Abstract P5-09-03: Healthcare Providers’ Support and Lymphedema Risk Reduction
Authors: Fu MR , Guth AA , Axelrod DM. 
Published: April 2011

Abstract
Background: A critical issue influencing the impact of lymphedema on breast cancer survivors was whether breast cancer survivors received information from their health care providers. In early 1990's, 90% of breast cancer survivors denied receiving basic information concerning their risk of developing lymphedema and expressed concerns regarding lack of lymphedema education. Now more than 10 years later, greater than 50% of breast cancer survivors have been provided with lymphedema information. Despite this improvement, breast cancer survivors still feel frustrated by their healthcare providers’ inability to provide information on lymphedema and risk reduction.
Purpose: The purpose of this study was to explore the effects of survivors’ perceived healthcare provider support on lymphedema risk reduction in terms of survivors’ risk-reduction commitment, perceived competence and motivation, cognitive and behavior outcomes.
Materials &
Methods: Data was collected from 133 breast cancer survivors using a Demographic and Medical Information interview instrument, a Scale for Lymphedema Risk Reduction Commitment, Competence, and Motivation, a Scale for Perceived Support from Healthcare Providers, a Knowledge Test for cognitive outcome, and the Lymphedema Risk Reduction Behavior Checklist for behavior outcome. Data analysis included descriptive statistics, multiple linear regression models, and assessment of moderation and mediation. Model fit was evaluated through the R2 for the overall model and incremental change in R2.
Results: While participants reported higher positive caring, understanding, and encouraging patient-provider relationship, perceptions of having necessary information regarding lymphedema and risk reduction were lower. Survivors with higher positive cognitive outcome scored significantly higher in perceived competence (r=0.48; P&lt;0.000), motivation (r=0.21; p=0.02), and reported more risk reduction behaviors being practiced (r=0.29; P&lt;0.000). A model was created and evaluated with final model fit indices suggested a good fit to the sample data (X2[(3, N=133)= 3.94 (p= .268); CFI = .99; RMSEA= .05 (0 to .16); AIC = 29.94; X2(diff)= .181, p = .913). This model substantiates the importance of provider support which is directly associated with participants’ reported commitment, perceived competence and motivation, and with risk-reduction behavior. Behavior outcome was a direct function of cognitive outcome, provider support, and motivation, and indirectly influenced by levels of competence. Discussions: Cognitive outcome was a significant predictor for survivors’ perceived competence, motivation, and behavior outcome. Feeling well supported by healthcare providers did not assist in the gaining or retention of cognitive outcome. Yet, feeling well supported by healthcare providers did increase survivors’ motivation, a significant predictor for behavior outcome.
Clinical Implications: Healthcare providers should be trained and encouraged to increase patients’ perceptions of provider support. In turn, this will help promote competence and motivation, resulting in a positive impact on behavior outcome.
Implementation of a lymphedema risk reduction program to increased patients’ cognitive outcome impacts positively on patients’ perceived competence, motivation and behavior outcome.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-09-03.