Are self-management skills associated with depressive symptoms, quality of life, and healthcare utilisation? A cross-sectional survey among patients with advanced cancer in the Netherlands
Evi M. Bakker (Erasmus MC)
Sophie van Dongen (Erasmus MC)
Erica Witkamp (Rotterdam University of Applied Sciences)
Leonieke W. Kranenburg (Erasmus MC)
Carin C.D. van der Rijt (Erasmus MC)
Kate Lorig (Stanford University School of Medicine)
Natasja Raijmakers (Integraal Kankercentrum Nederland (IKNL))
Janneke van Roij (Reinier van Arkel Mental Health Institute)
Judith Rietjens (Erasmus MC, TU Delft - Industrial Design Engineering)
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Abstract
OBJECTIVES: Patients with advanced cancer are increasingly encouraged to self-manage the medical, psychosocial, and practical consequences of their illness. However, the impact of self-management skills on patient outcomes and healthcare utilisation remains unclear. Therefore, we examined self-management skills among patients with advanced cancer and their associations with depressive symptoms, quality of life, and formal and informal healthcare utilisation. DESIGN AND SETTING: We embedded a cross-sectional questionnaire study in a Dutch nationwide prospective observational cohort study (eQuiPe study). PARTICIPANTS: 464 patients with advanced cancer (response rate 42.1%). 50% of the participants were women, and the mean age was 66 years (SD = 10). OUTCOME MEASURES: Self-management skills were assessed using three scales of the Health Education Impact Questionnaire: Skill and technique acquisition (STA), Self-monitoring and insight (SMI), and Health services navigation (HSN) (range: 1-4). Multivariate linear and logistic regression analyses were performed to examine associations (adjusting for sociodemographic and medical characteristics) between self-management skills and depressive symptoms (Hospital Anxiety and Depression Scale), quality of life (European Organisation for Research and Treatment of Cancer), and healthcare utilisation in the past month (healthcare organisations and disciplines; hospital admissions; emergency care visits; informal care). RESULTS: Mean (SD) scores were 3.0 (0.5) for STA, 3.2 (0.4) for SMI, and 3.4 (0.5) for HSN. Higher scores of self-management skills on all three scales were significantly associated with fewer depressive symptoms (STA: β = -2.36, 95% CI -2.98 to -1.69; SMI: β = -2.88, 95% CI -3.64 to -2.09; HSN: β = -2.06, 95% CI -2.76 to -1.37). Patients with higher levels of STA and SMI reported better quality of life (β = 8.54, 95% CI 5.84 to 11.01 and β = 8.41, 95% CI 4.75 to 11.99, respectively). Regarding healthcare utilisation, only HSN showed a significant association, with higher scores being associated with increased nurse contact (β = 1.65, 95% CI 1.09 to 2.56). CONCLUSIONS: Greater self-management skills were associated with fewer depressive symptoms and improved quality of life in patients with advanced cancer. However, self-management skills were hardly associated with healthcare utilisation. TRIAL REGISTRATION NUMBER: Netherlands Trial Register; NTR6584.
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