Cancer survivors’ perspectives on adjustment-focused self-management interventions: a qualitative meta-synthesis

Abstract

General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms AbstractPurpose Self-management interventions improve patient outcomes across a range of long-term conditions, but are often limited by low uptake and completion rates. The aim of this paper was to conduct a meta-synthesis of qualitative studies exploring cancer survivors' views and experiences of engaging with adjustment-focused selfmanagement interventions in order to inform the development of future interventions targeting this population.Methods Four electronic databases were systematically searched. Studies that used qualitative methods to explore cancer survivors' views and experiences of engaging with adjustment-focused self-management interventions were included. A meta-ethnographic approach was used to synthesize the findings.Results Thirteen studies met the inclusion criteria. Engaging with adjustment-focused self-management interventions enabled cancer survivors to gain emotional and informational support from peers and/or facilitators in an open, non-judgemental environment, become empowered through enhancing knowledge and skills and regaining confidence and control, and move beyond cancer by accepting illness experiences, reprioritising goals and adopting a positive outlook. However, the extent to which they engaged with, and benefited from, such interventions was mitigated by diverse preferences regarding intervention design, content and delivery. Personal obstacles to engagement included low perceived need, reticence to discuss cancer-related experiences and various practical issues.Conclusions Cancer survivors derive a range of benefits from participating in adjustment-focused selfmanagement interventions; potential barriers to engagement should be addressed more comprehensively in intervention marketing, design and delivery.Implications for cancer survivors The findings suggest some key considerations for the development and implementation of future adjustment-focused self-management interventions that may help to optimize their appeal and effectiveness among cancer survivors.

Investigating the impact of self‐management behaviours on quality of life and fear of recurrence in head and neck cancer survivors: A population‐based survey

“…Whilst these findings were contrary to our hypotheses relating to self‐monitoring, they are perhaps unsurprising, given that elevated levels of self‐monitoring may be closely linked to hypervigilance to signs of recurrence in cancer survivors. Hypervigilance is a key component in conceptualisations of FoR and maladaptive coping in HNC and is associated with the incidence of post‐traumatic stress disorder in cancer survivorship In contrast, self‐monitoring has typically been regarded as adaptive for individuals with cancer, with recommendations to target this behaviour in cancer self‐management interventions and qualitative accounts supporting its positive effects . In light of this, further research is needed to gain a better understanding of the impact of self‐monitoring on outcomes in HNC survivorship, eg, to establish if a threshold point exists where adaptive self‐monitoring becomes maladaptive hypervigilance in HNC survivors.…”

“…The findings also have important implications for the design and implementation of supported self‐management interventions for HNC survivors. Adjustment‐focused self‐management interventions supporting the acquisition of specific self‐management skills may lead to positive effects in relation to QoL and FoR for HNC survivors. Furthermore, self‐management intervention components related to self‐monitoring may need to be specifically tailored to consider the potential for maladaptive self‐monitoring amongst HNC survivors (and, potentially, amongst other cancer survivors).…”

“…FoR 31 and maladaptive coping in HNC 32,33 and is associated with the incidence of post-traumatic stress disorder in cancer survivorship 34,35 In contrast, self-monitoring has typically been regarded as adaptive for individuals with cancer, 3 with recommendations to target this behaviour in cancer self-management interventions 9 and qualitative accounts supporting its positive effects. 36 In light of this, further research is needed to gain a better understanding of the impact of self-monitoring on outcomes in HNC survivorship, eg, to establish if a threshold point exists where adaptive self-monitoring becomes maladaptive hypervigilance in HNC survivors. Furthermore, selfmanagement behaviour scales like the HEIQ may need to be revised for use in cancer survivors generally in order to account for the potential continuum of adaptive self-monitoring to maladaptive hypervigilance in cancer survivorship.…”

Perceptions and experiences of diabetic foot ulceration and foot care in people with diabetes: A qualitative meta‐synthesis

“…Interventions that aim to promote engagement by improving self‐efficacy could result in greater and longer‐lasting behavioural change . Self‐management interventions enhance patients' ability and confidence to manage long‐term conditions (LTCs) effectively by providing education, training, and support to develop their knowledge, skills, and both internal and external resources . Their utility in improving clinical and psychosocial outcomes and reducing health care costs among people with LTCs including diabetes has been widely demonstrated.…”

Effects of transtheoretical model‐based intervention on the self‐management of patients with an ostomy: A randomised controlled trial

“…Improving the self‐management ability of patients with an ostomy and their long‐term quality of life remains challenging. Therefore, it is necessary to put ostomy management into effect, which has been shown to promote rehabilitation and improved health (Coffey et al, ).…”