Colorectal cancer patient\u2019s self-efficacy for managing illness-related problems in the first 2\xa0years after diagnosis, results from the ColoREctal Well-being (CREW) study

Chloe Grimmett,Claire Foster,Lynn Calman,Joanne Haviland,Amy Din,Jane Winter,Peter W F Smith,Alison Richardson

doi:10.1007/s11764-017-0636-x

Abstract

PurposeThere is a growing emphasis on self-management of cancer aftercare. Little is known about patient’s self-efficacy (confidence) to manage illness-related problems and how this changes over time. This paper describes the patterns of self-efficacy for managing illness-related problems amongst colorectal cancer patients in the 2 years following diagnosis.MethodsIn this prospective cohort study, questionnaires were administered at baseline (pre-surgery), 3, 9, 15 and 24 months to 872 colorectal cancer patients. Self-efficacy (confidence to manage illness-related problems), anxiety, social support, affect, socio-demographics, physical symptoms and clinical and treatment characteristics were assessed. Group-based trajectory analysis identified trajectories of self-efficacy up to 24 months and predictors.ResultsFour trajectories of self-efficacy were identified: group 1 (very confident) 16.0% (95% confidence interval (CI) 10.7–21.3%), group 2 (confident) 45.6% (95% CI 40.3–51.0%), group 3 (moderately confident) 29.5% (95% CI 25.1–33.8%) and group 4 (low confidence) 8.9% (95% CI 6.4–11.4%). Greater deprivation, domestic status, more co-morbidities, worse fatigue and pain, lower positivity and greater negativity were significantly associated with lower self-efficacy. There was an increase in mean scores for self-efficacy over time for the whole sample, but this did not reach the cut-off for minimally important differences. At 2 years, the lowest level of confidence to manage was for symptoms or health problems.ConclusionAround 40% of patients had suboptimal levels of confidence to manage illness-related problems with little change from the time of diagnosis across the four groups.Implications for cancer survivorsScreening for self-efficacy at diagnosis would enable targeted, early intervention which could in turn enhance health-related quality of life.

Highlights

Cancer is increasingly being viewed as a chronic health condition with evidence that cancer and its treatment can have a significant impact on people’s lives in the months and years following treatment [1,2,3]
There was an increase in mean scores for selfefficacy over time for the whole sample, but this did not reach the cut-off for minimally important differences
Implications for cancer survivors Screening for self-efficacy at diagnosis would enable targeted, early intervention which could in turn enhance health-related quality of life

Summary

Introduction

Cancer is increasingly being viewed as a chronic health condition with evidence that cancer and its treatment can have a significant impact on people’s lives in the months and years following treatment [1,2,3]. This is reflected in a growing emphasis on selfmanagement of cancer aftercare. Data from cross-sectional studies support a positive association between self-efficacy and quality of life [5], adjustment following a cancer diagnosis [6, 7] and symptom distress [8]. In a study of 112 women receiving adjuvant endocrine therapy, increasing physical symptoms were only associated with lower functional and emotional well-being in those reporting low self-efficacy for coping with symptoms [9]

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