Thursday, December 20, 2012
Author on Call Blog (36:1) Part 1
Dr. Hinds posed a question to Dr. Hoffman, based on her article "Enhancing Self-efficacy for Optimized Patient Outcomes Through the Theory of Symptom Self-management" published in CANCER NURSING Volume 36 Issue 1. Enjoy Dr. Hoffman's insightful response below:
Dr. Hinds: If an adult with cancer who is experiencing symptoms possesses the knowledge needed for self-management and expresses a belief that he or she could achieve the desired level of management if willing to commit to the collaboratively developed plan, how would the Theory of Symptom Management be applicable to this clinical situation if the adult declines to implement the plan because of a preference not to follow the plan or an unwillingness to do so?
Dr. Hoffman: The Theory of Symptom Self-Management is applicable in this situation in that it depicts the states that are affected by the cancer patient’s choice to not implement the plan as well as the various feedback loops that will provide for the change in states in the symptom self-management process. For instance, if a patient is suffering from fatigue and believes that a collaboratively developed plan of exercise will improve their fatigue but elects not to implement the plan, the participant’s perceived self-efficacy (PSE; perception of ability) to manage their fatigue may remain the same as they have a “plan” they could implement at any time that they believe will work should they elect to implement it. However, changes in health status or circumstances can affect this as depicted by the Theory of Symptom Self-Management. For instance, if the patient’s fatigue continues to worsen and their functional status decreases, this feeds back into the model resulting in a deterioration of their PSE to manage their fatigue as their belief in their ability to implement the exercise plan decreases with their failing health. Likewise, events such as a change in a person’s circumstances such that they learn they need chemotherapy or radiation therapy, can result in a sudden change in the patient’s PSE to self-manage their fatigue since they may believe that the collaborative “plan” that they elected not to implement is no longer a viable option for them as they may believe that these treatments will eliminate their ability to incorporate the plan. In the case where the patient’s fatigue and functional status improves over time, this also feeds back into the model and will increase the patient’s PSE for fatigue self-management as they have been able to improve their status and they still have a “plan” they can incorporate should they need to. These scenarios should be discussed as part of building the participant’s initial PSE when developing the collaborative plan to include the fact that they may improve without incorporating the plan but not as quickly and if they wait they may lose their opportunity to incorporate the plan altogether.
Do you have any comments or questions for Dr. Hoffman? We welcome you to submit feedback through the blog and Dr. Hoffman will answer your questions directly!