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Trajectory Patterns and Factors Influencing Self-management Behaviors in Chinese Patients With Breast Cancer

Wu, Fulei, PhD; Howell, Doris, PhD; Fang, Qiong, MD; Chen, Jing, RN; Yuan, Changrong, PhD

doi: 10.1097/NCC.0000000000000681
Article: PDF Only

Background Self-management plays an important role in improving quality of life among patients with breast cancer. Self-management behaviors change with treatment periods, and the trajectory varies in patients with different demographic and psychosocial characteristics. However, the trajectory patterns and the predictive factors have not been fully studied.

Objectives The aim of this study was to identify the trajectory patterns of self-management behaviors in Chinese patients with breast cancer and their predictive factors.

Methods A total of 128 patients with breast cancer were recruited. Demographic and disease-related information, self-management behaviors, self-efficacy, coping modes, emotional distress, and social support were investigated across 5 time points. Growth mixture modeling was used to identify the trajectory patterns of self-management behaviors. Logistic regression was used to determine the predictors for membership.

Results The best-fit growth mixture modeling revealed a 2-class model; model fit indices were all in acceptable ranges. Class 1 and 2 were named as the group of “stable” (34.38%) and the group of “sharply decreased” (65.62%), respectively, based on the tendency of change. Modified radical mastectomy, avoidance coping mode, anxiety, and low self-efficacy level were predictors of the patients' membership to the sharply decreased group.

Conclusion Our study proved the heterogeneity of self-management behaviors and the influencing effect of treatment and psychosocial factors on the development of self-management behaviors in Chinese patients with breast cancer.

Implications for Practice Health professionals should pay more attention to patients who are at higher risk of developing a poor self-management pattern. Targeted interventions should be developed across subpopulations and treatment periods accordingly.

Author Affiliations: School of Nursing, Second Military Medical University, Shanghai, China (Drs Wu and Yuan); Department of Supportive Care, Princess Margaret Cancer Center, Toronto, Canada (Dr Howell); Nursing Department, Ruijin Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China (Dr Fang); Department of General Surgery, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China (Mrs Chen).

This research was supported by the Natural Science Foundation of China (project ID 71473262).

The authors have no conflicts of interest to disclose.

Correspondence: Changrong Yuan, PhD, RN, FAAN, School of Nursing, Second Military Medical University, 800 Xiangyin Rd, Yangpu, Shanghai, China 200433 (

Accepted for publication October 4, 2018.

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