Exploring prostate cancer survivors’ self-management behaviours and social supportive experiences using questionnaires and electronic behavioural diaries: :does social support buffer the relationship between coping and health-related quality of life?

摘要

Background: Prostate cancer is now the most common type of cancer in men in the UK. Physical effects of treatments have been well documented; however, the extent to which psycho-social factors may impact upon health-related quality of life (HRQoL) is limited. Little is known about the self-management behaviours of men affected by prostate cancer or how they cope with prostate cancer. Men living with and beyond prostate cancer have reported a lack of support in their pursuit to cope with the physical and psychological sequelae. Social support may help men with self-management, but may also buffer the relationship between coping and HRQoL. Most healthcare research has been conducted between individuals and is limited to aggregate group level effects, and has overlooked the importance of within-person experience and change over time. Any future theoretically driven intervention study should be supported empirically at the level it is intended: “the individual man”. Aim: To assess the mechanism effect between the relationship that links coping and social support to HRQoL in a sample of men affected by prostate cancer using between individuals and within individual methodological approaches. In addition, this thesis aimed to identify the actual self-management behaviours and social supportive experiences of men over the cancer journey, between and within individuals over time.Methods: A quantitative approach consisted of a prospective, longitudinal survey and single-case electronic diary data. Clinical, demographic and survey data were collected at baseline (before treatment) and at 6 months follow-up. A sub-sample of n=12 participants completed an electronic behavioural diary for 1 month. Men completed the electronic behavioural diary in the month following their treatment. The duration, timing and design of the behavioural diary were guided by methodological considerations, service users and clinicians’ comments. Findings: The prospective longitudinal survey identified that baseline perceived social support was the most important social support construct that predicted HRQoL (ß=0.266, p=0.021) and depression (ß=0.243, p=0.029) at 6 months and explained approximately 30% of the variance of the dependent variables. Moderation and mediation effects were not identified from the prospective longitudinal findings. Testing theoretical models “within-individuals” over time demonstrated different results for main, moderating and mediating pathways that linked coping and social support to emotional outcome. Men performed a number of self-management behaviours for urinary, bowel and sexual dysfunction, but often with little relief.Discussion/Relevance: Real time data collection moves far beyond traditional retrospective evaluations, enabling a much clearer understanding of the individual patient experience over time. The results from the series of single-case studies have demonstrated the one size does not fit all. The findings from the prospective longitudinal study and the 11 single-case studies suggest that men may benefit from a supported self-management intervention study tailored to the “individual’s needs” of prostate cancer survivors.