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Testing a Theoretical Model of Perceived Self-efficacy for Cancer-Related Fatigue Self-management and Optimal Physical Functional Status

Hoffman, Amy J.; von Eye, Alexander; Gift, Audrey G.; Given, Barbara A.; Given, Charles W.; Rothert, Marilyn

doi: 10.1097/NNR.0b013e3181903d7b
Features

Background: Critical gaps exist in the understanding of cancer symptoms, particularly for cancer-related fatigue (CRF). Existing theories and models do not examine the key role perceived self-efficacy (PSE) plays in a person's ability to manage symptoms.

Objectives: The objective of this study was to test the hypothesis that physical functional status (PFS) is predicted through patient characteristics, CRF, other symptoms, and PSE for fatigue self-management in persons with cancer.

Methods: This study is a secondary data analysis from the baseline observation of two randomized control trials. The combined data set includes 298 participants who were undergoing a course of chemotherapy. Key variables included physiological and contextual patient characteristics, the severity from CRF and other symptoms, PSE, and PFS. Path analysis examined the relationships among the variables in the proposed theoretical model.

Results: Persons with cancer reported CRF as the most prevalent symptom among a mean of 7.4 other concurrent symptoms. The severity from CRF had a direct and indirect effect on PFS, with CRF having a direct adverse impact on PFS (t = −7.02) and an indirect adverse effect as part of the severity from the other symptoms (t = 9.69), which also adversely impacted PFS (t = −2.71). Consistent with the proposed theoretical model, PSE had a positive effect on the PFS (t = 2.87) of persons with cancer while serving as a mediator between CRF severity and PFS.

Discussion: Cancer-related fatigue is prevalent and related to the presence of other symptoms, and PSE for fatigue self-management is an important factor influencing CRF and PFS. A foundation is provided for future intervention studies to increase PSE to achieve optimal PFS in persons with cancer.

Amy J. Hoffman, PhD, RN, is Assistant Professor, Kirkhof College of Nursing, Cook DeVos Center for Health Sciences, Grand Valley State University, Grand Rapids, Michigan.

Alexander von Eye, PhD, is Professor, Department of Psychology; Audrey G. Gift, PhD, RN, FAAN, is Professor Emeritus, College of Nursing; Barbara A. Given, PhD, RN, FAAN, is University Distinguished Professor, College of Nursing; Charles W. Given, PhD, is Professor, Department of Family Practice, College of Human Medicine; and Marilyn Rothert, PhD, RN, FAAN, is Dean/Professor Emerita, College of Nursing, Michigan State University, East Lansing.

Accepted for publication August 4, 2008.

This study was supported by the (a) National Institutes of Health, National Institute of Nursing Research, Individual Ruth L. Kirschstein National Research Service Award, Grant 1F31 NR009621-01A1, with a project title of "Fatigue, Self-Efficacy, and Functional Status in Persons with Lung Cancer" (principal investigator Amy Hoffman); (b) Mary Margaret Walther Cancer Research Fellowship, Behavioral Cooperative Oncology Group, Walther Cancer Institute, Indianapolis, Indiana; (c) Blue Cross Blue Shield of Michigan Foundation, Grant 1044.SAP, with a project title of "Fatigue, Self-Efficacy, and Functional Status in Persons with Lung Cancer" (principal investigator Amy Hoffman); (d) Sigma Theta Tau International Honor Society of Nursing, Kappa Epsilon Chapter-At-Large, Michigan; and (e) John F. Dunkel Scholarship Award, College of Nursing, Michigan State University, 2003 and 2004.

The following data source was used: "The Family Home Care for Cancer: A Community-Based Model for Symptom Management" project (R01 CA-079280), sponsored by Barbara A. Given, PhD, RN, FAAN, principal investigator, and "The Automated Telephone Monitoring for Symptom Management" project (R01 CA-30724), sponsored by Charles W. Given, PhD, principal investigator.

Corresponding author: Amy J. Hoffman, PhD, RN, Kirkhof College of Nursing, Cook DeVos Center for Health Sciences, Grand Valley State University, Room 474, 301 Michigan Street NE, Grand Rapids, MI 49503-3314 (e-mail: hoffmana@gvsu.edu; ahoffman32@aol.com).

© 2009 Lippincott Williams & Wilkins, Inc.