Self-management and transitions in women with advanced breast cancer

Context: Self-management involves behaviors that individuals perform to handle health conditions. Self-management may be particularly challenging during transitions - shifts from one life phase or status to another, for example, from cure- to noncure-oriented care - because they can be disruptive and stressful. Little is known about individuals' experiences with self-management, especially during transitions. Objectives: Our purpose was to describe experiences of self-management in the context of transitions among women with advanced breast cancer. Methods: We interviewed a purposive sample of 15 women with metastatic breast cancer about their self-management preferences, practices, and experiences, including how they managed transitions. Interviews were recorded and transcribed. The qualitative method of interpretive description was used to code and analyze the data. Results: Participants' mean age was 52 years (range 37-91 years); most were White (80%), married (80%), and college educated (60%). Self-management practices related to womens' health and to communication with loved ones and providers. Participants expressed a range of preferences for participation in self-management. Self-management included developing skills, becoming empowered, and creating supportive networks. Barriers to self-management included symptom distress, difficulty obtaining information, and lack of knowledge about the cancer trajectory. Women identified transitions as shifts in physical, emotional, and social well-being, as when their cancer progressed and there was a need to change therapy. Transitions often prompted changes in how actively women self-managed and were experienced as positive, negative, and neutral. Conclusion: Self-management preferences can vary. Providers should explore and revisit patients' preferences and ability to self-manage over time, particularly during transitions.