NURSING INTERVENTIONS SELF-HELP RESPONSE TO CANCER

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The purposes of this investigation are: 1) to determine the of efficacy of self-care/self-help promotion and uncertainty management nurse directed interventions for women who have received treatment for breast cancer; and, 2) to describe the person, disease, contextual factors and time as variables that enhance or limit self-care/self-help activities, uncertainty management activities and life quality following breast cancer treatment. The study contains two components: 1) a multivariate experimental analysis of nurse intervention assessment base, effect and durability over time relative to three outcomes; self-care, self-help and life quality. The analyzes allow determination of which nursing interventions, alone or in combination, are effective in promoting self-care/self-help and in managing uncertainty among women who have received treatment for breast cancer; and, 2) analysis of covariance of mediating variables (enabling skill, mastery, challenge or threat appraisal and uncertainty management) and multiple regression/correlation analysis (MRC) for tenting and interpreting the effect of time on the learned process of self-help response to cancer treatment. Analyses include tenting both direct and interactive effects of groups of concomitant variables: Person Conditions, e.g. ethnicity, information seeking styles, etc.; Disease Conditions, e.g. tumor staging, type of treatment, symptom pattern, etc.; Contextual Conditions, e.g. social support, event familiarity, event congruence, trust in the health care provider, etc. The design for the multivariate experimental analyses in a 2 X 2 repeated measures design with two levels in the learning context treatment factor crossed with two levels in the reinforcing factor. The two levels of the learning context are: Self-help class and natural condition. The two levels of reinforcement are: Nurse case manager and natural condition. The measures are taken at baseline, at 6 weeks following completion of the nurse intervention or exposure to natural learning conditions, at 3 months following completion of the intervention, at 6 months and at 9 months. The proposed extension of follow-up measures at 6 months and 9 months in based on recent reported findings of a building of effect following psycho behavioral interventions through at least the sixth month post intervention.