Self-Management and Transitions in Women With Advanced Breast Cancer

Abstract

Context Self-management involves behaviors that individuals perform to handle health conditions. Self-management may be particularly challenging during transitions—shifts from one life phase or status to another, for example, from cure- to noncure-oriented cared—because they can be disruptive and stressful. Little is known about individuals’ experiences with self-management, especially during transitions. Objectives Our purpose was to describe experiences of self-management in the context of transitions among women with advanced breast cancer. Methods We interviewed a purposive sample of 15 women with metastatic breast cancer about their self-management preferences, practices, and experiences, including how they managed transitions. Interviews were recorded and transcribed. The qualitative method of interpretive description was used to code and analyze the data. Results Participants’ mean age was 52 years (range 37–91 years); most were White (80%), married (80%), and college educated (60%). Self-management practices related to womens’ health and to communication with loved ones and providers. Participants expressed a range of preferences for participation in self-management. Self-management included developing skills, becoming empowered, and creating supportive networks. Barriers to self-management included symptom distress, difficulty obtaining information, and lack of knowledge about the cancer trajectory. Women identified transitions as shifts in physical, emotional, and social well-being, as when their cancer progressed and there was a need to change therapy. Transitions often prompted changes in how actively women self-managed and were experienced as positive, negative, and neutral. Conclusion Self-management preferences can vary. Providers should explore and revisit patients’ preferences and ability to self-manage over time, particularly during transitions.

Supporting self-management of pain by patients with advanced cancer: views of palliative care professionals

“…A key finding from studies in this field is that education for self-management of cancer pain should be integrated into routine practice [29,19,30]. Despite optimism that this can be achieved 'without undue extra resources or time' [14, p393] there are numerous factors, often presented as barriers, which influence the implementation of patient education for selfmanagement -including health professionals' knowledge, attitudes and beliefs [26,30].…”

“…At the same time, individual capacities and preferences for self-management are likely to vary according to health status [14,19], learning styles [24] and sociodemographic profile [1,38]. Over-enthusiastic and simplistic promotion of selfmanagement might risk reinforcing inequality in favour of those individuals and groups with greater resources for self-care.…”

“…It is a relatively well-defined concept in long-term conditions such as arthritis, diabetes and asthma; but self-management of a long-term condition has been seen as very different from self-management of a lifeshortening illness [14]. Understanding of self-management in people with advanced cancer has been developing over the last decade or so [15][16][17][18][19][20]. For example, research has shown that 'self-action strategies' to manage the effects of advanced cancer on appetite and eating can lead to changes in patients' thinking and behaviour which enhance well-being [17]; the importance of recognizing and supporting patients' selfmanagement strategies in regard to medicines taking when their life expectancy is reduced by advanced cancer has been demonstrated; and, importantly, self-management has been shown to fluctuate during the trajectory of an illness, with advancing metastatic disease and/or feeling more ill prompting changes in how actively individuals self-manage [19].…”

“…Understanding of self-management in people with advanced cancer has been developing over the last decade or so [15][16][17][18][19][20]. For example, research has shown that 'self-action strategies' to manage the effects of advanced cancer on appetite and eating can lead to changes in patients' thinking and behaviour which enhance well-being [17]; the importance of recognizing and supporting patients' selfmanagement strategies in regard to medicines taking when their life expectancy is reduced by advanced cancer has been demonstrated; and, importantly, self-management has been shown to fluctuate during the trajectory of an illness, with advancing metastatic disease and/or feeling more ill prompting changes in how actively individuals self-manage [19]. Supporting self-management has become a standard approach for health care professionals working with people who experience chronic non-cancer pain [21,22] and many studies and reviews have reported that patient-focused educational interventions, including self-management, can also improve pain control in patients with advanced cancer [23][24][25][26][27][28][29][30].…”

Integrating palliative care into self-management of breast cancer: Protocol for a pilot randomized controlled trial

“…Self-management skills include building knowledge about one's health condition, communicating effectively, developing self-efficacy, and using health care resources appropriately [10]. Women with breast cancer want to self-manage with their family caregivers and health care providers [11-13]; however, these parties are often uninformed or uncomfortable discussing palliative care [14] because it is frequently mistaken as being only for patients at the end of life. An intervention that teaches about palliative care among the range of care options that also includes curative and hospice care may help patients to integrate palliative care into their self-management plans in a more timely way.…”