Factors associated with professional healthcare advice seeking in women at risk for developing breast cancer-related lymphedema

Kerry A. Shermana, Christopher J. Kilbya, Elisabeth Elder, Sheila H. Ridner. Patient Education an Counselling 2017

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Factors associated with professional healthcare advice seeking in women at risk for developing breast cancer-related lymphedema

Kerry A. Shermana, Christopher J. Kilbya, Elisabeth Elder, Sheila H. Ridner. Patient Education an Counselling 2017

Objectives: Approximately 6–20% of breast cancer patients undergoing lymph node surgery will develop lymphedema. At-risk individuals are encouraged to seek professional healthcare advice if symptoms arise. This study aimed to identify cognitive and affective factors associated with professional healthcare advice (PHCA) seeking behavior in women with heightened lymphedema risk.

Methods: Women with increased lymphedema risk (N = 462) completed an online survey measuring cognitive and affective responses to lymphedema risk, including the Illness Perception Questionnaire (Revised), and adherence to seeking PHCA.

Results: Overall, 62% of women reported seeking professional healthcare advice if symptoms arose. Logistic regression analysis indicated that adherence to seeking PHCA if lymphedema symptoms arise was associated with greater illness coherence, belief in the efficacy of seeking PHCA, and lymphedema risk-related emotional distress.

Conclusion: Women were more likely to seek PHCA if symptoms arose if they held a coherent understanding of lymphedema and believed in the usefulness of seeking PHCA. For these women, psychological distress associated with lymphedema risk was associated with enhanced adherence to seeking PHCA.

Practice implications: Health professionals should target lymphedema education to ensure at-risk women have a coherent understanding of lymphedema and that they believe in the effectiveness of seeking PHCA to help manage lymphedema symptoms.

Main findings

  • Adherence to a particular protective health behaviour for a chronic illness, such as lymphedema, will be influenced by a number of cognitive and affective factors.
  • Cognitive factors that may influence risk management approaches include the woman’s perceived level of risk for developing breast cancer-related lymphedema, her understanding of lymphedema, and the extent to which it makes “sense” (i.e., illness coherence), her perceived ability to action these recommendations (i.e., self-efficacy), and her beliefs about the effectiveness of the recommendations to manage lymphedema risk (i.e., response efficacy). The woman’s beliefs about her ability to control lymphedema risk, the perceived chronicity and consequences of lymphedema are also important cognitive factors.
  • Moderate levels of health-threat related psychological distress may facilitate health protective actions, whereas very low and high levels of emotional distress may inhibit these actions.
  • Professional healthcare advice seeking increased after education on the importance of a risk management strategy, but dropped off by the 12-month follow-up, suggesting that factors, in addition to knowledge, influence ongoing adherence.
  • This research measured: self-regulatory factors, knowledge, illness coherence, self regulation of negative effect, professional healthcare advice (PHCA) seeking behaviour, physical quality of life and demographics and medical history.
  • This study identifies the importance of three cognitive and affective factors in understanding patient behaviour in relation to lymphedema risk management. The identification of illness coherence as an important factor highlights the need for women to not only be knowledgeable about lymphedema, but to feel as though this understanding makes sense to them. In addition, response efficacy was another important factor, which suggests that women need to believe in the usefulness of seeking PHCA. Finally, emotional representations suggest that women who are more emotionally invested in their risk may be more likely to seek PHCA.
  • The implication from these findings is that an informational intervention targeting illness coherence and response efficacy beliefs regarding lymphedema risk management may be particularly effective in improving PHCA-seeking behavior. Several studies have demonstrated that illness coherence is a modifiable characteristic when in the context of disease risk management.
  • One well-placed resource to implement such messages may be clinic breast care nurses, as these individuals have been previously identified as key influencers in promoting lymphedema risk management behaviours. Healthcare providers working with women at-risk of lymphedema should strive to ensure these women have a coherent understanding of the psychological and physiological risks associated with breast cancer-related lymphedema, as well as confidence in the effectiveness of seeking PHCA to minimise their risk, to maximise their willingness to seek PHCA.