An Intervention to Increase Quality of Life and Self-Care Self-Efficacy and Decrease Symptoms in Breast Cancer Patients

Article excerpt

This study tested effects of a nurse-administered self-efficacy intervention given on five monthly occasions and designed to enhance patients' self-care self-efficacy. The hypotheses were that at four months and eight months after beginning chemotherapy the efficacy-enhancing experimental group would have significantly higher scores on quality of life and self-care self-efficacy than the control group and significantly less symptom distress. Fifty-six women receiving chemotherapy for breast cancer were randomized to the experimental and control groups. Outcome variables were quality of life, measured by the Functional Assessment of Cancer Treatment-Breast (FACT-B), symptom distress, measured by the Symptom Distress Scale (SDS), and factors of self-care self-efficacy, measured by Strategies Used by Patients to Promote Health (SUPPH). The interaction effects for the FACT-B ranged from small for functional concerns (eta square = .03) to large for social concerns (eta square = .110); effects for the SDS were large (eta square = .140), and for factors on the SUPPH effect sizes ranged from small (eta square = .01) for Enjoying Life and Stress Reduction to medium (eta square = .089) for Coping, and large (etasquare = .141) for Making Decisions. Interventions to promote self-efficacy may increase quality of life and decrease symptom distress for women diagnosed with breast cancer.

Medical treatments for patients with chronic illnesses are increasingly being evaluated by quality of life issues as well as life extension (Andrykowski et al., 1995; Del Giudice, Leszcz, Pritchard, Vincent, & Goodwin, 1997; Ferrell et al., 1996). As the effectiveness of antineoplastic agents became widely known, many new antineoplastic drugs were introduced in the 1980s and concern about patient quality of life increased (Cellaetal., 1993). Measures of quality of life may include health functioning, socioeconomic, psychological and family concerns, physical symptoms, psychological symptoms, well-being, and social support, symptom distress, and the impact of symptoms on activities (Ferrans, 1990; Ferrell, Wisdom, Wenzl, & Brown, 1989; Longman, Braden, & Mishel, 1996).

Uncontrolled side effects of treatment, including anticipatory nausea and vomiting and weight gain, are problems for women receiving chemotherapy for breast cancer that may decrease quality of life and potentially threaten survival (Del Giudice, Leszcz, Pritchard, Vincent, & Goodwin, 1997; Demark-Wahnefried, Winer, & Rimer, 1993; Longman, Braden, & Mishel, 1996). Although follow-up studies reported that distress may persist over time, patients receiving chemotherapy took few preventive actions to manage side effects of treatment (Dodd, 1984; Longman, Braden, & Mishel, 1996).

Attention to psychosocial issues is an integral part of a comprehensive oncologic program (Coluzzi et al., 1995). Psychological interventions to enhance quality of life and given to cancer patients early in the adjustment process may be important for reducing emotional distress, enhancing coping and improving adjustment (Andersen, 1992; Baider, Uziely, & DeNour, 1994; Cunningham, Edmonds, & Williams, 1999; Del Giudice, Leszcz, Pritchard, Vincent, & Goodwin, 1997; Fawzy, 1995; Fawzy, Fawzy, Arndt, & Pasnau, 1995; Walker & Eremin, 1996). Treatment components underlying different studies included the use of various behavior therapy procedures such as relaxation training, cognitive distraction, and goal setting (Burish, 1994; Edgar, Rosberger, &Nowlis, 1992; Edmonds, Lockwood, & Cunningham, 1999; Fawzy & Fawzy, 1994; Vasterling, Jenkins, Tope, & Burish, 1993; Walker et al., 1999). Studies investigated effects of interventions given by trained intervenors to newly diagnosed adult cancer patients. When interventions were delivered on five occasions, significant differences in outcomes were found (Burish, Synder, & Jenkins, 1991; Edgar, Rosberger, & Nowlis, 1992; Vasterling, Jenkins, Tope, & Burish, 1993). …