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

Mi Hye Seo; Kyung Hee Lim

doi:10.7469/kjan.2016.28.4.378

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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

DOI: https://doi.org/10.7469/kjan.2016.28.4.378

¹Nurse, Yeungnam University Medical Center, Daegu

²Assistant Professor, College of Nursing, Keimyung University, Daegu, Korea

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

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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Abstract
REFERENCES

Abstract

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)
Educational level	≥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)
Religion	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)
Perceived health condition	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)
Cancer pain level	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
Characteristics	Categories	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)
Age (year)	≤40^a	3.81±1.90	1.75	4.55±1.99	0.70	3.96±0.44	4.56
	41~50^b	3.45±2.01	(.160)	4.05±2.35	(.556)	3.88±0.52	(.004)
	51~60^c	4.32±2.30		4.60±2.39		3.60±0.55	a, b＞c^†
	≥61^d	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
Educational level	≥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	Single^a	4.13±2.50	2.24	4.47±2.50	0.52	3.77±0.34	3.64
	Married^b	3.68±1.99	(.110)	4.36±2.34	(.597)	3.81±0.55	(.028)
	Divorce, separate, bereave^c	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
Religion	No	4.33±2.28	(.959)	4.33±2.28	(.959)	3.78±0.53	(.866)
Monthly household income (10,000 won)	＜100^a	4.15±2.42	2.09	4.21±2.39	2.57	3.47±0.37	4.18
	100~199^b	4.52±1.74	(.104)	5.26±2.05	(.056)	3.66±0.36	(.007)
	200~299^c	3.79±2.09		4.34±2.45		3.77±0.57	a＜d^†
	≥300^d	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
Perceived health condition	Not good	5.53±2.29	(.001)	5.53±2.29	(.001)	3.51±0.45	(.002)
Medical expense payer	Own^a	4.21±2.28	2.33	4.53±2.17	0.81	3.74±0.49	3.81
	Spouse^b	3.46±1.95	(.100)	4.07±2.37	(.447)	3.85±0.56	(.024)
	Others^c	3.99±1.87		4.56±2.73		3.47±0.38	b＞c^†
Economic burden	High^a	4.32±2.19	3.16	4.60±2.44	1.43	3.63±0.55	2.97
	Moderate^b	3.41±1.91	(.045)	3.99±2.13	(.243)	3.86±0.53	(.054)
	Low^c	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
Cancer pain level	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
Variables	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

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

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)
Educational level	≥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)
Religion	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)
Perceived health condition	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)
Cancer pain level	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
Characteristics	Categories	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)
Age (year)	≤40^a	3.81±1.90	1.75	4.55±1.99	0.70	3.96±0.44	4.56
	41~50^b	3.45±2.01	(.160)	4.05±2.35	(.556)	3.88±0.52	(.004)
	51~60^c	4.32±2.30		4.60±2.39		3.60±0.55	a, b＞c^†
	≥61^d	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
Educational level	≥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	Single^a	4.13±2.50	2.24	4.47±2.50	0.52	3.77±0.34	3.64
	Married^b	3.68±1.99	(.110)	4.36±2.34	(.597)	3.81±0.55	(.028)
	Divorce, separate, bereave^c	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
Religion	No	4.33±2.28	(.959)	4.33±2.28	(.959)	3.78±0.53	(.866)
Monthly household income (10,000 won)	＜100^a	4.15±2.42	2.09	4.21±2.39	2.57	3.47±0.37	4.18
	100~199^b	4.52±1.74	(.104)	5.26±2.05	(.056)	3.66±0.36	(.007)
	200~299^c	3.79±2.09		4.34±2.45		3.77±0.57	a＜d^†
	≥300^d	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
Perceived health condition	Not good	5.53±2.29	(.001)	5.53±2.29	(.001)	3.51±0.45	(.002)
Medical expense payer	Own^a	4.21±2.28	2.33	4.53±2.17	0.81	3.74±0.49	3.81
	Spouse^b	3.46±1.95	(.100)	4.07±2.37	(.447)	3.85±0.56	(.024)
	Others^c	3.99±1.87		4.56±2.73		3.47±0.38	b＞c^†
Economic burden	High^a	4.32±2.19	3.16	4.60±2.44	1.43	3.63±0.55	2.97
	Moderate^b	3.41±1.91	(.045)	3.99±2.13	(.243)	3.86±0.53	(.054)
	Low^c	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
Cancer pain level	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
Variables	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.

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)

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

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