5
Average: 5 (1 vote)
Journal Club
Open Access Article

Health Behaviors in Family Members of Patients Completing Cancer Treatment

Susan R. Mazanec
Susan A. Flocke
Barbara J. Daly
ONF 2015, 42(1), 54-62 DOI: 10.1188/15.ONF.54-62

Purpose/Objectives: To describe the impact of the cancer experience on the health behaviors of survivors' family members and to determine factors associated with family members' intentions for health behavior change.

Design: Descriptive, cross-sectional, correlational.

Setting: A National Cancer Institute-designated comprehensive cancer center in the midwestern United States.

Sample: 39 family members and 50 patients with diagnoses of breast, colorectal, head and neck, lung, or prostate cancer who were completing definitive cancer treatment.

Methods: Patients and family members were approached in the clinic at three weeks or fewer before the completion of their course of treatment. Family members completed surveys and a structured interview in person or via telephone.

Main Research Variables: Intention, perceived benefit, and confidence about eating a healthful diet, physical activity, and smoking cessation; emotional distress; and family cohesion, conflict, and expressiveness.

Findings: Family members had high ratings for intention, perceived benefit, and confidence related to the behaviors of eating a healthful diet and performing 30 minutes of daily moderate-intensity physical activity. They also had high ratings for the extent to which the cancer experience had raised awareness of their cancer risk and made them consider undergoing screening tests for cancer; ratings were lower for making changes in their health behaviors.

Conclusions: Family members expressed strong intentions to engage in health-promoting behaviors related to physical activity and nutrition at the post-treatment transition.

Implications for Nursing: Oncology nurses are in a key position to engage family members and patients in behavior change. Nurses should assess family members at the completion of treatment for distress and provide interventions to influence the trajectory of distress in survivorship.

References 

Beesley, V. L., Price, M. A., & Webb, P. M. (2011). Loss of lifestyle: Health behaviour and weight changes after becoming a caregiver of a family member diagnosed with ovarian cancer. <i>Supportive Care in Cancer, 19</i>, 1949-1956. doi:10.1007/s00520-010-1035-2

Bellizzi, K. M., Rowland, J. H., Jeffery, D. D., & McNeel, T. (2005). Health behaviors of cancer survivors: Examining opportunities for cancer control intervention. <i>Journal of Clinical Oncology, 23</i>, 8884-8893. doi:10.1200/JCO.2005.02.2343

Bowman, K. F., Rose, J. H., & Deimling, G. T. (2005). Families of long-term cancer survivors: Health maintenance advocacy and practice. <i>Psycho-Oncology, 14</i>, 1008-1017. doi:10.1002/pon.911

Carlson, L. E., Waller, A., Groff, S. L., Giese-Davis, J., & Bultz, B. D. (2013). What goes up does not always come down: Patterns of distress, physical and psychosocial morbidity in people with cancer over a one year period. <i>Psycho-Oncology, 22</i>, 168-176. doi:10.1002/pon.2068

Choi, C. W., Stone, R. A., Kim, K. H., Ren, D., Schulz, R., Given, C. W., … Sherwood, P. R. (2012). Group-based trajectory modeling of caregiver psychological distress over time. <i>Annals of Behavioral Medicine, 44</i>, 73-84. doi:10.1007/s12160-012-9371-8

Cox, M. J., & Paley, B. (1997). Families as systems. <i>Annual Review of Psychology, 48</i>, 243-267. doi:10.1146/annurev.psych.48.1.243

Demark-Wahnefried, W., Aziz, N. M., Rowland, J. H., & Pinto, B. M. (2005). Riding the crest of the teachable moment: Promoting long-term health after the diagnosis of cancer. <i>Journal of Clinical Oncology, 23</i>, 5814-5830. doi:10.1200/JCO.2005.01.230

Demark-Wahnefried, W., Peterson, B., McBride, C., Lipkus, I., & Clipp, E. (2000). Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas. <i>Cancer, 88</i>, 674-684.

Falba, T. A., & Sindelar, J. L. (2008). Spousal concordance in health behavior change. <i>Health Services Research, 43</i>, 96-116. doi:10.1111/j.1475-6773.2007.00754.x

Fishbein, M., & Ajzen, I. (2010). <i>Predicting and changing behavior: The reasoned action approach.</i> New York, NY: Psychology Press.

Ganz, P. A. (2005). A teachable moment for oncologists: Cancer survivors, 10 million strong and growing! <i>Journal of Clinical Oncology, 23</i>, 5458-5460. doi:10.1200/JCO.2005.04.916

Gilliam, M. B., Madan-Swain, A., Whelan, K., Tucker, D. C., Demark-Wahnefried, W., & Schwebel, D. C. (2013). Cognitive influences as mediators of family and peer support for pediatric cancer survivors' physical activity. <i>Psycho-Oncology, 22</i>, 1361-1368. doi:10.1002/pon.3140

Hawkins, N. A., Smith, T., Zhao, L., Rodriguez, J., Berkowitz, Z., & Stein, K. D. (2010). Health-related behavior change after cancer: Results of the American Cancer Society's studies of cancer survivors (SCS). <i>Journal of Cancer Survivorship, 4</i>, 20-32. doi:10.1007/s11764-009-0104-3

Humpel, N., Magee, C., & Jones, S. C. (2007). The impact of a cancer diagnosis on the health behaviors of cancer survivors and their family and friends. <i>Supportive Care in Cancer, 15</i>, 621-630. doi:10.1007/s00520-006-0207-6

Jacobsen, P. B., Donovan, K. A., Trask, P. C., Fleishman, S. B., Zabora, J., Baker, F., & Holland, J. C. (2005). Screening for psychologic distress in ambulatory cancer patients. <i>Cancer, 103</i>, 1494-1502. doi:10.1002/cncr.20940

Karam-Hage, M., Cinciripini, P. M., & Gritz, E. R. (2014). Tobacco use and cessation for cancer survivors: An overview for clinicians. <i>CA: A Cancer Journal for Clinicians, 64</i>, 272-290. doi:10.3322/caac.21231

Khan, C. M., Stephens, M. A., Franks, M. M., Rook, K. S., & Salem, J. K. (2013). Influences of spousal support and control on diabetes management through physical activity. <i>Health Psychology, 32</i>, 739-747. doi:10.1037/a0028609

Kim, Y., Carver, C. S., Rocha-Lima, C., & Shaffer, K. M. (2013). Depressive symptoms among caregivers of colorectal cancer patients during the first year since diagnosis: A longitudinal investigation. <i>Psycho-Oncology, 22</i>, 362-367. doi:10.1002/pon.2100

Lauver, D., Connolly-Nelson, K., & Vang, P. (2007). Health-related goals in female cancer survivors after treatment. <i>Cancer Nursing, 30</i>, 9-15. doi:10.1097/00002820-200701000-00002

Lemon, S. C., Zapka, J. G., & Clemow, L. (2004). Health behavior change among women with recent familial diagnosis of breast cancer. <i>Preventive Medicine, 39</i>, 253-262. doi:10.1016/j.ypmed.2004.03.039

Lewis, F. M. (2006). The effects of cancer survivorship on families and caregivers. More research is needed on long-term survivors. <i>American Journal of Nursing, 106</i>, 20-25.

Lewis, M. A., McBride, C. M., Pollak, K. I., Puleo, E., Butterfield, R. M., & Emmons, K. M. (2006). Understanding health behavior change among couples: An interdependence and communal coping approach. <i>Social Science and Medicine, 62</i>, 1369-1380. doi:10.1016/j.socscimed.2005.08.006

Mayer, D. K., Terrin, N. C., Menon, U., Kreps, G. L., McCance, K., Parsons, S. K., & Mooney, K. H. (2007). Health behaviors in cancer survivors. <i>Oncology Nursing Forum, 34</i>, 643-651. doi:10.1188/07.ONF.643-651

Mazanec, S. R., Daly, B. J., Douglas, S. L., & Lipson, A. R. (2011). Work productivity and health of informal caregivers of persons with advanced cancer. <i>Research in Nursing and Health, 34</i>, 483-495. doi:10.1002/nur.20461

McBride, C. M., & Ostroff, J. S. (2003). Teachable moments for promoting smoking cessation: The context of cancer care and survivorship. <i>Cancer Control, 10</i>, 325-333.

McDonald, P. E., & Wykle, M. L. (2003). Predictors of health-promoting behavior of African-American and white caregivers of impaired elders. <i>Journal of the National Black Nurses Association, 14</i>, 1-12.

McKenzie, S. H., & Harris, M. F. (2013). Understanding the relationship between stress, distress and healthful lifestyle behaviour: A qualitative study of patients and general practitioners. <i>BMC Family Practice, 14</i>, 166. doi:10.1186/1471-2296-14-166

Mitchell, A. J. (2007). Pooled results from 38 analyses of the accuracy of Distress Thermometer and other ultra-short methods of detecting cancer-related mood disorders. <i>Journal of Clinical Oncology, 25</i>, 4670-4681. doi:10.1200/JCO.2006.10.0438

Moos, R. H. (1990). Conceptual and empirical approaches to developing family-based assessment procedures: Resolving the case of the Family Environment Scale. <i>Family Process, 29</i>, 199-208.

Moos, R. H., & Moos, B. S. (2009). <i>Family Environment Scale manual and sampler set: Development, applications and research</i> (4th ed.). Menlo Park, CA: Mind Garden, Inc.

Mullens, A. B., McCaul, K. D., Erickson, S. C., & Sandgren, A. K. (2004). Coping after cancer: Risk perceptions, worry, and health behaviors among colorectal cancer survivors. <i>Psycho-Oncology, 13</i>, 367-376. doi:10.1002/pon.751

National Comprehensive Cancer Network. (2013). <i>NCCN Clinical Practice Guidelines in Oncology: Distress management</i> [v.2.2013]. Retrieved from <a target="_blank" href='http://www.nccn.org/professionals/physician_gls/f_guidelines.asp'>http:/...

Northouse, L. (2005). Helping families of patients with cancer. <i>Oncology Nursing Forum, 32</i>, 743-750. doi:10.1188/04.ONF.743-750

Park, C. L., & Gaffey, A. E. (2007). Relationships between psychosocial factors and health behavior change in cancer survivors: An integrative review. <i>Annals of Behavioral Medicine, 34</i>, 115-134. doi:10.1080/08836610701564089

Pekmezi, D. W., & Demark-Wahnefried, W. (2011). Updated evidence in support of diet and exercise interventions in cancer survivors. <i>Acta Oncologica, 50</i>, 167-178. doi:10.3109/0284186X.2010.529822

Phua, J. J. (2013). The reference group perspective for smoking cessation: An examination of the influence of social norms and social identification with reference groups on smoking cessation self-efficacy. <i>Psychology of Addictive Behavior, 27</i>, 102-112. doi:10.1037/a0029130

Pinto, B. M., & Trunzo, J. J. (2005). Health behaviors during and after a cancer diagnosis. <i>Cancer, 104</i>, 2614-2623. doi:10.1002/cncr.21248

Pitceathly, C., & Maguire, P. (2003). The psychological impact of cancer on patients' partners and other key relatives: A review. <i>European Journal of Cancer, 39</i>, 1517-1524. doi:10.1016/S0959-8049(03)00309-5

Ross, A., Sundaramurthi, T., & Bevans, M. (2013). A labor of love: The influence of cancer caregiving on health behaviors. <i>Cancer Nursing, 36</i>, 474-483. doi:10.1097/NCC.0b013e3182747b75

Russ, T. C., Stamatakis, E., Hamer, M., Starr, J. M., Kivimaki, M., & Batty, G. D. (2012). Association between psychological distress and mortality: Individual participant pooled analysis of 10 prospective cohort studies. <i>BMJ, 345</i>, e4933. doi:10.1136/bmj.e4933

Samuel-Hodge, C. D., Gizlice, Z., Cai, J., Brantley, P. J., Ard, J. D., & Svetkey, L. P. (2010). Family functioning and weight loss in a sample of African Americans and whites. <i>Annals of Behavioral Medicine</i>, 40, 294-301. doi:10.1007/s12160-010-9219-z

Son, K. Y., Park, S. M., Lee, C. H., Choi, G. J., Lee, D., Jo, S., … Cho, B. (2011). Behavioral risk factors and use of preventive screening services among spousal caregivers of cancer patients. <i>Supportive Care in Cancer, 19</i>, 919-927. doi:10.1007/s00520-010-0889-7

Spector, D., Deroo, L. A., & Sandler, D. P. (2011). Lifestyle behaviors in black and white women with a family history of breast cancer. <i>Preventive Medicine, 52</i>, 394-397. doi:10.1016/j.ypmed.2011.03.001

Tseng, T. S., Lin, H. Y., Moody-Thomas, S., Martin, M., & Chen, T. (2012). Who tended to continue smoking after cancer diagnosis: The national health and nutrition examination survey 1999-2008. <i>BMC Public Health, 12</i>, 784. doi:10.1186/1471-2458-12-784

U. S. Department of Health and Human Services. (2008). <i>2008 physical activity guidelines for Americans.</i> Retrieved from <a target="_blank" href='http://www.health.gov/paguidelines/pdf/paguide.pdf'>http://www.health.go...

Zabora, J., BrintzenhofeSzoc, K., Curbow, B., Hooker, C., & Piantadosi, S. (2001). The prevalence of psychological distress by cancer site. <i>Psycho-Oncology, 10</i>, 19-28.

Zwahlen, D., Hagenbuch, N., Carley, M. I., Recklitis, C. J., & Buchi, S. (2008). Screening cancer patients' families with the Distress Thermometer (DT): A validation study. <i>Psycho-Oncology, 17</i>, 959-966. doi:10.1002/pon.1320