Evidence Synthesis
The self management project group has taken an evidence-based approach to the design of models and interventions currently being piloted within test sites. Guided by reviews of the relevant literature as well as insight gained into current practice, the project group has established what is known about supported self-management for cancer survivors and what requires further research. Subsequently, models being piloted are based on evidence of what works whilst also building on this established knowledge base. Summaries of the main findings are listed below and the full reports are available to download.
1. What is already known about self-management for chronic conditions?
Download - Self Management Support: A Review of the Evidence [PDF, 508KB]
Main Findings
By reviewing self-management support for long-term conditions, 7 key areas emerged as requiring further research in terms of self-management support for cancer survivors:
- Survivorship care plans
- Topic specific programmes
- Programmes for socially disadvantaged groups
- Support materials
- Key worker role
- Health professional training
- Ways of evaluating efficacy of self-management interventions
2. How could supported self-management be integrated into models of personalised aftercare?
Download - Cancer Follow-Up: Towards a Personalised Approach to Aftercare Services. A Review of Current Practice and Selected Initiatives [PDF, 1.00MB]
Main Findings
Shifts are being made away from secondary care based follow-up towards ‘patient-initiated’ approaches that comprise:
- Rapid access to specialist consultation should the need arise
- Self-management education programmes
- Regularly collected patient-reported symptoms to monitor changing needs
This shift has produced a requirement for planned supported self-management, so that patients are confident, informed, and aware in terms of managing their health and navigating the healthcare system.
3. What does cancer-specific self-management currently look like? Which are the most effective components?
Download - Self-Management Support for Cancer Survivors: Developing Interventions. An Update of the Evidence [PDF, 1.25MB]
Main Findings
Supported self-management for cancer survivors has both similar and unique components when compared to long-term conditions. In general, supported self-management for cancer survivors has three levels according to:
- Type (adjustment-focused or problem-focused)
- Delivery (groups; one-to-one; technology-assisted; home visits; professionally-led; peer led; co-tutor approach)
- Techniques (goal setting; action plans; problem solving; stress management; information provision; counselling; coaching; motivational interviewing; peer modelling).
Dfferent types of supported self-management can be provided based on individual.
4. What outcome measures are available for testing supported self-management?
Download - Self-Management Programmes for Cancer Survivors: A Structured Review of Outcome Measures [PDF, 870KB]
Main Findings
It is crucial that outcome measures to test models of supported self-management are psychometrically robust and operationally feasible.
Six areas of outcome include: quality of life; health behaviours; self-efficacy; symptom management; patient-centred communication; and healthcare utilisation. Instruments have been recommended for these outcomes, based on a psychometric evaluation and consideration of project objectives.
The most appropriate outcome measures will depend on project aims and objectives as well as pragmatic factors such as ease of completion.
5. What is the role of lifestyle in self-management in terms of the cancer trajectory and symptom management?
Download - Advising Cancer Survivors about Lifestyle. A Selective Review of the Evidence [PDF, 1.61MB]
There is now persuasive evidence that a healthy lifestyle during and after cancer treatments is associated with improved physical and psychological well being, reduced risks of treatment, enhanced self esteem, reduced risk of recurrence, and improved survival.
Recommendations are made for diet, physical activity, body weight, smoking and alcohol use.
Significant limitations can be found in the evidence available for cancer survivors, including:
- Long term outcomes of lifestyle choices
- Low levels of adherence to interventions
- A paucity of studies addressing external validity
- Equality across tumour groups
- Lack of cultural considerations relating to dietary advice
- A paucity of individualised lifestyle advice and tailored support
Last updated on December 20, 2010