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Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs
“ability to manage the symptoms, treatment, physical and psychosocial consequences and lifestyle changes inherent in living with a chronic condition” (Barlow et al., 2002:178). This term is associated most often with conditions such as diabetes mellitus whose severity and progression can be significantly affected by lifestyle changes. There is now considerable evidence for many (noncancer) chronic diseases that interventions directed at improving patients’ knowledge, skills, and confidence in managing their illness improves outcomes (Chodosh et al., 2005).
One particular illness self-management approach that has an explicitly stated conceptual model and has been empirically validated for a variety of chronic illnesses (e.g., heart disease, lung disease, stroke, and arthritis) is that of Stanford University (Stanford University School of Medicine, 2006). The Stanford model addresses the day-to-day tasks and skills necessary to live successfully with a chronic illness, including behavioral health practices, social and interpersonal role functioning, and emotional management (Lorig and Holman, 2003). These tasks and skills pertain, for example, to monitoring illness symptoms; using medications appropriately; practicing behaviors conducive to good health in such areas as nutrition, sleep, and exercise; employing stress reduction practices and managing negative emotions; using community resources appropriately; communicating effectively with health care providers; and practicing health-related problem solving and decision making. This model has been shown to reduce pain and disability, lessen fatigue, decrease needed visits to physicians and emergency rooms, and increase self-reported energy and health (Bodenheimer et al., 2000; Lorig et al., 2001; Lorig and Holman, 2003). Illness self-management also is one of the essential components of the Chronic Care Model, which can help inform the development of a conceptual framework.
Health-related quality of life Conceptual models developed to describe the variety of effects cancer has on psychological health, functional abilities, family relationships and other social roles, and important aspects of life also underpin numerous instruments designed to measure health-related quality of life (HRQOL). Examples of these instruments include “generic” instruments used to assess problems for any type of illness, such as the Short Form Health Survey (SF) instruments of the Medical Outcomes Study, and instruments used specifically to assess problems occurring in patients with cancer. These latter instruments (developed for research purposes) include, for example, the Cancer Rehabilitation Evaluation System, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Functional Assessment of Cancer Therapy (FACT) instruments, and the Quality of Life Breast Cancer Instrument (IOM and NRC, 2004). However, the committee that authored the IOM report FromCancer Patient to Cancer Survivor: Lost In Transition found no agreed-