Online Exclusive Article

Relationships Between Three Beliefs as Barriers to Symptom Management and Quality of Life in Older Breast Cancer Survivors

Hyun-E Yeom

Susan M. Heidrich

symptom management, quality of life, adult cancer survivors, breast cancer survivors
ONF 2013, 40(3), E108-E118. DOI: 10.1188/13.ONF.E108-E118

Purpose/Objectives: To describe relationships among perceived barriers to symptom management and quality of life and to test the mediating role of perceived communication difficulties on the relationships between other perceived barriers to symptom management and quality of life in older adult breast cancer survivors.

Design: Cross-sectional descriptive-correlational design using baseline data from a randomized, controlled trial that tested the efficacy and durability of the individualized representational intervention in reducing symptom distress and improving quality of life in older adult breast cancer survivors.

Setting: The community, an oncology clinic, and a state tumor registry.

Sample: 190 older adult breast cancer survivors (X age = 70.4 years) who were an average of 3.3 years after breast cancer diagnosis.

Methods: Path analysis using Mplus, version 5.1.

Main Research Variables: Negative beliefs about symptom management (Symptom Management Beliefs Questionnaire [SMBQ]), perceived negative attitudes from healthcare providers (Communication Attitudes [CommA]), perceived communication difficulties (CommD), and quality of life.

Findings: Significant direct effects of SMBQ and CommA on CommD were found after controlling for age, number of health problems, and number of symptoms. CommD was a significant mediator of the effects of CommA on quality of life after controlling for the covariates. SMBQ had significant total effects on quality of life after adjusting for the covariates but was not mediated by CommD.

Conclusions: Patient-provider communication is an important factor in the quality of life of older adult breast cancer survivors.

Implications for Nursing: Developing and testing nursing interventions focusing on enhancing both positive beliefs about symptom management and effective communication in old age is suggested.

Knowledge Translation: Older adults and healthcare providers must overcome stereotyped beliefs about aging that may affect self-care and health outcomes for this population. Older adults must be allowed to express their views and emotions about aging.

Jump to a section

    References

    Armstrong-Esther, C. A., Sandilands, M. L., & Miller, D. (1989). Attitudes and behaviours of nurses toward the elderly in an acute care setting. Journal of Advanced Nursing, 14, 34-41. doi:10.1111/j.1365-2648.1989.tb03402.x
    Baker, R. R. (1984). Attitudes of healthcare providers toward elderly patients with normal aging and disease-related symptoms. Gerontologist, 24, 543-545. doi:10.1093/geront/24.5.543
    Bandalos, D. L. (2002). The effects of item parceling on goodness-of-fit and parameter estimate bias in structural equation modeling. Structural Equation Modeling: A Multidisciplinary Journal, 9, 78-102. doi:10.1207/S15328007SEM0901_5
    Beisecker, A. E. (1988). Aging and the desire for information and input in medical decisions: Patient consumerism in medical encounters. Gerontologist, 28, 330-335. doi:10.1093/geront/28.3.330
    Brody, E. M., & Kleban, M. H. (1981). Physical and mental health symptoms of older people: Who do they tell? Journal of the American Geriatrics Society, 29, 442-449.
    Ceber, E., Soyer, M. T., Ciceklioglu, M., & Cimat, S. (2006). Breast cancer risk assessment and risk perception on nurses and midwives in Bornova Health District in Turkey. Cancer Nursing, 29, 244-249. doi:10.1097/00002820-200605000-00013
    Cegala, D. J., Post, D. M., & McClure, L. (2001). The effects of patient communication skills training on the discourse of older patients during a primary care interview. Journal of the American Geriatrics Society, 49, 1505-1511. doi:10.1046/j.1532-5415.2001.4911244.x
    Dawson, R., Sellers, D. E., Spross, J. A., Jablonski, E. S., Hoyer, D. R., & Solomon, M. Z. (2005). Do patients' beliefs act as barriers to effective pain management behaviors and outcomes in patients with cancer-related or noncancer-related pain? Oncology Nursing Forum, 32, 363-374. doi:10.1188/05.ONF.363-374
    Deimling, G. T., Bowman, K. F., & Wagner, L. J. (2007). The effects of cancer-related pain and fatigue on functioning of older adult, long-term cancer survivors. Cancer Nursing, 30, 421-433.
    Gitlin, L. N., Winter, L., Dennis, M. P., Corcoran, M., Schinfeld, S., & Hauck, W. W. (2006). A randomized trial of a multicomponent home intervention to reduce functional difficulties in older adults. Journal of the American Geriatrics Society, 54, 809-816. doi:10.1111/j.1532-5415.2006.00703.x
    Greene, M. G., & Adelman, R. D. (2003). Physician-older patient communication about cancer. Patient Education and Counseling, 50, 55-60. doi:10.1016/S0738-3991(03)00081-8
    Gunnarsdottir, S., Donovan, H. S., Serlin, R. C., Voge, C., & Ward, S. (2002). Patient-related barriers to pain management: The Barriers Questionnaire II (BQ-II). Pain, 99, 385-396. doi:10.1016/S0304-3959(02)00243-9
    Hagger, M. S., & Orbell, S. (2003). A meta-analytic review of the Common Sense Model of illness representations. Psychology and Health, 18, 141-184. doi:10.1080/088704403100081321
    Heidrich, S. M., Brown, R. L., Egan, J. J., Perez, O. A., Phelan, C. H., Yeom, H., & Ward, S. E. (2009). An individualized representational intervention to improve symptom management (IRIS) in older breast cancer survivors: Three pilot studies [Online exclusive]. Oncology Nursing Forum, 36, E133-E143. doi:10.1188/09.ONF.E133-E143
    Heidrich, S. M., Egan, J. J., Hengudomsub, P., & Randolph, S. M. (2006). Symptoms, symptom beliefs, and quality of life of older breast cancer survivors: A comparative study. Oncology Nursing Forum, 33, 315-322. doi:10.1188/06.ONF.315-322
    Kagan, S. H. (2008). Ageism in cancer care. Seminars in Oncology Nursing, 24, 246-253. doi:10.1016/j.soncn.2008.08.004
    Leventhal, H., Brissette, I., & Leventhal, E. A. (2003). The Common Sense Model of self-regulation of health and illness. In L. D. Cameron & H. Leventhal (Eds.), The self-regulation of health and illness behavior (pp. 42-65). London, England: Routledge.
    Levy, B. R., Ashman, O., & Slade, M. D. (2009). Age attributions and aging health: Contrast between the United States and Japan. Journals of Gerontology Series B, Psychological Sciences and Social Sciences, 64, 335-338. doi:10.1093/geronb/gbp002
    Levy, B. R., & Myers, L. M. (2004). Preventive health behaviors influenced by self-perceptions of aging. Preventive Medicine, 39, 625-629. doi:10.1016/j.ypmed.2004.02.029
    Levy, B. R., Slade, M. D., Kunkel, S. R., & Kasl, S. V. (2002). Longevity increased by positive self-perceptions of aging. Journal of Personality and Social Psychology, 83, 261-270. doi:10.1037/0022-3514.83.2.261
    Liang, W., Burnett, C. B., Rowland, J. H., Meropol, N. J., Eggert, L., Hwang, Y. T., … Mandelblatt, J. S. (2002). Communication between physicians and older women with localized breast cancer: Implications for treatment and patient satisfaction. Journal of Clinical Oncology, 20, 1008-1016. doi:10.1200/JCO.20.4.1008
    Mandelblatt, J., Figueiredo, M., & Cullen, J. (2003). Outcomes and quality of life following breast cancer treatment in older women: When, why, how much, and what do women want? Health and Quality of Life Outcomes, 1, 45. doi:10.1186/1477-7525-1-45
    Morgan, R., Pendleton, N., Clague, J. E., & Horan, M. A. (1997). Older people's perceptions about symptoms. British Journal of General Practice, 47, 427-430.
    National Cancer Institute. (2009). SEER cancer statistics review, 1975-2007. Retrieved from http://seer.cancer.gov/csr/1975_2007
    Nelson, T. D. (2002). Ageism: Stereotyping and prejudice against older persons. Cambridge, MA: MIT Press.
    Nussbaum, J. F., Baringer, O., & Kundrat, A. (2003). Health, communication, and aging: Cancer and older adults. Health Communication, 15, 185-192. doi:10.1207/S15327027HC1502_6
    Robb, C., Haley, W., Balducci, L, Extermann, M., Perkins, A., Small, B., & Mortimer, J. (2007). Impact of breast cancer survivorship on quality of life in older women. Critical Reviews in Oncology/Hematology, 62, 84-91. doi:10.1016/j.critrevonc.2006.11.003
    Royer, H. R., Phelan, C. H., & Heidrich, S. M. (2009). Older breast cancer survivors' symptom beliefs. Oncology Nursing Forum, 36, 463-470. doi:10.1188/ONF.09.463-470
    Ryff, C. D. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology, 57, 1069-1081. doi:10.1037/0022-3514.57.6.1069
    Ryff, C. D., & Keyes, C. L. (1995). The structure of psychological well-being revisited. Journal of Personality and Social Psychology, 69, 719-727. doi:10.1037/0022-3514.69.4.719
    Sánchez Palacios, C., Trianes Torres, M. V., & Blanca Mena, M. J. (2009). Negative aging stereotypes and their relation with psychosocial variables in the elderly population. Archives of Gerontology and Geriatrics, 48, 385-390. doi:10.1016/j.archger.2008.03.007
    Sarkisian, C. A., Hays, R. D., & Mangione, C. M. (2002). Do older adults expect to age successfully? The association between expectations regarding aging and beliefs regarding healthcare seeking among older adults. Journal of the American Geriatrics Society, 50, 1837-1843. doi:10.1046/j.1532-5415.2002.50513.x
    Schlenk, E. A., Erlen, J. A., Dunbar-Jacob, J., McDowell, J., Engberg, S., Sereika, S. M., … Bernier, M. J. (1998). Health-related quality of life in chronic disorders: A comparison across studies using the MOS SF-36. Quality of Life Research, 7, 57-65. doi:10.1023/A:1008836922089
    Schnoll, R. A., Knowles, J. C., & Harlow, L. (2002). Correlates of adjustment among cancer survivors. Journal of Psychosocial Oncology, 20, 37-60. doi:10.1300/J077v20n01_03
    Siminoff, L. A., Graham, G. C., & Gordon, N. H. (2006). Cancer communication patterns and the influence of patient characteristics: Disparities in information-giving and affective behaviors. Patient Education and Counseling, 62, 355-360. doi:10.1016/j.pec.2006.06.011
    Spagnola, S., Zabora, J., BrintzenhofeSzoc, K., Hooker, C., Cohen, G., & Baker, F. (2003). The Satisfaction With Life Domains Scale for Breast Cancer (SLDS-BC). Breast Journal, 9, 463-471. doi:10.1046/j.1524-4741.2003.09603.x
    Stewart, M., Meredith, L., Brown, J. B., & Galajda, J. (2000). The influence of older patient-physician communication on health and health-related outcomes. Clinics in Geriatric Medicine, 16, 25-36. doi:10.1016/S0749-0690(05)70005-7
    Stoller, E. P., & Forster, L. E. (1994). The impact of symptom interpretation on physician utilization. Journal of Aging and Health, 6, 507-534. doi:10.1177/089826439400600405
    Tomich, P. L., & Helgeson, V. S. (2002). Five years later: A cross-sectional comparison of breast cancer survivors with healthy women. Psycho-Oncology, 11, 154-169. doi:10.1002/pon.570
    Ward, S. E., Carlson-Dakes, K., Hughes, S., Kwekkeboom, K. L., & Donovan, H. (1998). The impact on quality of life of patient-related barriers to pain management. Research in Nursing and Health, 21, 405-413.
    Ware, J. E., Jr., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30, 473-483. doi:10.1097/00005650-199206000-00002
    Ware, J. E., Jr., Snow, K. K., Kosinski, M., & Gandek, B. (Eds.). (2000). SF-36 health survey. Manual and interpretation guide (2nd ed.). Lincoln, RI: Quality-Metric Inc.
    Yeom, H. E., & Heidrich, S. M. (2009). Effect of perceived barriers to symptom management on quality of life in older breast cancer survivors. Cancer Nursing, 32, 309-316.