services may provide a convenient shelter for healthcare workers to be detached and to simply focus on a narrowly defined scope of intervention. However, the existential problems are still there. Based upon eastern philosophies and holistic health practices, we propose the body-mind-spirit approach in healthcare settings., Methods: This is a review paper summarizing the application of the approach on various clinical populations., Results: The approach has been trialled with promising results in a number of health conditions and psychosocial predicaments. Spirituality is not restricted to any religious practices, nor is it narrowed to the pursuit of knowledge at a high level of abstraction. The interconnectedness of the body, mind and spirit presupposes that the practice of spirituality is multidimensional and multi-levelled., Conclusions: Using the body-mind-spirit framework flexibly we can engage more clients while facilitating the important process of exploration and change. The key components include getting in touch with the inner self, coming back to our senses, connecting our body and mind and rebalancing our relationship with the natural and social environment. The ultimate goal is to move out of meaninglessness and to reach a state of mature spirituality of tranquillity and transcendence., Relevance to Clinical Practice: The practice of spirituality can be easily applied to daily life.