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National Cancer Survivorship Initiative

Supported Self Management

Surviving and living with or beyond cancer is rising at an estimated 3.2% per year with breast cancer contributing the most to the totality of survivors (Maddams et al 2008).  Having had a diagnosis of cancer and had treatment for it, significant numbers of people are left to deal with the consequences not just of having cancer, but also of the effects of the treatments they have received, many ignorant of late or long term consequences of treatment.  In addition, increasing numbers of people with active cancer are living long term and are dealing with their condition and treatments on an ongoing basis.

All these changes are leading to an increasing need for cancer survivors to be supported to take an active and leading role in their recovery, rehabilitation, or ongoing care. This support will take many forms. It may include planned programmes to develop self management skills, helping the development of practical and emotional coping skills, overcoming the physical effects of some treatments, and understanding the need to make lifestyle changes which will enhance their health and wellbeing. It may also include education to ensure a person is skilled and knowledgeable about monitoring their own risk of recurrence of disease and able to gain advice when they think this is needed. Access to relevant information with support to integrate that information in to their lives is also important to self management.

Evidence for Self Management Support

The project group has been rigorous in its approach to establishing what is known through current evidence, before proceeding to promote, advise, and test models, interventions, and outcome measurements for supported self-management for cancer survivors. This process is building a toolkit which will support clinicians in making self-management support integral to good care and realising its potential in delivering enhanced outcomes for cancer survivors.

Pointers for Effective Self Management

High impact pointers for effective self-management support will include:

  • Tailored information – this alone can increase knowledge and prepare patients for change, and should be provided for all survivors.  However, additional tailored support and ongoing input from healthcare professionals will be needed to help some people use this information.
  • A key component of effective self-management is self-efficacy (the confidence to use self-management skills successfully). Self-efficacy can be achieved through:
    –  Mastery
    –  Vicarious experience
    –  Verbal persuasion
    –  Physiological feedback
  • One size does not fit all. There is a patient ‘self-management journey’ and people should be assessed for their understanding and confidence for self-management along the continuum of skill and confidence so that self-management support can be tailored.
  • A collaborative partnership between patients and health professionals which empowers patients to take on responsibility for their health and well-being. Clinicians can learn specific communication skills that foster effective partnership with patients.
  • Self-management support interventions can be designed, taking account of three factors:
    –  Type – adjustment focused (facilitating transition to survivorship) or problem focused – (for specific issues e.g. exercise for fatigue, enhancing coping skills) or a combination of both.
    –  Delivery – in a group; one to one; technology-based; home-based; peer led; professionally-led; or a combination designed for impact.
    –  Techniques – goal setting; action plans; problem solving; self-monitoring; stress management; information provision; sharing experiences; counselling; coaching; motivational interviewing; feedback; peer modelling.

Useful Self Management Links

The following websites also have useful information on the self management of long term conditions:

Flinders Human Behaviour and Health Research Unit
National Primary Care Research and Development Centre
Stanford Self Management Programmes
Long Term Conditions Alliance Scotland
Expert Patient Programme

Last updated on July 10, 2013