Supportive Care in Cancer

, Volume 25, Issue 4, pp 1323–1355 | Cite as

Self-management education interventions for patients with cancer: a systematic review

  • Doris Howell
  • Tamara Harth
  • Judy BrownEmail author
  • Cathy Bennett
  • Susan Boyko
Review Article



This systematic review was intended to identify the effectiveness and inclusion of essential components of self-management education interventions to support patients with cancer in developing the skills needed for effective self-management of their disease and the acute or immediate, long-term, and late harmful effects of treatments.


Self-management education interventions were included if they were randomized controlled trials (RCTs) containing at least one of the eight core elements outlined by the research team. A systematic search was conducted in Ovid MEDLINE (2005 through April 2015), Embase (2005 to 2015, week 15), the Cochrane Database of Systematic Reviews (Issue 4, April 2015), CINAHL (2005 to 2015) and PsychINFO (2005 to 2015). Keywords searched include ‘self-management patient education’ or ‘patient education’.


Forty-two RCTs examining self-management education interventions for patients with cancer were identified. Heterogeneity of interventions precluded meta-analysis, but narrative qualitative synthesis suggested that self-management education interventions improve symptoms of fatigue, pain, depression, anxiety, emotional distress and quality of life. Results for specific combinations of core elements were inconclusive. Very few studies used the same combinations of core elements, and among those that did, results were conflicting. Thus, conclusions as to the components or elements of self-management education interventions associated with the strength of the effects could not be assessed by this review.


Defining the core components of cancer self-management education and the fundamental elements for inclusion in supporting effective self-management will be critical to ensure consistent and effective provision of self-management support in the cancer system.


Education interventions Cancer patients Systematic review 



We would like to extend our appreciation to the researchers who conducted the studies included in this review and the patients with cancer who participated in them. We would also like to thank the Program in Evidence-Based Care (PEBC) for their support and guidance in conducting this research.

Compliance with ethical standards

Conflict of interest

The authors and members of the expert panel from the Program in Evidence-Based Care, McMaster University, Hamilton, ON, Canada and the Cancer Care Ontario, Patient Education Program, Toronto, ON, Canada reported that they had no conflicts of interest.


The PEBC is a provincial initiative of Cancer Care Ontario supported by the Ontario Ministry of Health and Long-Term Care. All work produced by the PEBC is editorially independent from the Ontario Ministry of Health and Long-Term Care.


  1. 1.
    Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. Globocan 2012, Cancer incidence and mortality worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer. 2014Google Scholar
  2. 2.
    Health Council of Canada Self-management support for Canadians with chronic health conditions: a focus for primary health care Toronto: Health Council of Canada, 2012Google Scholar
  3. 3.
    Davis K, Schoen C, Schoenbaum SC (2000) A 2020 vision for American health care. Arch Intern Med 160(22):3357–3362PubMedGoogle Scholar
  4. 4.
    Henry DH, Viswanathan HN, Elkin EP, Traina S, Wade S, Cella D (2008) Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the US. Support Care Cancer 16(7):791–801PubMedGoogle Scholar
  5. 5.
    Reilly CM, Bruner DW, Mitchell SA, Minasian LM, Basch E, Dueck AC et al (2013) A literature synthesis of symptom prevalence and severity in persons receiving active cancer treatment. Support Care Cancer 21(6):1525–1550PubMedPubMedCentralGoogle Scholar
  6. 6.
    Spoelstra SL, Given BA, Given CW, Grant M, Sikorskii A, You M et al (2013) An intervention to improve adherence and management of symptoms for patients prescribed oral chemotherapy agents: an exploratory study. Cancer Nurs 36(1):18–28PubMedGoogle Scholar
  7. 7.
    Brearley S, Stamataki Z, Addington-Hall J, Foster C, Hodges L, Jarrett N et al (2011) The physical and practical problems experienced by cancer survivors: a rapid review and synthesis of the literature. Eur J Oncol Nurs 15(3):204–212PubMedGoogle Scholar
  8. 8.
    Phillips JL, Currow DC (2010) Cancer as a chronic disease. Collegian 17(2):47–50PubMedGoogle Scholar
  9. 9.
    Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J (2002) Self-management approaches for people with chronic conditions: a review. Patient Educ Couns 48(2):177–187PubMedGoogle Scholar
  10. 10.
    Foster C, Fenlon D (2011) Recovery and self-management support following primary cancer treatment. Br J Cancer 105:S21–SS8PubMedPubMedCentralGoogle Scholar
  11. 11.
    Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Fischl AH et al (2015) Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes Educator 41(4):417–430PubMedGoogle Scholar
  12. 12.
    Redman BK. Patient self-management of chronic disease: the health care provider’s challenge: Jones & Bartlett Learning; 2004.Google Scholar
  13. 13.
    Lorig KR, Holman H (2003) Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med 26(1):1–7PubMedGoogle Scholar
  14. 14.
    Howell D, Bezjak A, Sidani S, Dudgeon D, Husain A, Fernandez G et al (2014) Self-management interventions for breathlessness in adult cancer patients: a systematic review and meta-analysis. Support Care Cancer 1:S218Google Scholar
  15. 15.
    Fenlon D, Foster C (2009) Self-management support: a review of the evidence. University of Southampton, SouthamptonGoogle Scholar
  16. 16.
    Reed E, Corner J, Simmonds P Defining the illness trajectory of metastatic breast cancer. BMJ supportive & palliative care. 2013:bmjspcare-2012-000415.Google Scholar
  17. 17.
    Creer TL, Holroyd KA (2006) Self-management of chronic conditions: the legacy of Sir William Osler. Chronic Illn 2(1):7–14PubMedGoogle Scholar
  18. 18.
    Adams RJ (2010) Improving health outcomes with better patient understanding and education. Risk Management and Healthcare Policy 3:61–72PubMedPubMedCentralGoogle Scholar
  19. 19.
    Gao WJ, Yuan CR (2011) Self-management programme for cancer patients: a literature review. Int Nurs Rev 58(3):288–295PubMedGoogle Scholar
  20. 20.
    Hammer MJ, Ercolano EA, Wright F, Dickson VV, Chyun D, Melkus GD (2015) Self-management for adult patients with cancer: an integrative review. Cancer Nurs 38(2):E10–E26PubMedGoogle Scholar
  21. 21.
    McCorkle R, Ercolano E, Lazenby M, Schulman-Green D, Schilling LS, Lorig K et al (2011) Self-management: enabling and empowering patients living with cancer as a chronic illness. CA Cancer J Clin 61(1):50–62PubMedPubMedCentralGoogle Scholar
  22. 22.
    Adams K, Greiner A, Corrigan J (eds) (2004) 1st Annual Crossing the Quality Chasm Summit: a focus on communities. National Academies Press, Washington D.C.Google Scholar
  23. 23.
    McGowan EL, Prapavessis H, Campbell N, Gray C, Elkayam J (2012) The effect of a multifaceted efficacy intervention on exercise behavior in relatives of colon cancer patients. Int J Behav Med. 19(4):550–562PubMedGoogle Scholar
  24. 24.
    Davies NJ, Batehup L, Thomas R (2011) The role of diet and physical activity in breast, colorectal, and prostate cancer survivorship: a review of the literature. Br J Cancer 105(Suppl 1):S52–S73PubMedPubMedCentralGoogle Scholar
  25. 25.
    Hibbard JH, Stockard J, Mahoney ER, Tusler M (2004) Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res 39(4p1):1005–1026PubMedPubMedCentralGoogle Scholar
  26. 26.
    Barlow JH, Bancroft GV, Turner AP (2005) Self-management training for people with chronic disease: a shared learning experience. J Health Psychol 10(6):863–872PubMedGoogle Scholar
  27. 27.
    Davies NJ, Batehup L. Self-management support for cancer survivors: guidance for developing interventions 2010.Google Scholar
  28. 28.
    Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928PubMedPubMedCentralGoogle Scholar
  29. 29.
    Antoni MH, Lechner S, Diaz A, Vargas S, Holley H, Phillips K et al (2009) Cognitive behavioral stress management effects on psychosocial and physiological adaptation in women undergoing treatment for breast cancer. Brain Behav Immun 23(5):580–591PubMedGoogle Scholar
  30. 30.
    Boesen EH, Ross L, Frederiksen K, Thomsen BL, Dahlstrom K, Schmidt G et al (2005) Psychoeducational intervention for patients with cutaneous malignant melanoma: a replication study. J Clin Oncol 23(6):1270–1277PubMedGoogle Scholar
  31. 31.
    Brown JC, Cheville AL, Tchou JC, Harris SR, Schmitz KH (2014) Prescription and adherence to lymphedema self-care modalities among women with breast cancer-related lymphedema. Support Care Cancer 22(1):135–143PubMedGoogle Scholar
  32. 32.
    Ell K, Xie B, Quon B, Quinn DI, Dwight-Johnson M, Lee PJ (2008) Randomized controlled trial of collaborative care management of depression among low-income patients with cancer. J Clin Oncol 26(27):4488–4496PubMedPubMedCentralGoogle Scholar
  33. 33.
    Koller A, Miaskowski C, De Geest S, Opitz O, Spichiger E (2013) Supporting self-management of pain in cancer patients: methods and lessons learned from a randomized controlled pilot study. Eur J Oncol Nurs 17(1):1–8PubMedGoogle Scholar
  34. 34.
    Korstjens I, May AM, van Weert E, Mesters I, Tan F, Ros WJ et al (2008) Quality of life after self-management cancer rehabilitation: a randomized controlled trial comparing physical and cognitive-behavioral training versus physical training. Psychosom Med 70(4):422–429PubMedGoogle Scholar
  35. 35.
    Kravitz RL, Tancredi DJ, Grennan T, Kalauokalani D, Street RL Jr, Slee CK et al (2011) Cancer health empowerment for living without pain (Ca-HELP): effects of a tailored education and coaching intervention on pain and impairment. Pain 152(7):1572–1582PubMedGoogle Scholar
  36. 36.
    Mishel MH, Germino BB, Gil KM, Belyea M, Laney IC, Stewart J et al (2005) Benefits from an uncertainty management intervention for African-American and Caucasian older long-term breast cancer survivors. Psychooncology 14(11):962–978PubMedGoogle Scholar
  37. 37.
    Phillips KM, Antoni MH, Lechner SC, Blomberg BB, Llabre MM, Avisar E et al (2008) Stress management intervention reduces serum cortisol and increases relaxation during treatment for nonmetastatic breast cancer. Psychosom Med 70(9):1044–1049PubMedPubMedCentralGoogle Scholar
  38. 38.
    Rustoen T, Valeberg BT, Kolstad E, Wist E, Paul S, Miaskowski C (2012) The PRO-SELF(©) Pain Control Program improves patients’ knowledge of cancer pain management. J Pain Symptom Manag 44(3):321–330Google Scholar
  39. 39.
    Sikorskii A, Given CW, Siddiqi AE, Champion V, McCorkle R, Spoelstra SL et al (2015) Testing the differential effects of symptom management interventions in cancer. Psychooncology 24(1):25–32PubMedGoogle Scholar
  40. 40.
    Stagl JM, Bouchard LC, Lechner SC, Blomberg BB, Gudenkauf LM, Jutagir DR et al (2015) Long-term psychological benefits of cognitive-behavioral stress management for women with breast cancer: 11-year follow-up of a randomized controlled trial. Cancer 121(11):1873–1881PubMedPubMedCentralGoogle Scholar
  41. 41.
    Vargas S, Antoni MH, Carver CS, Lechner SC, Wohlgemuth W, Llabre M et al (2014) Sleep quality and fatigue after a stress management intervention for women with early-stage breast cancer in southern Florida. Int J Behav Med. 21(6):971–981PubMedPubMedCentralGoogle Scholar
  42. 42.
    Ames SC, Tan WW, Ames GE, Stone RL, Rizzo TD, Crook JE et al (2011) A pilot investigation of a multidisciplinary quality of life intervention for men with biochemical recurrence of prostate cancer. Psycho-Oncology 20(4):435–440PubMedGoogle Scholar
  43. 43.
    Antoni MH, Wimberly SR, Lechner SC, Kazi A, Sifre T, Urcuyo KR et al (2006) Reduction of cancer-specific thought intrusions and anxiety symptoms with a stress management intervention among women undergoing treatment for breast cancer. Am J Psychiatry 163(10):1791–1797PubMedPubMedCentralGoogle Scholar
  44. 44.
    Aranda S, Jefford M, Yates P, Gough K, Seymour J, Francis P et al (2012) Impact of a novel nurse-led prechemotherapy education intervention (ChemoEd) on patient distress, symptom burden, and treatment-related information and support needs: results from a randomised, controlled trial. Ann Oncol 23(1):222–231PubMedGoogle Scholar
  45. 45.
    Armes J, Chalder T, Addington-Hall J, Richardson A, Hotopf M (2007) A randomized controlled trial to evaluate the effectiveness of a brief, behaviorally oriented intervention for cancer-related fatigue. Cancer 110(6):1385–1395PubMedGoogle Scholar
  46. 46.
    Boesen EH, Boesen SH, Frederiksen K, Ross L, Dahlstrom K, Schmidt G et al (2007) Survival after a psychoeducational intervention for patients with cutaneous malignant melanoma: a replication study. J Clin Oncol 25(36):5698–5703PubMedGoogle Scholar
  47. 47.
    Boesen EH, Karlsen R, Christensen J, Paaschburg B, Nielsen D, Bloch IS et al (2011) Psychosocial group intervention for patients with primary breast cancer: a randomised trial. Eur J Cancer 47(9):1363–1372PubMedGoogle Scholar
  48. 48.
    Borosund E, Cvancarova M, Moore SM, Ekstedt M, Ruland CM (2014) Comparing effects in regular practice of e-communication and Web-based self-management support among breast cancer patients: preliminary results from a randomized controlled trial. J Med Internet Res 16(12):e295PubMedPubMedCentralGoogle Scholar
  49. 49.
    Chan CW, Richardson A, Richardson J (2011) Managing symptoms in patients with advanced lung cancer during radiotherapy: results of a psychoeducational randomized controlled trial. J Pain Symptom Manag 41(2):347–357Google Scholar
  50. 50.
    Crawford D, Texter T, Hurt K, VanAelst R, Glaza L, Vander Laan KJ (2012) Traditional nurse instruction versus 2 session nurse instruction plus DVD for teaching ostomy care: a multisite randomized controlled trial. J Wound Ostomy Continence Nurs 39(5):529–537PubMedGoogle Scholar
  51. 51.
    Dodd MJ, Cho MH, Miaskowski C, Painter PL, Paul SM, Cooper BA et al (2010) A randomized controlled trial of home-based exercise for cancer-related fatigue in women during and after chemotherapy with or without radiation therapy. Cancer Nurs 33(4):245–257PubMedPubMedCentralGoogle Scholar
  52. 52.
    Dolbeault S, Cayrou S, Bredart A, Viala AL, Desclaux B, Saltel P et al (2009) The effectiveness of a psycho-educational group after early-stage breast cancer treatment: results of a randomized French study. Psychooncology 18(6):647–656PubMedGoogle Scholar
  53. 53.
    Doorenbos A, Given B, Given C, Verbitsky N, Cimprich B, McCorkle R (2005) Reducing symptom limitations: a cognitive behavioral intervention randomized trial. Psychooncology 14(7):574–584PubMedPubMedCentralGoogle Scholar
  54. 54.
    Ell K, Xie B, Kapetanovic S, Quinn DI, Lee PJ, Wells A et al (2011) One-year follow-up of collaborative depression care for low-income, predominantly Hispanic patients with cancer. Psychiatr Serv 62(2):162–170PubMedGoogle Scholar
  55. 55.
    Gaston-Johansson F, Fall-Dickson JM, Nanda JP, Sarenmalm EK, Browall M, Goldstein N (2013) Long-term effect of the self-management comprehensive coping strategy program on quality of life in patients with breast cancer treated with high-dose chemotherapy. Psychooncology 22(3):530–539PubMedGoogle Scholar
  56. 56.
    Gil KM, Mishel MH, Belyea M, Germino B, Porter LS, Clayton M (2006) Benefits of the uncertainty management intervention for African American and White older breast cancer survivors: 20-month outcomes. Int J Behav Med 13(4):286–294PubMedGoogle Scholar
  57. 57.
    Howell D, Bezjak A, Sidani S, Dudgeon D, Mayo S, Bourbeau J, et al. Abstracts of the 2014 International MASCC/ISOO Symposium, June 26–28, 2014, Miami, Florida. Support Care Cancer. 2014;22 Suppl 1:1–238Google Scholar
  58. 58.
    Jacobsen PB, Phillips KM, Jim HS, Small BJ, Faul LA, Meade CD et al (2013) Effects of self-directed stress management training and home-based exercise on quality of life in cancer patients receiving chemotherapy: a randomized controlled trial. Psychooncology 22(6):1229–1235PubMedGoogle Scholar
  59. 59.
    Jahn P, Kuss O, Schmidt H, Bauer A, Kitzmantel M, Jordan K et al (2014) Improvement of pain-related self-management for cancer patients through a modular transitional nursing intervention: a cluster-randomized multicenter trial. Pain 155(4):746–754PubMedGoogle Scholar
  60. 60.
    Jahn P, Renz P, Stukenkemper J, Book K, Kuss O, Jordan K et al (2009) Reduction of chemotherapy-induced anorexia, nausea, and emesis through a structured nursing intervention: a cluster-randomized multicenter trial. Support Care Cancer 17(12):1543–1552PubMedGoogle Scholar
  61. 61.
    Koller A, Miaskowski C, De Geest S, Opitz O, Spichiger E (2013) Results of a randomized controlled pilot study of a self-management intervention for cancer pain. Eur J Oncol Nurs 17(3):284–291PubMedGoogle Scholar
  62. 62.
    Korstjens I, Mesters I, May AM, van Weert E, van den Hout JH, Ros W et al (2011) Effects of cancer rehabilitation on problem-solving, anxiety and depression: a RCT comparing physical and cognitive-behavioural training versus physical training. Psychol Health 26(Suppl 1):63–82PubMedGoogle Scholar
  63. 63.
    Kravitz RL, Tancredi DJ, Jerant A, Saito N, Street RL, Grennan T et al (2012) Influence of patient coaching on analgesic treatment adjustment: secondary analysis of a randomized controlled trial. J Pain Symptom Manag 43(5):874–884Google Scholar
  64. 64.
    Krischer MM, Xu P, Meade CD, Jacobsen PB (2007) Self-administered stress management training in patients undergoing radiotherapy. J Clin Oncol 25(29):4657–4662PubMedGoogle Scholar
  65. 65.
    Kurtz ME, Kurtz JC, Given CW, Given B (2006) Effects of a symptom control intervention on utilization of health care services among cancer patients. Med Sci Monit 12(7):CR319–CR324PubMedGoogle Scholar
  66. 66.
    Lee MK, Yun YH, Park HA, Lee ES, Jung KH, Noh DY (2014) A Web-based self-management exercise and diet intervention for breast cancer survivors: pilot randomized controlled trial. Int J Nurs Stud 51(12):1557–1567PubMedGoogle Scholar
  67. 67.
    Loprinzi CE, Prasad K, Schroeder DR, Sood A (2011) Stress Management and Resilience Training (SMART) program to decrease stress and enhance resilience among breast cancer survivors: a pilot randomized clinical trial. Clin Breast Cancer 11(6):364–368PubMedGoogle Scholar
  68. 68.
    McCorkle R, Dowd M, Ercolano E, Schulman-Green D, Williams AL, Siefert ML et al (2009) Effects of a nursing intervention on quality of life outcomes in post-surgical women with gynecological cancers. Psychooncology 18(1):62–70PubMedPubMedCentralGoogle Scholar
  69. 69.
    Penedo FJ, Molton I, Dahn JR, Shen BJ, Kinsinger D, Traeger L et al (2006) A randomized clinical trial of group-based cognitive-behavioral stress management in localized prostate cancer: development of stress management skills improves quality of life and benefit finding. Ann Behav Med 31(3):261–270PubMedGoogle Scholar
  70. 70.
    Ream E, Richardson A, Alexander-Dann C (2006) Supportive intervention for fatigue in patients undergoing chemotherapy: a randomized controlled trial. J Pain Symptom Manag 31(2):148–161Google Scholar
  71. 71.
    Risendal BC, Dwyer A, Seidel RW, Lorig K, Coombs L, Ory MG (2014) Meeting the challenge of cancer survivorship in public health: results from the evaluation of the chronic disease self-management program for cancer survivors. Front Public Health 2:214PubMedGoogle Scholar
  72. 72.
    Rissanen R, Nordin K, Ahlgren J, Arving C. A stepped care stress management intervention on cancer-related traumatic stress symptoms among breast cancer patients—a randomized study in group versus individual setting. Psychooncology. 2015.Google Scholar
  73. 73.
    Rustoen T, Valeberg BT, Kolstad E, Wist E, Paul S, Miaskowski C (2014) A randomized clinical trial of the efficacy of a self-care intervention to improve cancer pain management. Cancer Nurs 37(1):34–43PubMedGoogle Scholar
  74. 74.
    Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R, Lewis-Grant L et al (2009) Weight lifting in women with breast-cancer-related lymphedema. N Engl J Med 361(7):664–673PubMedPubMedCentralGoogle Scholar
  75. 75.
    Schou Bredal I, Karesen R, Smeby NA, Espe R, Sorensen EM, Amundsen M et al (2014) Effects of a psychoeducational versus a support group intervention in patients with early-stage breast cancer: results of a randomized controlled trial. Cancer Nurs 37(3):198–207PubMedGoogle Scholar
  76. 76.
    Sherwood P, Given BA, Given CW, Champion VL, Doorenbos AZ, Azzouz F et al (2005) A cognitive behavioral intervention for symptom management in patients with advanced cancer. Oncol Nurs Forum 32(6):1190–1198PubMedPubMedCentralGoogle Scholar
  77. 77.
    Sikorskii A, Given CW, Given B, Jeon S, Decker V, Decker D et al (2007) Symptom management for cancer patients: a trial comparing two multimodal interventions. J Pain Symptom Manag 34(3):253–264Google Scholar
  78. 78.
    Stanton AL, Ganz PA, Kwan L, Meyerowitz BE, Bower JE, Krupnick JL et al (2005) Outcomes from the Moving Beyond Cancer psychoeducational, randomized, controlled trial with breast cancer patients. J Clin Oncol 23(25):6009–6018PubMedGoogle Scholar
  79. 79.
    Strong V, Waters R, Hibberd C, Murray G, Wall L, Walker J et al (2008) Management of depression for people with cancer (SMaRT oncology 1): a randomised trial. Lancet 372(9632):40–48PubMedGoogle Scholar
  80. 80.
    van Waart H, Stuiver MM, van Harten WH, Geleijn E, Kieffer JM, Buffart LM et al (2015) Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: results of the PACES randomized clinical trial. J Clin Oncol 33(17):1918–1927PubMedGoogle Scholar
  81. 81.
    Wang YJ, Boehmke M, Wu YW, Dickerson SS, Fisher N (2011) Effects of a 6-week walking program on Taiwanese women newly diagnosed with early-stage breast cancer. Cancer Nurs 34(2):E1–13PubMedGoogle Scholar
  82. 82.
    Yates P, Aranda S, Hargraves M, Mirolo B, Clavarino A, McLachlan S et al (2005) Randomized controlled trial of an educational intervention for managing fatigue in women receiving adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol 23(25):6027–6036PubMedGoogle Scholar
  83. 83.
    Zhang M, Chan SW, You L, Wen Y, Peng L, Liu W et al (2014) The effectiveness of a self-efficacy-enhancing intervention for Chinese patients with colorectal cancer: a randomized controlled trial with 6-month follow up. Int J Nurs Stud 51(8):1083–1092PubMedGoogle Scholar
  84. 84.
    Ream E, Gargaro G, Barsevick A, Richardson A (2015) Management of cancer-related fatigue during chemotherapy through telephone motivational interviewing: modeling and randomized exploratory trial. Patient Educ Couns 98(2):199–206PubMedGoogle Scholar
  85. 85.
    Hibbard JH, Mahoney ER, Stock R, Tusler M (2007) Do increases in patient activation result in improved self-management behaviors? Health Serv Res 42(4):1443–1463PubMedPubMedCentralGoogle Scholar
  86. 86.
    Warsi A, Wang PS, LaValley MP, Avorn J, Solomon DH (2004) Self-management education programs in chronic disease: a systematic review and methodological critique of the literature. Arch Intern Med 164(15):1641–1649PubMedGoogle Scholar
  87. 87.
    Howell DM, Bezjak A, Sidani S, Dudgeon D, Husain A, Fernandes G, et al. Self management interventions for breathlessness in adult cancer patients. The Cochrane Library. 2012.Google Scholar
  88. 88.
    Corner J (2008) Addressing the needs of cancer survivors: issues and challenges. Expert Rev Pharmacoecon Outcomes Res 8(5):443–451PubMedGoogle Scholar
  89. 89.
    Schwarzer R (2001) Social-cognitive factors in changing health-related behaviors. Curr Dir Psychol Sci 10(2):47–51Google Scholar
  90. 90.
    Taylor D, Bury M (2007) Chronic illness, expert patients and care transition. Sociol Health Illn 29(1):27–45PubMedGoogle Scholar
  91. 91.
    Kennedy A, Reeves D, Bower P, Lee V, Middleton E, Richardson G et al (2007) The effectiveness and cost effectiveness of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomised controlled trial. J Epidemiol Community Health 61(3):254–261PubMedPubMedCentralGoogle Scholar

Copyright information

© Crown Copyright  2017

Authors and Affiliations

  1. 1.University Health Network, Princess Margaret Cancer Center and Lawrence S. Bloomberg Faculty of NursingUniversity of TorontoTorontoCanada
  2. 2.Provincial Head Patient EducationCancer Care OntarioTorontoCanada
  3. 3.Program in Evidence-Based CareMcMaster UniversityHamiltonCanada
  4. 4.Hamilton Health SciencesJuravinski Cancer CentreHamiltonCanada
  5. 5.Northeast Cancer CentreSudburyCanada

Personalised recommendations