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The Effects of Fatigue and Distress on Self-efficacy among Breast Cancer Survivors
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Korean J Adult Nurs : Korean Journal of Adult Nursing

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Original Article

The Effects of Fatigue and Distress on Self-efficacy among Breast Cancer Survivors

Mi Hye Seo, MSN, RN1, Kyung Hee Lim, Ph.D. RN2
Korean Journal of Adult Nursing 2016;28(4):378-387.
Published online: August 31, 2016

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Corresponding author: Lim, Kyung Hee College of Nursing, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea. Tel: +82-53-580-3909, Fax: +82-53-580-3904, E-mail: khlim7@kmu.ac.kr
• Received: April 27, 2016   • Accepted: August 24, 2016

Copyright © 2016 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this study was to describe the impact of fatigue and distress on self-efficacy among breast cancer survivors and to provide a base for development of nursing intervention strategy to improve self-efficacy.
  • Methods
    A descriptive research design was used. The subjects were 158 patients who were either being treated or were receiving follow-up care at a university breast center in D City from May 30 to August 30, 2014. Structured questionnaires, Revised Piper Fatigue Scale, Distress Thermometer, and Self-Efficacy Scale for Self-Management of Breast Cancer were used to measure fatigue, distress, and self-efficacy. Data were analyzed using t-test, ANOVA, Pearson's correlation coefficients, and multiple regressions.
  • Results
    The mean scores of fatigue, distress, and self-efficacy were 3.83, 4.31, and 3.77, respectively. There were significant differences among participants in terms of educational background, current treatment methods, perceived health status, economic burden for fatigue and perceived health status for distress. Self-efficacy was impacted by age, educational background, marital status, average monthly income, perceived health status, and medical expenses. Fatigue, age, and the burden on medical expense had the most impact on self-efficacy, accounting for 17% of the variance.
  • Conclusion
    Fatigue should be managed to improve self-efficacy of breast cancer survivors. Therefore, nursing programs designed to decrease fatigue may be helpful.
  • Key Words: Fatigue; Distress; Self-efficacy; Breast neoplasm
Table 1.
General and Clinical Characteristics of Participants (N=158)
Characteristics Categories n (%) or M±SD
Age (year)   49.8±9.4
≤40 22 (13.9)
41~50 64 (40.5)
51~60 55 (34.8)
≥61 17 (10.8)
Educational level ≤Junior high school 32 (20.3)
≥High school 126 (79.7)
Residence area Metropolitan city 105 (66.5)
Small and medium-sized 31 (19.6)
cities  
Town 22 (13.9)
Marital status Unmarried 15 (9.5)
Married 129 (81.6)
Divorce, separate, bereave 14 (8.9)
Occupation Homemaker 100 (63.3)
Self-employed 11 (7.0)
Specialized job, office job 26 (16.5)
Salaried worker 9 (5.7)
Other 12 (7.5)
Religion Yes 115 (72.8)
No 43 (27.2)
Monthly household income (10,000 won) ＜100 19 (12.0)
100~199 31 (19.6)
200~299 41 (25.9)
≥300 67 (42.5)
Time since diagnosis was made (month)   13.11±5.80
6~12 73 (46.2)
13~18 51 (32.3)
19~24 34 (21.5)
Current treatment modality Chemotherapy radiation 27 (17.1)
therapy  
Others, follow up 131 (82.9)
Perceived health condition Good 126 (79.7)
Not good 32 (20.3)
Medical expense payer Own 66 (41.8)
Spouse 76 (48.1)
Others 16 (10.1)
Economic burden High 52 (32.9)
Moderate 76 (48.1)
Low 30 (19.0)
Cancer pain level Mild 142 (89.9)
Severe 16 (10.1)

CRT=chemotherapy radiation therapy

Table 2.
Degree of Fatigue, Distress, and Self-efficacy (N=158)
Variables M±SD
Total fatigue score 3.83±2.11
   Behavioral severity 3.89±2.23
   Affective meaning 3.75±2.34
   Sensory 3.89±2.52
   Cognition/mood 3.78±2.29
Distress score 4.31±2.32
Total self-efficacy score 3.77±0.53
   Coping with psycho-informational demand d 3.96±0.71
   Management of side effects 3.44±0.72
   Maintenance of healthy lifestyle 3.79±0.67
   Therapeutic compliance 4.59±0.53
   Sexual life 3.12±1.15
Table 3.
Differences in Fatigue, Distress, and Self-efficacy by Participants' Characteristics (N=158)
Characteristics Categories Fatigue Distress Self-efficacy
M±SD t or F (p) M±SD t or F (p) M±SD t or F (p)
Age (year) ≤40a 3.81±1.90 1.75 4.55±1.99 0.70 3.96±0.44 4.56
41~50b 3.45±2.01 (.160) 4.05±2.35 (.556) 3.88±0.52 (.004)
51~60c 4.32±2.30   4.60±2.39   3.60±0.55 a, b＞c†
≥61d 3.68±1.88   4.06±2.44   3.64±0.43  
Educational level ≤Junior high school 4.57±2.04 2.26 4.50±2.30 0.52 3.56±0.55 -2.60
≥High school 3.64±2.09 (.025) 4.26±2.34 (.606) 3.82±0.51 (.010)
Residence area Metropolitan city 3.70±1.98 .81 4.42±2.37 0.52 3.82±0.54 1.95
Small & medium-sized city 3.89±2.55 (.449) 3.94±2.08 (.598) 3.73±0.54 (.146)
Countryside 4.33±2.05   4.32±2.46   3.58±0.42  
Marital status Singlea 4.13±2.50 2.24 4.47±2.50 0.52 3.77±0.34 3.64
Marriedb 3.68±1.99 (.110) 4.36±2.34 (.597) 3.81±0.55 (.028)
Divorce, separate, bereavec 4.87±2.51   3.71±2.02   3.41±0.33 b＞c†
Occupation Housewife 4.03±2.12 1.71 4.25±2.36 0.92 3.75±0.57 0.35
Self-employed 3.10±2.12 (.151) 4.82±2.75 (.454) 3.72±0.41 (.841)
Professionals 3.31±1.97   4.23±1.99   3.87±0.44  
Service 4.80±2.11   5.44±2.55   3.67±0.51  
Other 3.23±2.02   3.67±2.15   3.79±0.45  
Religion Yes 4.30±2.35 0.05 4.30±2.35 0.05 3.76±0.53 0.17
No 4.33±2.28 (.959) 4.33±2.28 (.959) 3.78±0.53 (.866)
Monthly household income (10,000 won) ＜100a 4.15±2.42 2.09 4.21±2.39 2.57 3.47±0.37 4.18
100~199b 4.52±1.74 (.104) 5.26±2.05 (.056) 3.66±0.36 (.007)
200~299c 3.79±2.09   4.34±2.45   3.77±0.57 a＜d†
≥300d 3.43±2.13   3.88±2.27   3.90±0.57  
Time since diagnosis was made (month) 6~12 4.10±2.09 1.16 4.55±2.24 0.90 3.74±0.56 0.18
13~18 3.65±2.17 (.316) 3.98±2.42 (.411) 3.79±0.59 (.832)
19~24 3.51±2.04   4.29±2.36   3.79±0.33  
Current treatment modality Chemotherapy radiation 4.63±1.73 2.19 4.41±2.15 0.24 3.64±0.53 -1.35
therapy   (.030)   (.812)   (.179)
Others, follow up 3.66±0.53   4.29±2.36   3.79±0.53  
Perceived health condition Good 4.00±2.24 -3.44 4.00±2.24 -3.44 3.83±0.53 3.20
Not good 5.53±2.29 (.001) 5.53±2.29 (.001) 3.51±0.45 (.002)
Medical expense payer Owna 4.21±2.28 2.33 4.53±2.17 0.81 3.74±0.49 3.81
Spouseb 3.46±1.95 (.100) 4.07±2.37 (.447) 3.85±0.56 (.024)
Othersc 3.99±1.87   4.56±2.73   3.47±0.38 b＞c†
Economic burden Higha 4.32±2.19 3.16 4.60±2.44 1.43 3.63±0.55 2.97
Moderateb 3.41±1.91 (.045) 3.99±2.13 (.243) 3.86±0.53 (.054)
Lowc 4.02±2.30 a＞b† 4.63±2.55   3.77±0.43  
Cancer pain level Mild 4.19±2.28 -1.31 4.19±2.28 -1.80 3.79±0.52 1.69
Severe 5.22±2.49 (.192) 5.38±2.53 (.090) 3.56±0.55 (.092)

†Scheffé test.

Table 4.
Correlation among Fatigue, Distress, and Self efficacy (N=158
Variables Fatigue Distress Self-efficacy
r (p) r (p) r (p)
Fatigue 1    
Distress .56 (＜.001) 1  
Self-efficacy -.33 (＜.001) -.28 (＜.001) 1
Table 5.
Influencing Factors on Self-efficacy of the Breast Cancer Survivors (N=158)
Step Variables Adjusted R2 F p B SE β t p
Step 1 Fatigue .11 19.60 ＜.001 -.08 .02 -.33 -4.43 ＜.001
Step 2 Fatigue .15 15.15 ＜.001 -.08 .02 -.33 -4.43 ＜.001
  Age       -.01 .01 -.23 -3.10 .002
Step 3 Fatigue .17 12.00 ＜.001 -.08 .02 -.32 -4.37 ＜.001
  Age       -.01 .01 -.20 -2.76 .006
  One million won†       -.26 .12 -.16 -2.20 .028

†Monthly household income.

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    The Effects of Fatigue and Distress on Self-efficacy among Breast Cancer Survivors
    Korean J Adult Nurs. 2016;28(4):378-387.   Published online August 31, 2016
    DOI: https://doi.org/10.7475/kjan.2016.28.4.378
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    The Effects of Fatigue and Distress on Self-efficacy among Breast Cancer Survivors
    Korean J Adult Nurs. 2016;28(4):378-387.   Published online August 31, 2016
    DOI: https://doi.org/10.7475/kjan.2016.28.4.378
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    The Effects of Fatigue and Distress on Self-efficacy among Breast Cancer Survivors
    The Effects of Fatigue and Distress on Self-efficacy among Breast Cancer Survivors

    General and Clinical Characteristics of Participants (N=158)

    Characteristics Categories n (%) or M±SD
    Age (year)   49.8±9.4
    ≤40 22 (13.9)
    41~50 64 (40.5)
    51~60 55 (34.8)
    ≥61 17 (10.8)
    Educational level ≤Junior high school 32 (20.3)
    ≥High school 126 (79.7)
    Residence area Metropolitan city 105 (66.5)
    Small and medium-sized 31 (19.6)
    cities  
    Town 22 (13.9)
    Marital status Unmarried 15 (9.5)
    Married 129 (81.6)
    Divorce, separate, bereave 14 (8.9)
    Occupation Homemaker 100 (63.3)
    Self-employed 11 (7.0)
    Specialized job, office job 26 (16.5)
    Salaried worker 9 (5.7)
    Other 12 (7.5)
    Religion Yes 115 (72.8)
    No 43 (27.2)
    Monthly household income (10,000 won) ＜100 19 (12.0)
    100~199 31 (19.6)
    200~299 41 (25.9)
    ≥300 67 (42.5)
    Time since diagnosis was made (month)   13.11±5.80
    6~12 73 (46.2)
    13~18 51 (32.3)
    19~24 34 (21.5)
    Current treatment modality Chemotherapy radiation 27 (17.1)
    therapy  
    Others, follow up 131 (82.9)
    Perceived health condition Good 126 (79.7)
    Not good 32 (20.3)
    Medical expense payer Own 66 (41.8)
    Spouse 76 (48.1)
    Others 16 (10.1)
    Economic burden High 52 (32.9)
    Moderate 76 (48.1)
    Low 30 (19.0)
    Cancer pain level Mild 142 (89.9)
    Severe 16 (10.1)

    CRT=chemotherapy radiation therapy

    Degree of Fatigue, Distress, and Self-efficacy (N=158)

    Variables M±SD
    Total fatigue score 3.83±2.11
       Behavioral severity 3.89±2.23
       Affective meaning 3.75±2.34
       Sensory 3.89±2.52
       Cognition/mood 3.78±2.29
    Distress score 4.31±2.32
    Total self-efficacy score 3.77±0.53
       Coping with psycho-informational demand d 3.96±0.71
       Management of side effects 3.44±0.72
       Maintenance of healthy lifestyle 3.79±0.67
       Therapeutic compliance 4.59±0.53
       Sexual life 3.12±1.15

    Differences in Fatigue, Distress, and Self-efficacy by Participants' Characteristics (N=158)

    Characteristics Categories Fatigue Distress Self-efficacy
    M±SD t or F (p) M±SD t or F (p) M±SD t or F (p)
    Age (year) ≤40a 3.81±1.90 1.75 4.55±1.99 0.70 3.96±0.44 4.56
    41~50b 3.45±2.01 (.160) 4.05±2.35 (.556) 3.88±0.52 (.004)
    51~60c 4.32±2.30   4.60±2.39   3.60±0.55 a, b＞c†
    ≥61d 3.68±1.88   4.06±2.44   3.64±0.43  
    Educational level ≤Junior high school 4.57±2.04 2.26 4.50±2.30 0.52 3.56±0.55 -2.60
    ≥High school 3.64±2.09 (.025) 4.26±2.34 (.606) 3.82±0.51 (.010)
    Residence area Metropolitan city 3.70±1.98 .81 4.42±2.37 0.52 3.82±0.54 1.95
    Small & medium-sized city 3.89±2.55 (.449) 3.94±2.08 (.598) 3.73±0.54 (.146)
    Countryside 4.33±2.05   4.32±2.46   3.58±0.42  
    Marital status Singlea 4.13±2.50 2.24 4.47±2.50 0.52 3.77±0.34 3.64
    Marriedb 3.68±1.99 (.110) 4.36±2.34 (.597) 3.81±0.55 (.028)
    Divorce, separate, bereavec 4.87±2.51   3.71±2.02   3.41±0.33 b＞c†
    Occupation Housewife 4.03±2.12 1.71 4.25±2.36 0.92 3.75±0.57 0.35
    Self-employed 3.10±2.12 (.151) 4.82±2.75 (.454) 3.72±0.41 (.841)
    Professionals 3.31±1.97   4.23±1.99   3.87±0.44  
    Service 4.80±2.11   5.44±2.55   3.67±0.51  
    Other 3.23±2.02   3.67±2.15   3.79±0.45  
    Religion Yes 4.30±2.35 0.05 4.30±2.35 0.05 3.76±0.53 0.17
    No 4.33±2.28 (.959) 4.33±2.28 (.959) 3.78±0.53 (.866)
    Monthly household income (10,000 won) ＜100a 4.15±2.42 2.09 4.21±2.39 2.57 3.47±0.37 4.18
    100~199b 4.52±1.74 (.104) 5.26±2.05 (.056) 3.66±0.36 (.007)
    200~299c 3.79±2.09   4.34±2.45   3.77±0.57 a＜d†
    ≥300d 3.43±2.13   3.88±2.27   3.90±0.57  
    Time since diagnosis was made (month) 6~12 4.10±2.09 1.16 4.55±2.24 0.90 3.74±0.56 0.18
    13~18 3.65±2.17 (.316) 3.98±2.42 (.411) 3.79±0.59 (.832)
    19~24 3.51±2.04   4.29±2.36   3.79±0.33  
    Current treatment modality Chemotherapy radiation 4.63±1.73 2.19 4.41±2.15 0.24 3.64±0.53 -1.35
    therapy   (.030)   (.812)   (.179)
    Others, follow up 3.66±0.53   4.29±2.36   3.79±0.53  
    Perceived health condition Good 4.00±2.24 -3.44 4.00±2.24 -3.44 3.83±0.53 3.20
    Not good 5.53±2.29 (.001) 5.53±2.29 (.001) 3.51±0.45 (.002)
    Medical expense payer Owna 4.21±2.28 2.33 4.53±2.17 0.81 3.74±0.49 3.81
    Spouseb 3.46±1.95 (.100) 4.07±2.37 (.447) 3.85±0.56 (.024)
    Othersc 3.99±1.87   4.56±2.73   3.47±0.38 b＞c†
    Economic burden Higha 4.32±2.19 3.16 4.60±2.44 1.43 3.63±0.55 2.97
    Moderateb 3.41±1.91 (.045) 3.99±2.13 (.243) 3.86±0.53 (.054)
    Lowc 4.02±2.30 a＞b† 4.63±2.55   3.77±0.43  
    Cancer pain level Mild 4.19±2.28 -1.31 4.19±2.28 -1.80 3.79±0.52 1.69
    Severe 5.22±2.49 (.192) 5.38±2.53 (.090) 3.56±0.55 (.092)

    †Scheffé test.

    Correlation among Fatigue, Distress, and Self efficacy (N=158

    Variables Fatigue Distress Self-efficacy
    r (p) r (p) r (p)
    Fatigue 1    
    Distress .56 (＜.001) 1  
    Self-efficacy -.33 (＜.001) -.28 (＜.001) 1

    Influencing Factors on Self-efficacy of the Breast Cancer Survivors (N=158)

    Step Variables Adjusted R2 F p B SE β t p
    Step 1 Fatigue .11 19.60 ＜.001 -.08 .02 -.33 -4.43 ＜.001
    Step 2 Fatigue .15 15.15 ＜.001 -.08 .02 -.33 -4.43 ＜.001
      Age       -.01 .01 -.23 -3.10 .002
    Step 3 Fatigue .17 12.00 ＜.001 -.08 .02 -.32 -4.37 ＜.001
      Age       -.01 .01 -.20 -2.76 .006
      One million won†       -.26 .12 -.16 -2.20 .028

    †Monthly household income.
    Table 1. General and Clinical Characteristics of Participants (N=158)

    CRT=chemotherapy radiation therapy

    Table 2. Degree of Fatigue, Distress, and Self-efficacy (N=158)

    Table 3. Differences in Fatigue, Distress, and Self-efficacy by Participants' Characteristics (N=158)

    Scheffé test.

    Table 4. Correlation among Fatigue, Distress, and Self efficacy (N=158

    Table 5. Influencing Factors on Self-efficacy of the Breast Cancer Survivors (N=158)

    Monthly household income.

    Table 1.

    Table 2.

    Table 3.

    Table 4.

    Table 5.

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