An exploration of patients' perceived control, self efficacy and involvement in self care during chemotherapy for colorectal cancer

Abstract

This thesis describes a three year study which explored perceptions and experiences of being involved in self care and perceptions of control and self-efficacy over time amongst patients receiving a six month course of chemotherapy treatment for colorectal cancer. The study was underpinned by Leventhal’s Self Regulation Model and aimed to explore how patients undergoing chemotherapy for colorectal cancer perceived the meaning of self care, what they did as part of their self care in managing the effects of their treatment and whether this changed between the beginning and end of their six month course of chemotherapy. The study also set out to explore the relationship between patients’ perceptions of control and self efficacy and their involvement in self care.

The study adopted a patient focussed, mixed method, longitudinal approach for complementarity and expansion purposes in which the qualitative findings formed the focus of the investigation, supplemented by the quantitative findings. This was important to provide a greater breadth and range to the study and to obtain a realistic understanding of patients’ perceptions and experiences of being involved in self care during their six month course of chemotherapy treatment and the influence of their perceptions of control and self efficacy on their involvement in self care. Thirty one patients participated in the study and data were collected using qualitative semi structured interviews (with a subsample of patients who participated in the study) and quantitative questionnaires (Illness Perception Questionnaire-revised and the Strategies Used by People to Promote Health) and prospective self care diaries with the full study sample. Data were collected at several time points over the course of patients’ chemotherapy treatment (beginning, middle and end of treatment) and were analysed and integrated in accordance with Tashakkori and Teddlie (1998)’s guidance for integrating qualitative and quantitative findings in a mixed methods study.

The study findings revealed that the use of a mixed method, longitudinal study design was a valuable approach for understanding patients’ involvement in self care during chemotherapy for colorectal cancer and the influence of factors, such as their perceptions of control, on their subsequent involvement in their self care. In particular, the principal findings suggested that self care held a range of meanings to the patients in this study. Principally, patients’ self care consisted of two components; physical self care, carried out to manage the physical impact of undergoing treatment, and emotional self care, carried out to manage their emotional response to being diagnosed with, and undergoing treatment for, cancer. The findings suggested that there was no association between patients’ perceptions of control and the degree of self care that they carried out identified in the quantitative analysis. However, in the qualitative analysis, it was revealed that patients’ perceptions of control were likely to influence their attitudes towards their active involvement in self care and the importance with which they viewed this role. In particular, patients who considered themselves to have a high degree of control during their treatment were more likely to believe that they could limit the impact of the treatment through their own actions, that being actively involved in their self care was important and were interested in taking on this role, and that they would use a greater range of self care strategies in helping to manage the impact of their treatment. Conversely patients who considered themselves to have a lower degree of control during their treatment were less likely to believe that they could limit the impact of the treatment through their own actions, that their active involvement in self care was important and were less likely to expect to take on an active role, preferring to leave the management of treatment-related effects to health professionals, whom they regarded as being the “experts”.

The findings from this study have implications for nursing practice because they reinforce the importance of the listening to the patient’s experience and how this approach can contribute to a fuller and more accurate understanding of how patients become involved in their self care and the factors that influence this. This is important so that nurses can provide holistic care, tailored to meet their patients’ self care needs and preferences, and to encourage partnership working between patients, nurses, allied health professionals and other agencies in promoting involvement in self care. The findings also have implications for theories relating to self care in emphasising the importance of patient centred models of care and for Leventhal’s Self Regulation Model in adding further support for the components of the model yet also offering a greater understanding of how the model fits with patients’ emotional responses to the effects of illness and its’ treatments. Finally, the study findings have implications for future research, calling for further research to focus on the meaning of constructs such as self care and control from the patients’ perspective and to further explore the use of the mixed methodology in researching and understanding patients’ involvement in self care and the factors that influence this.