Career readiness, developmental work personality and age of onset in young adult central nervous system survivors

Barriers to employment for young adult central nervous system tumor survivors: The role of career readiness and core self-evaluations

BACKGROUND: Although the majority of childhood cancer survivors make successful transitions to adulthood, research suggests that a significant group experiences ongoing medical concerns, such as psychological distress, that significantly impact the achievement of crucial social roles including employment. OBJECTIVE: The purpose of this study was to examine the relationship between career decision making, core self-evaluations, and perceived internal and external barriers to employment in a sample of young adult central nervous system tumor survivors. METHOD: A sample of 110 young adult survivors of pediatric central nervous system tumors was surveyed. Mediation analysis with structural equational modeling was used to correlate a number of different measures (Career Decision Making [CTI], Perceived Employment Barriers [PEB], and Core-Self Evaluations [CSE]). RESULTS: The presence of both significant direct and indirect effects of career decision making on perceived employment barriers implied that there was a partial mediating effect of core self-evaluations on the association between career readiness and employment barriers. CONCLUSION: Career decision-making is a robust construct that can be applied to young adult central nervous system tumor survivors in effort to gain more insight into the vocational psychological factors that impact career development and employment in this group. Core self-evaluations was found to be a mediator between career decision making and perceived career barriers.

Short- and long-term impact of cancer on employment and financial outcomes of adolescents and young adults (AYAs): a large population-based case-control registry study in the Netherlands

Background

Adolescent and young adult (AYA) cancer survivors, 18-39 years at initial cancer diagnosis, often self-report negative consequences of cancer (treatment) for their career. Less is known, however, about the objective impact of cancer on employment and financial outcomes. This study examines the employment and financial outcomes of AYA cancer survivors with nationwide population-based registry data and compares the outcomes of AYAs with cancer with an age- and sex-matched control population at year of diagnosis, 1 year later (short-term) and 5 years later (long-term).

Patients and methods

A total of 2527 AYAs, diagnosed in 2013 with any invasive tumor type and who survived for 5 years, were identified from the Netherlands Cancer Registry (clinical and demographic data) and linked to Statistics Netherlands (demographic, employment and financial data). AYAs were matched 1 : 4 with a control population based on age and sex (10 108 controls). Analyses included descriptive statistics, chi-square tests, independent samples t-tests, McNemar tests and logistic regression.

Results

AYA cancer survivors were significantly less often employed compared with their controls 1 year (76.1% versus 79.5%, P < 0.001) and 5 years (79.3% versus 83.5%, P < 0.001) after diagnosis, and received more often disability benefits (9.9% versus 3.1% 1 year after diagnosis, P < 0.001; 11.2% versus 3.8% 5 years after diagnosis, P < 0.001). Unemployed AYAs were more often diagnosed with higher disease stages (P < 0.001), treated with chemotherapy (P < 0.001), radiotherapy (P < 0.001) or hormone therapy (P < 0.05) and less often with local surgery (P < 0.05) compared with employed AYAs 1 and 5 years after diagnosis.

Conclusion

Based on objective, nationwide, population-based registry data, AYAs’ employment and financial outcomes are significantly affected compared with age- and sex-matched controls, both short and long-term after cancer diagnosis. Providing support regarding employment and financial outcomes from diagnosis onwards may help AYAs finding their way (back) into society.

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Based on objective data, AYAs’ employment and financial outcomes are significantly affected compared with matched controls.

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AYAs were significantly more often unemployed compared with their controls 1 and 5 years after diagnosis.

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AYAs received significantly more often disability benefits compared with their controls 1 and 5 years after diagnosis.

Work Personality, Core Self-evaluation and Perceived Career Barriers in Young Adult Central Nervous System Cancer Survivors

PURPOSE

The purpose of this study is to examine the relationship between work personality, core self-evaluation (CSE), and perceived internal and external barriers to employment in a group of young adult CNS survivors.

METHODS

The participants consisted of 110 young adult survivors of pediatric central nervous system (CNS) tumors aged between 18 and 30 years old (M = 23.05, SD = 3.36). Mediation analysis with structural equational modeling (SEM) technique was used to correlate a number of different measures (Work Personality [WP], Perceived Employment Barriers [PEB], and Core-Self Evaluation [CSE]).

RESULTS

Results revealed an exceptionally well-fitting model to our data with work personality predicting CSE positively: β = 0.34, SE = 0.07, 95% CI (0.18, 0.47) while CSE inversely predicts Perceived Barriers to Employment, β = - 0.60, SE = 0.06, 95% CI (- 0.70, - 0.49). There is a direct pathway from WP to PEB once CSE was accounted for β = - 0.20, SE = 0.07, 95% CI (- 0.33, - 0.06). The presence of both significant direct and indirect effects of WP on PEB implied that there was a partial mediating effect of CSE on the association between WP and PEB.

CONCLUSIONS

Work personality is a robust construct that can be applied to young adult CNS survivors in effort to gain more insight into the personality and psychological factors that impact career development and employment in this group. The major finding of this study was that work personality and CSE had a significant direct effect on perceived career barriers and that there was a significant indirect effect with CSE acting as a mediator between developmental work personality and perceived career barriers.

A tool to measure work adjustment in the post-pandemic economy: The Illinois work adjustment scale

OBJECTIVE: This article introduces the Illinois Work Adjustment Scale (IWAS) and sets out to confirm the internal validity of the IWAS as well as determine if there are meaningful dimensions among the items of the IWAS that can be further defined as instrument subscales. METHODS: In order to meet these objectives, a survey of 738 individuals, all of whom self-reported as having disabilities, was conducted online. RESULTS: As a result of this survey and exploratory and confirmatory factor analyses, the IWAS was reduced from a 26-question scale to an 18-question scale consisting of two meaningful subscales, Work Context and Work Capacity. Significant and meaningful correlations between the two subscales indicate that Work Context and Work Capacity are related to the broader concept of work adjustment and assess unique aspects of work. CONCLUSION: The IWAS has the potential to be applied to facilitate positive career development and vocational rehabilitation outcomes for people with disabilities and chronic health conditions. This is of greater importance now as the COVID-19 crisis has significantly impacted the economy and workforce, leaving those with the greatest barriers to employment such as individuals with disabilities and chronic health conditions further marginalized and disconnected from work.

A Vocational Rehabilitation Intervention Framework for People With Rheumatoid Arthritis

This article presents the Illinois Work and Well-Being Model (IW2M) as a framework that can be applied to facilitate vocational rehabilitation interventions for people with rheumatoid arthritis (RA). The model encompasses the interaction of contextual and career development domains to improve participation in the areas of work, society, community, and home. A discussion of the model's implications regarding vocational rehabilitation service and research is offered, with the overall goal of reinforcing career development as the foundation of vocational rehabilitation services for people with RA and other emerging age-related disabling conditions.

Correlates of dysfunctional career thoughts in breast cancer survivors from the Bahamas

Purpose: The purpose of this research was to examine the correlates of dysfunctional career thoughts (DCTs) in a sample of breast cancers survivors. Sample and design: A total of 195 breast cancer survivors from the Bahamas completed a cross-sectional survey. Methods: The Career Thoughts Inventory (CTI) and standard medical and demographic items were administered. Analysis of Variance and logistic regression models were used to examine associations. Findings: Total CTI scores differed by age group, marital status, surgical remedy, and employment prior to diagnosis. The odds of DCT were higher among younger (Odds Ratio [OR] = 4.4), married (OR = 2.4), who were unemployed prior to diagnosis (OR = 3.5). Conclusion: Dysfunctional career thoughts appear to be common in certain breast cancer survivors. Further research is needed to determine whether similar associations are observed in other samples. Implications for Providers: Providers should discuss DCTs after treatment.

Knowledge of Legal Protections and Employment-Related Resources Among Young Adults with Cancer

Purpose: Young adults (aged 18-39 years) who have received a cancer diagnosis can encounter significant barriers in their transition to employment. American young adults' familiarity with federal legislation and resources related to employment is unclear. The study questions included: (1) To what extent do young adults who have had a cancer diagnosis know about legal and programmatic supports that may help to address their employment-related needs and (2) What modes of receiving information about resources to address their employment-related concerns do young adults who have had a cancer diagnosis prefer? Methods: A cross-sectional online survey was conducted with a convenience sample composed of 203 young adults living in the United States, had a cancer diagnosis other than nonmelanoma skin cancer, and were between 18 and 39 years of age. Over half (57.6%) of respondents received a cancer diagnosis at age 24 years or older. The mean age at participation was 30.4. Results: More than half of the sample (57.0%) was familiar with the Americans with Disabilities Act yet many did not know that cancer was a covered condition. Almost 80% of the respondents were not familiar with other federal initiatives with employment protections for people with cancer. Participants preferred in-person trainings and resource fact sheets as the presentation channels, although sociodemographic factors such as employment status were related to preferred delivery methods. Conclusion: These young adults would benefit from additional outreach around federal guidelines concerning employment-related rights and services and programs applicable to young adult cancer survivors.

Development of the perceived barriers scale: a new instrument identifying barriers to career development and employment for young adult survivors of pediatric CNS tumors

PURPOSE

Given the significant employment disparities for survivors of pediatric brain tumors, there is increased need to conduct vocational and career research with this group. The purpose of the present study was to construct an instrument, the Perceived Barriers Scale, that is psychometrically sound and has both clinical and research application related to career and employment issues of pediatric brain tumor survivors.

METHOD

The participants consisted of 110 young adult central nervous system survivors of childhood cancer aged between 18 and 30 years old (M = 23.05, SD = 3.36) who were identified by the DFCI Pediatric Brain Tumor Clinic. The 12-item Perceived Barriers Scale was developed from a comprehensive literature review, clinical interviews conducted with survivors of pediatric brain tumors, and feedback from multidisciplinary providers. Exploratory factor analysis and correlations were completed to examine the initial psychometric properties of the scale.

RESULTS

Exploratory factors analysis identified two factors that accounted for 57.92% with the two factors labeled as internal barriers and external barriers. All factors loaded significantly onto their respective factors (.48 to .88). The results of the correlational analysis found significant relationships between both internal barrier and external barrier subscales and CSE and WHODAS-2 providing initial support for the construct validity of the Perceived Barriers Scale.

CONCLUSIONS

Overall, the study findings indicate good psychometrics with the brevity of the scale increasing potential application and utilization in both research and clinical settings.

IMPLICATIONS FOR CANCER SURVIVORS

Identification of employment barriers for brain tumor survivors provides opportunity for more targeted vocational intervention.

Workplace experiences and turnover intention among adult survivors of childhood cancer

PURPOSE

The purpose of this study was to investigate workplace experiences and turnover intention (consideration of leaving or changing a job) and to examine factors associated with turnover intention among survivors.

METHODS

Adult survivors of childhood cancer with a history of employment (n = 289) completed measures of workplace experiences (n = 50, 18-29 years; n = 183, 30-44 years; n = 56; > 45 years of age at follow-up). Turnover intention was assessed using three items from the Job Satisfaction Scale. Responses were dichotomized as reflecting high vs. low turnover intention. Path analysis was used to estimate the influence of demographic characteristics, treatment exposures (cranial radiation therapy [CRT]), and workplace experiences on turnover intention.

RESULTS

Thirty percent of survivors reported high turnover intention (95% CL, 25 to 36%). Exposure to CRT (P = 0.003), older attained age (P < 0.001), experiencing formal workplace discrimination (P = 0.008), and having lower continuance (P < 0.001) or affective commitment (P < 0.001) were associated with high turnover intention among survivors. Informal discrimination, mediated through job satisfaction, also influenced survivors' reported intent to leave their jobs.

CONCLUSIONS

One third of adult survivors of childhood cancer report turnover intention, which is related to their cancer treatment, but more temporally proximal, workplace discrimination. Additional research is needed to understand the consequences of turnover intention among survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Survivors and their health care providers should be aware of legislative policies related to workplace discrimination (e.g., American with Disabilities Act) and related implications for job turnover.

The Relationship Between Career Thoughts and Adjustment for Individuals With Multiple Sclerosis

The study investigated the relationship between the psychosocial adjustment and dysfunctional career thoughts for adults with multiple sclerosis. The Reactions to Impairment and Disability Inventory measured psychosocial adjustment, and the Career Thoughts Inventory measured dysfunctional career thoughts. The results found that (a) higher levels of depression were associated with higher levels of decision-making confusion and commitment anxiety and (b) higher levels of adjustment were associated with lower levels of decision-making confusion. Rehabilitation counselor implications are discussed.

Conceptualizing the driving forces for successful rehabilitation back to work

BACKGROUND

An earlier study states that the terms of desire, longing, and vanity carry with them ideas, emotions, and values that influence how individuals perceive themselves and their rehabilitation process. Our aim was (1) to use concept analysis to explore the meaning of the terms desire, longing, and vanity and (2) to investigate the potential role of these concepts in successful rehabilitation back to work.

METHODS

To achieve these two objectives, we used a model of concept analysis. The final step in the model is to define empirical references, for example, articles within the scientific literature, to determine the existence of a concept in a given situation.

RESULTS

The concept analysis resulted in 15 new searchable terms. All of these were accepted in the thesaurus system for the databases we used. We identified 59 scientific articles that were deemed relevant to the purposes of the study. Of these, only 20 was about emotions as driving forces in a rehabilitation process back to work.

CONCLUSION

The conclusion of the study is that the concepts of desire, longing, and vanity encompassed ideas, emotions, and values that influence how individuals perceived themselves and their situations. How individuals talk about and understand rehabilitation will undoubtedly play a role in how they respond to interventions, and thus, the success of the rehabilitation process back to work. Implications for rehabilitation Emotional energy often drives behavior and can provide significant motivation that potentially can mobilize vocational rehabilitation. The concepts of desire, longing and vanity encompass ideas, emotions, and values that influence individuals' self-perception and their view of their situation. To engage people in discussions on what they long for and desire could be a new way to connect with a person in a rehabilitation situation. It can be less provoking to talk about what a person desires or longs for than to ask them what they want or are motivated for. Feelings of meaningfulness are a basic driving force and a contributing factor in how health is experienced. By affirming the desire to do activities that are liked, this in turn generates motivation to be engaged in other activities. Individual confidence is generated through the experience of mastering a skill and this in turn can underpin a desire to return to work after long-term sick leave. Earlier experience of success can be an inspiration and create expectations for a forthcoming working-role. Emotions relating to work such as pride can generate motivation in a rehabilitation process. Vanity and the possibility of being "ashamed" in a certain situation can be an emotional driving force to re-establish one's self.

Adolescent and Young Adult Survivors of Childhood Brain Tumors: Life After Treatment in Their Own Words

BACKGROUND

To date, there are few studies that examine the perspectives of older survivors of childhood brain tumors who are living with their families in terms of their sense of self and their role in their families.

OBJECTIVE

The aim of this study was to describe how adolescent and young adult survivors of childhood brain tumors describe their health-related quality of life, that is, their physical, emotional, and social functioning.

METHODS

This qualitative descriptive study included a purposive sample of 41 adolescent and young adult survivors of a childhood brain tumor who live with their families. Home interviews were conducted using a semistructured interview guide. Directed content analytic techniques were used to analyze data using health-related quality of life as a framework.

RESULTS

This group of brain tumor survivors described their everyday lives in terms of their physical health, neurocognitive functioning, emotional health, social functioning, and self-care abilities. Overall, survivors struggle for normalcy in the face of changed functioning due to their cancer and the (late) effects of their treatment.

CONCLUSIONS

Neurocognitive issues seemed most compelling in the narratives. The importance of families went beyond the resources, structure, and support for functioning. Their families provided the recognition that they were important beings and their existence mattered to someone.

IMPLICATIONS FOR PRACTICE

The value and complexity of care coordination were highlighted by the multifaceted needs of the survivors. Advocacy for appropriate and timely educational, vocational, and social support is critical as part of comprehensive cancer survivorship care.

Vocational identity, positive affect, and career thoughts in a group of young adult central nervous system cancer survivors

The aims of this study were as follows: (a) to compare levels of career thoughts and vocational identity between young adult childhood central nervous system (CNS) cancer survivors and noncancer peers and (b) to investigate the contribution of vocational identity and affect on career thoughts among cancer survivors. Participants included 45 young adult CNS cancer survivors and a comparison sample of 60 college students. Participants completed Career Thoughts Inventory, My Vocational Situation, and the Positive and Negative Affect Schedule. Multivariate analysis of variance and multiple regression analysis were used to analyze the data in this study. CNS cancer survivors had a higher level of decision-making confusion than the college students. Multiple regression analysis indicated that vocational identity and positive affect significantly predicted the career thoughts of CNS survivors. The differences in decision-making confusion suggest that young adult CNS survivors would benefit from interventions that focus on providing knowledge of how to make decisions, while increasing vocational identity and positive affect for this specific population could also be beneficial.

Career readiness in adult survivors of childhood cancer: a report from the St. Jude Lifetime Cohort Study

PURPOSE

Adult survivors of childhood cancer experience difficulties in obtaining and maintaining employment. Employment-related challenges are associated with treatment-related health conditions and may also be related to vocational factors such as career readiness, skill acquisition, and work experience. Unfortunately, little is known about how treatment-, health-, and vocational-related factors interact to impact career development among childhood cancer survivors.

METHODS

Three hundred eighty-five adult survivors of childhood cancer (42.1% male, median age 38 years (21-62)), participating in the St. Jude Lifetime Cohort Study, completed a work experiences survey that included measures of career readiness and vocational identity. Logistic regression was used to compare characteristics of survivors in the low career readiness category to those in the medium or high career readiness category, and structural equation modeling (SEM) was utilized to evaluate associations between career readiness, vocational identity, treatment intensity, and physical/emotional health.

RESULTS

Low career readiness was prevalent in 17.4% of survivors. Univariate analysis did not identify any significant associations between cancer treatment-related factors and career readiness. Unemployed survivors (odds ratio (OR) 2.3, 95% confidence interval (CI) 1.2-4.5), those who were not college graduates (OR 3.0, 95% CI 1.6-5.6), and those who had no personal income (OR 5.9, 95% CI 1.7-30.9) were at increased risk of low career readiness. SEM indicated that associations between treatment intensity, physical health, age at diagnosis, and career readiness were mediated by emotional health and vocational identity. Sixty-three, 35, and 10% of the variance in career readiness, vocational identity, and emotional health, respectively, were explained by this theoretical model.

CONCLUSIONS

The results of this study indicate that individuals who reported low levels of career readiness were more likely to be unemployed and earn less than US$40,000 per year and were less likely to graduate from high school. The final structural model indicates that vocational identity and emotional health accounted for the indirect effect of treatment intensity, age at diagnosis, and physical health on career readiness.

IMPLICATIONS FOR CANCER SURVIVORS

Addressing career readiness may be important to improve employment outcomes for adult survivors of childhood cancer.

Perceptions of Young Adult Central Nervous System Cancer Survivors and Their Parents Regarding Career Development and Employment

Purpose: Identify barriers to career development and employment from both the survivor and parent perspective.

Method: Young adult survivors (N = 43) and their parents participated in focus groups to elicit information regarding perceptions regarding career development and employment.

Results: Perceptions of both the young adults and parents indicate that there is a significant need for comprehensive career and employment services targeted for young adult central nervous system cancer survivors.

Conclusions: Findings provide initial evidence and support for the need to incorporate career and vocational services into psychosocial treatment programs. More research is needed in this area to gain an understanding of the specific career and vocational needs and to further explore how the interaction between the young adults and their parents impact vocational outcomes.