Vocational identity, positive affect, and career

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Original article 297

Vocational identity, positive affect, and career thoughts in a group of young adult central nervous system cancer survivors Dustin D. Langea,*, Alex W.K. Wongb,c,*, David R. Strausera and Stacia Wagnerd 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

Introduction Young adult central nervous system (CNS) cancer survivors are faced with a unique set of obstacles after diagnosis, including the ability to maintain their work goals during a time of development. Work provides opportunities to advance, opportunities for social support systems, opportunities for self-expression, selfdetermination, and all necessary components of psychological health (Blustein, 2008). However, adults with a history of childhood CNS cancer experience significant problems related to obtaining and maintaining employment (Pang et al., 2008), and if survivors are employed, they are less often employed in higher-skill occupations (Kirchhoff et al., 2011). Young adult CNS cancer survivors experience problems related to career development and entering the labor market, and these difficulties have the potential to impact overall quality of life negatively (Strauser et al., 2013). As research continues to acknowledge the social, psychological, and financial impacts of childhood CNS cancer, identification of survivors for occupational interventions will help to improve their quality of life (Kirchhoff et al., 2011). Understanding the factors that contribute toward work outcomes after cancer will play a significant role in the future development of effective survivorships programs (Parsons et al., 2012). Exploratory research is needed in this area so that potential problem areas can be identified and so 0342-5282 © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

increasing vocational identity and positive affect for this specific population could also be beneficial. International Journal of Rehabilitation Research 37:297–301 © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. International Journal of Rehabilitation Research 2014, 37:297–301 Keywords: brain tumors, cancer, career development, career thoughts, employment a

Work and Disability Lab, University of Illinois at Urbana-Champaign, Champaign, Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, cCenter for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, Illinois, USA and dChildren’s Brain Tumor Foundation, New York, New York, USA b

Correspondence to Alex W.K. Wong, PhD, DPhil, Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, 345 East Superior Street/Onterie-964, Chicago, IL 60611-2654, USA Tel: + 1 312 238 2910; fax: + 1 312 238 4572; e-mail: [email protected] *Dustin D. Lange and Alex W.K. Wong are co-lead authors. Received 16 December 2013 Accepted 12 June 2014

that systematic programmatic intervention research can be carried out to increase the career development and employment of young adult CNS cancer survivors (Strauser et al., 2013). Earlier studies suggested that neurocognitive problems because of surgery, chemotherapy, or radiotherapy may negatively influence CNS cancer survivors’ capacity of career problem-solving and decision-making (Green et al., 2005; Kohli et al., 2007; Gehring et al., 2008). Examples of cognitive dysfunctions that may lead to negative effects on career problem-solving and decisionmaking are delirium, attention, memory, or executive function (Green et al., 2005). However, there is limited research investigating how psychological and vocational constructs influence the career outcomes of this population. This exploratory research focused on three factors including career thoughts, vocational identity (VI), and affect of young adult childhood CNS cancer survivors. Career thoughts are defined as outcomes of one’s thinking about assumptions, attitudes, behaviors, beliefs, feelings, plans, and strategies related to career problemsolving and decision-making (Sampson, 1998). Irrational thoughts in either of these domains that inhibit effective career problem-solving and decision-making are defined as dysfunctional career thoughts. VI has been defined as the possession of a clear and stable picture of one’s DOI: 10.1097/MRR.0000000000000071

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298 International Journal of Rehabilitation Research 2014, Vol 37 No 4

vocational goals, interests, and talents. Affect is a characteristic that describes how humans experience emotions and interact with others and with their surroundings (Naragon and Watson, 2009). Affect is further described as positive affect (PA) and negative affect (NA). PA reflects the extent to which an individual feels enthusiastic, active, and alert, whereas NA reflects the extent to which an individual feels distress and experiences a variety of negative mood states such as anger, disgust, guilt, fear, and nervousness. To date, there has been little knowledge of these factors that impact the career development of this population. Previous research has identified that career thoughts are one of the key factors that impacts the career development process and that VI and PA contribute toward increased levels of productive career thoughts (Yanchak et al., 2005; Strauser et al., 2008). Therefore, we have hypothesized that young adult CNS cancer survivors differ in their level of career thoughts when compared with the noncancer young adult peers. Also, we hypothesize that both increased levels of VI and PA contribute toward the increased level of career thoughts in young adult CNS cancer survivors. The following two research questions guided this exploratory study: (1) Do young adult CNS cancer survivors have higher levels of negative career thoughts and lower VI when compared with noncancer peers? (2) Do higher levels of PA and increased levels of VI contribute toward higher levels of productive career thoughts in young adult CNS cancer survivors?

Methods Participants

Study participants of the case group were young adults with CNS cancer from the Children’s Brain Tumor Foundation (CBTF) in New York City. Participants were recruited from a larger group that were participating in a postcancer treatment support group and were focusing on personal issues related to postcancer treatment aftermath. Study participants of the control group were college students at a large Midwestern University and indicated that they did not have a disability or a diagnosis of cancer. Procedures

Permission for the study was granted by lead investigator’s Institutional Review Board and all participants provided individual written consent. All participants were picked out of a larger post-treatment support group by the CBTF, informed that their participation was voluntary, and that they were free to withdraw without penalty (i.e. attendance points or loss of service from the CBTF). They were also informed that they could skip any items on any part of the packet without penalty. All participants were provided with a research packet containing a demographic form and the test instruments. Following

the time allotted to fill out the research packets, the packets were then collected from both groups by the lead investigators. Instruments

Career Thoughts Inventory (CTI; Sampson, 1998): The CTI is an instrument measuring one’s thinking about assumptions, attitudes, behaviors, beliefs, feelings, plans, or strategies related to career problem-solving and decision-making. The CTI consists of 48 items and produces a total score, each rated on a 0 (Strongly Disagree) to 3 (Strongly Agree). Higher scores indicate higher levels of negative career thoughts. It further divides into three subscales: (a) Decision Making Confusion (DMC; 14 items), (b) Commitment Anxiety (CA; 10 items), and (c) External Conflict (EC; five items). The CTI total is a global indicator of dysfunctional career thinking and career readiness. The DMC scale assesses the level of one’s inability to initiate or sustain the decision-making process. The CA scale assesses the impact that anxiety has on an individual’s ability to commit on a career decision. The EC scale assesses an individual’s inability to balance input from significant others with one’s own preference. My Vocational Situation (Holland et al., 1980): My Vocational Situation measures VI (18 items), occupational identity (four items), and barriers (four items) with a True (1) or a False (0) response on each of the items. Higher scores indicate higher levels of VI, occupational identity, and barriers. For this study, only the VI scale was used. VI measures the extent to which an individual possesses a clear and stable picture on one’s goals, interests, personality, and talents (Holland et al., 1993). Positive and Negative Affect Schedule (Watson et al., 1988): The Positive and Negative Affect Schedule is an instrument that is used to measure PA and NA within their individual scales. Participants completed 20 items (10 for positive; 10 for negative) on a five-point rating scale, with responses ranging from 1 (Very slightly or Not at all) to 5 (Extremely). Higher scores indicate higher levels of PA and NA. PA reflects the extent to which an individual feels enthusiastic, active, and alert. High PA is a state of high energy, full concentration, and pleasurable engagement, whereas low PA is characterized by sadness and lethargy. In contrast, NA is a general dimension of subjective distress and unpleasurable engagement that subsumes a variety of aversive mood states, including anger, contempt, disgust, guilt, fear, and nervousness, with low NA being a state of calmness and serenity. Data analysis

A multivariate analysis of variance (MANOVA) with follow-up univariate ANOVAs was carried out for the first aim of the study to investigate whether there were differences in career thoughts between young adult cancer survivors and a peer comparison group on a linear

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Career thoughts of CNS cancer survivors Lange et al. 299

combination of CTI total and three scale scores. Multiple regression analysis was carried out for the second aim of the study to determine the best linear combination of VI, PA, and NA for predicting career thoughts. The statistical significance was set at a P less than 0.05 two-tailed level. In addition, the primary focus of analysis for the present study was effect size indicated by the partial η2 statistics (Sink and Stroh, 2006) to inform the magnitude of effects and enhance judgment on the ‘practical significance’ of the study results (Vacha-Haase and Thompson, 2004; Ferguson, 2009).

Results Study participants of the case group were 45 young adults with CNS cancer from a foundation in New York City. We did not have the specific details on each type of cancer treatment that the participants went through, although, at the time of this study, the participants were not receiving treatment. The majority of the participants were White (78.6%), followed by 9.5% African American, 7.1% Asian/Pacific Islander, and 4.8% Hispanic. The majority of the participants (33.3%) had completed some college, followed by 26.6% completing grade 12 or below, 22.2% completing community college, 13.3% completing a 4-year college, and 4.4% completing graduate school. Participants reported an average age of brain tumor onset of 10.48 years (SD = 5.57) and average years off treatment of 6.62 years (SD = 5.81). Study participants of the control group were 60 college students at a large Midwestern University and indicated that they did not have a disability or a diagnosis of cancer (females = 66.7%; mean age = 18.1 years, SD = 0.4). The majority of the control group was White (61.7%), followed by 20.0% African American, 10% Asian/Pacific Islander, and 8.3% Hispanic. The aforementioned demographic information is shown in Table 1. Table 1

Demographic characteristics of samples

Sex (%) Male Female Ethnicity (%) White African American Hispanic Asian/Pacific Islander Education (%) Below college College or higher Age (years) [mean (SD)] Onset age of tumor (years) [mean (SD)] Years off treatment (years) [mean (SD)] NA, not applicable.

Cancer survivors (n = 45)

College students (n = 60)

44.4 55.6

33.3 66.7

78.6 9.5 4.8 7.1

61.7 20.0 8.3 10.0

26.6 73.2 21.86 (3.37) 10.48 (5.57)

0 100 18.10 (0.35) NA

6.62 (5.81)

NA

For the first aim of the study, our results indicated that the overall MANOVA model was significant [F(4,100) = 5.432, P = 0.001, η2 = 0.011]. Follow-up univariate ANOVAs indicated that the DMC scale score, when examined alone, was significantly different between the two groups [F(1,103) = 4.885, P = 0.029, η2 = 0.045]. Young adult childhood CNS cancer survivors had a higher level of DMC than the college students (Table 2). For the second aim of the study, results of the multiple regression analysis indicated that the combination of variables significantly predicted the CTI total score [F(3,39) = 18.660, P < 0.001, adjusted R2 = 0.558], with the VI scale and PA scores contributing significantly toward the prediction (Table 3). The beta weight suggested that higher levels of VI and PA were more likely to have lower levels of dysfunctional career thoughts as measured by the CTI total score. The same predictors including VI and PA were found to contribute significantly toward the regression model when the DMC [F(3,39) = 13.445, P < 0.001, adjusted R2 = 0.471] was entered as the dependent variable, whereas the VI was the only significant predictor when either CA [F(3,39) = 13.729, P < 0.001, adjusted R2 = 0.476] or EC [F(3,39) = 7.409, P < 0.001, adjusted R2 =0.314] was entered as the dependent variable. Beta weights of variables for each regression model are presented in Table 3.

Discussion The results of our study found that CNS cancer survivors had higher DMC than college students and that VI and PA predict career thoughts. The significant difference in DMC would suggest that young adult CNS cancer survivors might benefit from interventions that focus on providing knowledge of how to make decisions and also facilitate exploration of oneself and the world of work. In addition, the lack of a significant difference on the EC scale would suggest that this group may be better at managing external factors related to making career decisions, such as being able to balance the importance of one’s own self-perceptions with the importance of input and expectations from significant others. However, this conclusion would be counter to findings from a focus group with young adult CNS cancer survivors in which managing expectations from others was identified as a concern (Strauser et al., 2013). The results of research question two indicated that both VI and PA account for a significant portion of the variance in career thoughts. This finding is not surprising and is consistent with a previous study that has indicated that both VI and PA are important constructs that contribute toward career thoughts (Yanchak et al., 2005). However, our study was the first attempted to explore this construct with young adult CNS cancer survivors and provides

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300 International Journal of Rehabilitation Research 2014, Vol 37 No 4

Table 2

Univariate ANOVAs for total and scale scores of the Career Thought Inventory Mean (SD) Cancer survivors (n = 45)

Score Total Decision Making Confusion Commitment Anxiety External Conflict Error

48.84 11.58 12.56 4.22

(22.63) (7.86) (5.87) (2.34)

College students (n = 60) 44.08 8.35 13.45 3.33

(22.19) (7.05) (6.60) (2.75)

d.f.

F

P

η2

1 1 1 1 103

1.164 4.885 0.518 3.037

0.283 0.029 0.473 0.084

0.011a 0.045a–b 0.005a 0.029a

η2, partial η2 statistics; ANOVAs, analyses of variance. a Small effect (η2 = 0.01). b Medium effect (η2 = 0.06).

Table 3

Multiple regression analyses for predicting career thoughts among CNS cancer survivors

Variables DV: CTI-total Vocational identity Positive affect Negative affect Constant DV: CTI – DMC Vocational identity Positive affect Negative affect Constant DV: CTI – CA Vocational identity Positive affect Negative affect Constant DV: CTI – EC Vocational identity Positive affect Negative Constant

B

SEB

β

t

P

− 3.602 − 0.694 0.065 171.179

0.527 0.328 0.318 21.371

− 0.719 − 0.223 0.022 –

8.010 − 2.120 0.204 8.010

0.000 0.040 0.840 0.000

− 1.127 − 0.262 0.048 50.764

0.201 0.125 0.121 8.148

− 0.646 − 0.242 0.046 –

− 5.606 − 2.099 0.393 6.230

0.000 0.042 0.697 0.000

− 0.924 − 0.122 − 0.044 43.391

0.150 0.093 0.090 6.061

− 0.708 − 0.151 − 0.057 –

− 6.177 − 1.317 − 0.484 7.159

0.000 0.196 0.631 0.000

− 0.303 − 0.074 − 0.065 16.481

0.069 0.043 0.041 2.787

− 0.577 − 0.226 − 0.211 –

− 4.400 − 1.729 − 1.570 5.913

0.000 0.092 0.125 0.000

Adjusted R2 0.558

0.471

0.476

0.314

β, standardized coefficient; B, unstandardized coefficient; CNS, central nervous system; CTI, Career Thoughts Inventory; CTI – CA, Commitment Confusion; CTI – DMC, Decision Making Confusion; CTI – EC, External Conflict; CTI-total, Career Thought Inventory – total score; DV, dependent variable; SEB, standard error of the unstandardized coefficient.

support for the need to address both of these constructs as it relates to career development. Interventions that focus on building VI and increasing PA would appear to be warranted for this specific population. Overall, the results of this study provide additional support for the interplay between career and psychological variables and the need to incorporate career and vocational services as part of a comprehensive psychosocial treatment for young adult CNS cancer survivors. Incorporation of vocational and career services into psychosocial cancer treatment provides counselors or other rehabilitation service providers with an additional area where vocational rehabilitation counseling is needed and would be of significant benefit. The emphasis on vocational functioning has been an important focus of rehabilitation counseling, and research with young adult cancer survivors as a whole has indicated that career development and vocational functioning are an emerging area of needed service impacting young adult cancer survivors. In addition, a further step for future research in this field could assess the potential effect of cognitive

problems and the interplay between career and cognitive variables (Green et al., 2005; Gehring et al., 2008). Limitations

Conclusions on the results of this study are limited by the following considerations. First, this study utilized a crosssectional exploratory approach, which limits the ability to determine any causal link between the variables. Second, for this exploratory study, the sample size was relatively small, consisting of only 45 young adult CNS cancer survivors. As a result, our findings may not be truly representative and generalizable to the young adult CNS cancer survivor population as a whole. Selection bias might have occurred because our CNS cancer survivors were not drawn randomly from the beneficiary population, but from a convenient population at the CBTF. Third, our comparison group of noncancer survivors is limited because college students may indicate potential differences related to cultural and socioeconomic background and educational competency. Finally, the limitations of self-report measures are well documented in the research and social science/medical literature.

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Career thoughts of CNS cancer survivors Lange et al. 301

Conclusion

Young adult CNS cancer survivors have more dysfunctional career thoughts, especially in the area of DMC. In addition, increased levels of VI and PA are related to increased levels of positive and constructive career thoughts. The findings of this study provide additional support for the merits of incorporating career and vocational services in multidisciplinary psychosocial cancer treatment to increase PA and VI and clarify career thoughts in an effort to promote constructive career development and maximize employment.

Acknowledgements This research was partially supported by the Robert P. Larsen Grant for Research in Career Development from the University of Illinois Career Center and the National Institute on Disability and Rehabilitation Research (H133G110289). The authors also acknowledge the participants and staff members from the Children’s Brain Tumor Foundation in New York City for their involvement in this study. Conflicts of interest

There are no conflicts of interest.

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