Scoping review protocol of post-traumatic growth (PTG) in Korean cancer survivors

Abstract

Introduction

Cancer, a life-threatening chronic disease, is the leading cause of death in Korea, accounting for 27% of all deaths in 2020. Due to advancements in medical technology and early detection of cancer in Korea, the 5-year relative survival rate reached 70.7% (2015–2019), highlighting remarkable progress over the past decades. Although cancer has been seen as a traumatic event, cancer survivors also go through a subjective process of self-maturation, which is called post-traumatic growth (PTG). Because research on PTG among Korean cancer survivors has not been systematically synthesised, a scoping review on this topic will provide a better understanding of the positive psychological changes that occur as a patient moves through the illness trajectory of cancer from a Korean cultural perspective. The purpose of this study was to describe the protocol of a scoping review regarding PTG in Korean cancer survivors.

Methods and analysis

The scoping review framework suggested by Arksey and O’Malley and the manual refined by the Joanna Briggs Institute for scoping reviews will be used with the six framework guidelines developed by Levac et al. Searched databases will include Ovid-MEDLINE, PubMed, Embase, CINAHL, Cochrane Library and PsycInfo, as well as Korean databases, examining all articles published between 2012 and 2023 in Korean or English on PTG in Korean cancer survivors. Extracted data will be collated, charted and summarised.

Ethics and dissemination

Because the scoping review methodology undertakes a secondary analysis of collected data from previous research studies, this study does not require ethical approval. The results of this scoping review will be disseminated through presentations at conferences and publication in a scientific journal.

Strengths and limitations of this study.

• This scoping review protocol will synthesise an extensive range of research studies regarding the post-traumatic growth (PTG) in Korean cancer survivors.

• Six electronic databases of peer-reviewed literature, as well as Korean databases, will be searched to identify articles on post-traumatic growth in Korean cancer survivors.

• Articles reviewed will be limited to quantitative empirical studies, including randomised controlled trials, quasi-experimental, and cross-sectional studies or theoretical studies, written in English or Korean.

Introduction

Cancer is a life-threatening chronic disease that led to approximately 18 million new patients with cancer and 10 million death worldwide in 2020.^{1 2} According to the South Korea National Statistical Office, cancer was the primary leading cause of death in Korea in 2020, accounting for 27% of all deaths.³ Due to advances in medical technology and early detection for cancer in Korea, the 5-year relative survival rate reached 70.7% between 2015 and 2019, compared with 45.2% between 1996 and 2000, highlighting remarkable progress over the past decades.⁴

Cancer has been seen as a traumatic event because the diagnosis itself has a profound impact on patient’s life and the process of the disease triggers feelings of vulnerability and awareness of one’s own mortality.⁵ In addition, it can have negative effects on a patient’s long-term physical, psychological, sociocultural and spiritual well-being.⁶ However, cancer survivors also go through a subjective process of self-maturation, which is called post-traumatic growth (PTG).⁷ PTG encompasses a person’s positive transformation through cognitive awareness of traumatic experiences, including appreciation of their own life, an improvement in relationships with others, in personal strength and spirituality, and appreciation of new life opportunities.^{8 9}

With growing research interest in long-term survivorship and positive consequences from the experiences of cancer, PTG has drawn attention from researchers in recent decades.^{5 10} Cancer survivors with high PTG report high positive emotions such as hope and optimism,^{5 11} high psychosocial adaptation such as coping and social support,¹² high quality of life,^{13 14} high immunity¹⁵ and survival rates,¹⁵ and low negative emotions such as post-traumatic stress, anxiety and depression.⁵ While the mechanism by which PTG promotes well-being and quality of life has yet to be fully understood, the evidence indicates that PTG is linked to enhancements in physical and psychological health. This includes reductions in negative emotions and increases in positive emotions, in turn contributing to overall well-being and quality of life.^11–15

The concept of PTG and the Post-traumatic Growth Inventory (PTGI) were developed in the 1990s, and PTG research regarding individuals with various trauma has been conducted since then.7 9 16–18 Review studies of cancer research on PTG can summarise correlates of PTG5 10 19–22 including medical, social, psychological variables and effectiveness of intervention for PTG.^{23 24} In those review studies, one study²⁵ was focused on head and neck cancer survivors and two studies^{19 20} focused on breast cancer survivors. In addition, one study was a scoping review of qualitative evidence on PTG in cancer survivors.²⁶

However, the majority of review studies have primarily focused on Caucasian individuals or Asian immigrants who are cancer survivors residing in Western cultures.21–24 27 28 As a result, current research does not adequately capture the diverse range of experiences related to PTG among cancer survivors born and living in non-Western cultures, such as Korea.^{27 28} Although there have been studies exploring relevant concepts to PTG (eg, resilience)^{6 29} in Korean cancer survivors, current research still lacks comprehensive, clear understanding of PTG.

PTG research in Korea began in 2000 in counselling research, psychology and social welfare,³⁰ and nursing research on PTG has been underway since 2012. Most PTG studies in Korea were conducted for the general public, and studies on cancer survivors and their families accounted for only 20% of all Korean PTG research.³¹ In addition, cancer studies related to PTG for Koreans have been conducted mainly with breast cancer survivors and in intervention studies for breast cancer survivors.^{32 33} A few review studies on PTG have been conducted among Korean researchers, and these studies include a systematic review of PTG and cancer in 2009,³⁰ a meta-analysis of an intervention study for PTG in Korean cancer survivors in 2016³⁴ and a systematic review of PTG measures in breast cancer survivors in 2017.³⁵ In those review studies, only two to four Korean studies were included. As a result, we do not know what is known about PTG experiences among Korean cancer survivors. For example, we do not know what types of research evidence on PTG in Korean cancer survivors is available, how research has been conducted on PTG among Korean cancer survivors and what factors are related to PTG. In addition, research on PTG among Korean cancer survivors has not been identified or analysed for knowledge gaps.³⁶

Therefore, a scoping review study on this topic will be an ideal tool for identifying, mapping and discussing of the phenomenon of PTG in Korean with cancer survivors, which will in turn provide a better understanding from a Korean cultural perspective of the positive psychological changes that occur as a person moves through the illness trajectory of cancer. The purpose of this paper was to describe the protocol of a scoping review regarding PTG in Korean cancer survivors living in Korea.

Methods and analysis

A scoping review is regarded as the most appropriate method to provide a broad overview of a phenomenon of interest and can help draw conclusions about a topic by summarising research findings and recognising research gaps in current research.³⁶ This review used methods suggested by Arksey and O’Malley³⁷ and those in the manual refined by the Joanna Briggs Institute (JBI) for scoping reviews.³⁸ Our study is registered with the Open Science Foundation.³⁹ Moreover, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR)⁴⁰ and guidelines developed by Levac et al⁴¹ using the six framework stages will be used for the present protocol and future corresponding scoping review. This review will involve the following steps: (1) identifying the research questions; (2) identifying relevant studies; (3) study selection; (4) charting the data, (5) collating, summarising and disseminating the results; and (6) consultation. A tentative timeline for accomplishing of this review is from July 2023 to December 2023.

Stage 1: identification of the research questions

Because a scoping review is the method designed to provide knowledge regarding the nature of a phenomenon, this review will systematically examine research literature across theory, tools and interventions related to PTG in cancer and will map the factors associated with PTG in Korean cancer survivors. The purpose of this review is to investigate quantitative studies related to theories, intervention type, psychometric properties of PTG tools, factors related to PTG and outcomes. Based on a preliminary search, the following research questions were developed. Our research questions are:

1. What research theories are used to study PTG in Koreans with cancer?

2. What are the factors associated with PTG in Koreans with cancer?

3. What instruments have been used to study PTG in Koreans with cancer, and what is the psychometric evidence of the tools?

4. What is known regarding interventions to promote PTG in Koreans with cancer?

Stage 2: identifying relevant studies

In order to systematically search the database and consider the research questions, the research team will use the PCC (Population, Concept, Context) framework recommended by the JBI³⁸ for this review (table 1). This search strategy will be conducted by the research team with assistance from a medical librarian (online supplemental file 1).

Table 1.

PCC (Population, Concept, Context) framework

PCC element	Definition
Population	Cancer survivors
Concept	Post-traumatic growth
Context	South Korean

The databases chosen for this review are Ovid-MEDLINE, PubMed, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library and PsycInfo. We will also use Korean databases, including KoreaMed, Korean Medical Database (KMbase), Korean Studies Information Service System (KISS), Korea Institute of Science Technology Information (DBpia) and Research Information Sharing Service (RISS). In addition, we will manually check reference lists of selected articles and identify relevant journals. We will not include grey literature because it does not go through the peer review process. The literature search will be limited to studies published between January 2012 and June 2023 in English or Korean because Korean nursing research on PTG for cancer survivors has only been undertaken since 2012.

Database search terms will be developed by the research team and the medical librarian. A nested search syntax is ‘Neoplasms or Tumor* or Neoplasm* or Neoplasia* or Cancer* or Malignanc*’ and ‘post traumatic growth OR PTG’ as key terms (Psychological Stress OR Psychological Adaptation OR Perceived benefit OR Stress-related growth OR Benefit finding) AND (Korean). MeSH terms and some key words will be searched both in the title and abstract in order to more effectively identify relevant studies in English and Korean database. Furthermore, the term ‘exp Republic of Korea’ or Korean-related terms will be applied to limit the results to the studies about survivors in South Korea (online supplemental appendix 1). The PRISMA flow diagram will be used to keep accurate evidence of the searched literature.

Stage 3: study selection

The research team will search all published research papers written in English or Korean between January 2012 and June 2023. All research articles that resulted from the search process will be uploaded to a reference software program, EndNote (EndNote V.X9, Thomson Reuters, New York, USA) to remove all duplicates and allow easy access to retrieved articles. Three researchers will independently screen, review and extract data, and any discrepancies will be resolved through discussion. The protocol will clearly outline the eligibility criteria and data extraction template. The following provides a detailed explanation of how to conduct screening, reviewing, and data extraction. Initially, three researchers will independently screen to select eligible articles by reviewing the title and abstracts of retrieved articles. Publications that do not meet inclusion criteria will be excluded. Next, the researchers will individually read the full text of eligible articles and evaluate the eligibility of each article. Finally, eligible studies will be chosen through a cross-checking method in research team meeting. Discrepancies regarding eligible studies will be discussed among the research team to reach an agreement on final choice. The selection criteria for eligible studies will be guided by the following criteria:

1. Populations: Any cancer survivor who is 18 years old or older at the point of diagnosis, under treatment or throughout treatment⁴² in South Korea. A Korean cancer survivor who is living in another country will be excluded.

2. Main outcome(s): (1) Theories of PTG in cancer survivors, (2) tools to measure PTG among cancer survivors, (3) factors related to PTG in cancer survivors, (4) interventions to promote PTG for cancer survivors.

3. Studies: Quantitative empirical studies including randomised controlled trials, quasi-experimental and cross-sectional studies or theoretical studies, written in English or Korean, published between 2012 and June 2023. Qualitative studies, dissertations, case studies, review studies or commentaries will be excluded. Because the purpose of this review was to investigate quantitative studies related to theories, intervention type, psychometric properties of PTG tools, factors related to PTG and outcomes, we will exclude qualitative studies. In addition, we will not include grey literature due to a lack of peer review, as noted above.

Stage 4: charting the data

We will decide on structured data charting forms through research team meetings. For data charting, an Excel spreadsheet will be used to assist descriptive outlines of the results. We will focus on the title and year of the publication, authors, sample size, type of cancer, theories, intervention type, psychometric properties of the PTG tools, whether PTG tools have been validated for clinical/academic use as an additional datapoint, factors related to PTG, outcomes and results. Critical quality appraisal of the selected studies will not be performed because of the characteristics of scoping review. All reviewers will share the extracted data charting forms.

Stage 5: collating, summarising and reporting of the results

This scoping review aims to provide an overview of the research done on PTG and to elucidate the phenomenon of PTG in Korean cancer survivors. It will extract the breadth and characteristics of research studies on PTG in Korean cancer survivors. In addition, the results from extracted studies will be synthesised and disseminated to describe the progress of research on PTG. Identifying gaps in Korean research regarding PTG in cancer survivors will lead to proposals for future research. The results of the scoping review questions will be presented in descriptive summary tables, including patient characteristics, PTG theories and measures, psychometric properties of PTG, factors related to PTG, intervention characteristics and outcome measures.

Stage 6: consultation—patient and public involvement

According to the suggestions made by Arksey and O’Malley³⁷ and Levac et al,⁴¹ the consultation process can provide judgements or suggestions beyond the published studies. Because no patients or public will be involved in this scoping review, consultations will be held with several clinical or academic experts in oncology patients’ care. We will consult clinical oncology specialists who provide care and are involved in research for cancer survivors as consultants for this scoping review. To address patient-centred approach, experts will clarify research gaps in the extracted studies and make suggestions regarding the feasibility of future research on PTG in Korean cancer survivors.

Ethics and dissemination

Because the scoping review methodology undertakes a secondary analysis of collected data from previous research studies, this study does not require ethical approval. The results of this scoping review will be disseminated through presentations at conferences and publication in a scientific journal. This protocol for a scoping review of over a decade of published articles on PTG in Korean cancer survivors has been presented. It is a pioneering method to synthesise an extensive range of research studies regarding theories, tools, factors and interventions for PTG in Korean cancer survivors. This work will serve as a foundation for future PTG-based research regarding Korean cancer survivors and may translate to a future systematic review or other international PTG intervention research. The results of this review will serve as essential evidence for healthcare provider to identify potential trends and gaps in practice and to promote PTG in Korean cancer survivors, which can help to increase survivors’ quality of life and well-being.

Ethics statements

Patient consent for publication

Not applicable.