Counseling women with breast cancer using principles developed by Albert Bandura.

PROBLEM. Although researchers suggest treatments that provide patients with an active coping strategy may increase patients' sense of self-efficacy, previous studies have not measured patients' self-efficacy. METHODS. Eighteen women receiving chemotherapy for breast cancer were randomized to efficacy-enhancing experimental (n = 10) and usual-care control (n = 8) groups. The experimental group received five interventions delivered monthly. Variables--quality of life, symptom distress, and self-care self-efficacy--were measured at baseline and at 4 and 8 months later. FINDINGS. At 4 and 8 months the interaction effects for the Functional Assessment of Cancer Treatment-Breast, used to measure quality of life, ranged from small for functional concerns to large for social concerns. Interaction effects for symptom distress, measured by the Symptom Distress Scale, were large. Interaction effects for self-care self-efficacy ranged from small for Enjoying Life and Stress Reduction, medium for Stress Reduction, and large for Making Decisions. CONCLUSIONS. Interventions to promote self-efficacy may increase quality of life and decrease distress for women diagnosed with breast cancer. Key words: Communication, counseling, psychosocial oncology, self-care, self-efficacy Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer deaths among women in the United States. An estimated 175,000 new cases of breast cancer, approximately 109 cases per 100,000 women, were expected to have occurred in the United States during 1999 (American Cancer Society, 2000). Although clinicians identify distress in cancer patients, they may not offer treatment because they see the distress as being a "normal" reaction to cancer diagnosis and treatment (Walker & Eremin, 1996). Cancer patients who receive psychosocial interventions experience increased quality of life and psychological adjustment and decreased symptoms (Whatley & Milne, 1998). A recent study (Jacobson, Workman, & Kronenberg, 1999) revealed that one cancer patient in three uses some form of self-care strategy, often referred to as complementary or alternative medicine, to help him or her cope with the illness. The purpose of this paper is to report findings from a study that used a theory-based counseling intervention with breast cancer patients. The intervention was based on Bandura's (1997) principles of therapy. Counseling, carried out by students in a program of nursing, was congruent with the ANA's (1994) definition of basic interventions and included interviewing and communication techniques, problem solving, stress management, and behavior modifications. In contrast, psychotherapy, as employed by certified specialists in psychiatric mental health nursing, includes a wider range of therapeutic techniques designed to maintain or improve clients' mental health or regain previous health status and functional ability (ANA). Bandura's Theory of Self-Efficacy Albert Bandura's (1997) social learning theory emphasizes interactions among humans as the major source of information about ourselves and the physical world. Bandura suggested a model of human nature as the interaction with one's environment, behavior, and cognitive and other personal factors. His contention was that the environment, the person, and the person's behavior and beliefs all interact to produce subsequent behavior. Bandura's focus was on the importance of cognitive processes in understanding and changing behavior. One group of studies for which Bandura is well-known involves research studies based on observational learning or "modeling" (Bandura, 1997; Bandura, Reese, & Adams, 1982). Behaviorists long maintained that rewards were needed to influence behavior change. Bandura discovered, however, that children who found another person's behavior interesting changed their behavior based on their observations of another person, or model, even though no rewards were given. …