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Author on Call

The function of the “Author on Call” blog is to allow our readers and authors to interact with each other in a unique way. A few select authors will be chosen to share on the blog aspects of their papers that were especially meaningful to them personally or points that may not have made it into their published report. Readers will then have the opportunity to provide comments and questions, to which the authors will respond.

At times, as seen in our first entry, we will also post separate entries to the blog on various special topics that we feel would be informational or that we welcome your feedback on.

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!

Ms. Amy B. Bedinger said:
ON BEHALF OF AMY HOFFMAN: "Hello Raymond, Thank you for your kind words. I find the Theory of Symptom Self-Management to be useful as well in my daily clinical practice and research and appreciate having a systematic way to think about helping my patients. I too find partnering with patients to enact symptom self-management critical to achieve the highest level of symptom control. It is true that achieving behavior change involves many physical, psychological, and contextual characteristics that influence behavior change with one key factor being self-efficacy for symptom self-management. As we all know, lifestyle habits can be health beneficial with some being harmful. (comments continued below)
Ms. Amy B. Bedinger said:
(CONTINUED COMMENTS FROM AMY HOFFMAN) I can relate very well to your example of coffee consumption since I too really enjoy my coffee which can have so many health benefits when coffee consumption is in balance. An important part in collaborating on a successful self-management plan takes into account patient lifestyle choices that they may not be willing to change. If the patient is going to be self-managing their symptoms, they need a plan that they have the self-efficacy to successfully implement. Bandura recommends that health promoting communications should provide the belief that a person is able to change their health habits and should instruct on how to do it. In addition, Bandura notes that positive emotions increase thoughts of personal successes; whereas negative emotions make personal failures more pertinent. (comments continued below)
Ms. Amy B. Bedinger said:
(CONTINUED COMMENTS FROM AMY HOFFMAN) In the example of promoting good sleep hygiene, knowing that a patient finds comfort (positive emotion) in drinking coffee should be used in developing a self-management plan. From the patient’s perspective, simply knowing that they still can have a cup of coffee may be enough to make the symptom self-management plan achievable – being told they can’t drink coffee at all may make the plan unachievable. Working collaboratively with the patient on their symptom self-management plan to see if the patient believes it would be feasible to possibly limit the amount of coffee intake and pattern of intake may draw out a more optimistic feeling of ability to implement a sleep self-management plan since the patient still retains control to balance drinking their coffee with the possibility of improved sleep. (comments continued below)
Ms. Amy B. Bedinger said:
(CONTINUED COMMENTS FROM AMY HOFFMAN) This allows the patient to explore their limits while recognizing their limitations allowing the patient to take control, to decide what they want to do with their body, through a symptom self-management process. This builds their motivation and confidence producing a sense of competence to handle other symptom management situations that may come their way. All the Very Best, Amy J. Hoffman PhD, RN, College of Nursing, Michigan State University"
Mr. Ray Chan said:
Dear Dr Hoffman, This is Raymond Chan, from Australia. First of all, I find the Theory of Symptom Self-management very useful. Congratulations. In my opinion, both understanding patient preference and enhancing their perceived self-efficacy are important in symptom self-management. For an example, patients may believe that they can master/have the knowledge to implement a sleep hygiene program. They may adopt most of the sleep hygiene strategies as their self-management strategies during the collaborative planning. However, they might never be willing to cut down their coffee in take during the day due to their habit, and the comfort that the coffee brings them. The model the self-management emphasizes on patients taking control, developing a collaborative plan with their health professionals, rather than a plan prescribed by their health professionals.
About the Journal

Cancer Nursing
Cancer Nursing™ is one of the top ranked nursing journals across the globe, and has one of the top ranked impact factors. Our journal is a free-standing cancer specialty journal, with 3 editors in its history. We have published authors from more than 30 countries.