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Patients with endometrial cancer reported not receiving information about lifestyle modifications or behavior changes during follow-up care.
author Qualitative research Published in Journal of Psychosomatic Medicine, Obstetrics and Gynecology We identified behavior change techniques and intervention targets that can improve adherence to healthy lifestyle recommendations in patients with endometrial cancer.
Doctoral student Anne M. De Corte, MSc, and colleagues explained: Cancer Diagnosis They can be thought of as “teachable moments” that motivate patients to change their health behaviors.
“However, health care providers identify various barriers to lifestyle support, including lack of knowledge about behavior change techniques and lifestyle counseling strategies. Thus, evidence-based interventions targeting health care provider barriers are needed to improve follow-up care consultations with patients that leverage educational opportunities and support their lifestyle modifications,” the authors wrote.
Identifying barriers and facilitators to a healthy lifestyle
For the study, de Corte and colleagues conducted semi-structured interviews with 18 patients in the Netherlands with stage 1 or 2 endometrial cancer. The patients were aged 18 or older, had completed first-line treatment, and had not experienced a recurrence.
The interviews explored four main topics: current lifestyle, lifestyle changes, the need to discuss lifestyle during treatment or follow-up, and preferences for support and lifestyle interventions.
ability
Patients achieved success by taking small steps and gradually forming new habits, rather than pursuing specific goals or temporary solutions. Past experiences, such as failure to change behavior, also influenced patients’ current motivation.
Patients frequently reported a lack of knowledge about appropriate lifestyle and behavioral changes related to a cancer diagnosis. Additionally, interviewees felt that physicians were hesitant to share information or advice that could negatively impact the patient-physician relationship.
Physical discomfort and limitations were common and tended to lower patients’ self-confidence and increase stress. Patients were more likely to perceive themselves as physically active when they thought about possibilities rather than barriers.
opportunity
Findings showed that social support was a positive motivator for behavior change.
“Sharing intentions and goals encouraged people to work toward achieving their goals because they felt supported and more obligated to do so. Furthermore, information about healthy habits and successful behavior control was commonly shared among friends and family,” de Corte and colleagues wrote.
Patients are less motivated to change unhealthy habits if those closest to them have similar or even worse habits. Additionally, patients feel disrespected when they don’t receive the same care as others because of their weight.
The researchers also identified the physical environment as an important factor: Positive influences included changing the environment to encourage new behavioral cues or limit exposure to unwanted cues, and the presence of sports or medical facilities nearby.
Patients also reported that having a positive relationship with their clinician could motivate them to place more emphasis on lifestyle changes.
“The most important factor mentioned was good and open communication. However, when the relationship was damaged, patients tended to become more closed off and less likely to walk away with important information,” the researchers said.
Some patients reported that their lifestyle choices were not discussed with their physicians during treatment or follow-up, and most patients did not receive a referral for supportive care.
Of note, “some patients said that receiving further information so soon after diagnosis or initial treatment would likely be overwhelming and that they would either forget the information or be less willing to discuss the topic further, highlighting the importance of appropriate timing and counseling techniques,” de Corte et al. explained.
Patients did not report a lack of access to dieticians or physiotherapists, but those who saw dieticians said they would like more information about how to best serve them. Lose weight Improve your health. Patients are often focused on short-term solutions rather than long-term change.
motivation
The researchers further explained that identity contributes to motivation: For example, patients who experience repeated setbacks may begin to believe they are unable to change.
Not all patients were convinced that losing weight while ill would be beneficial, and some considered themselves cancer-free after their first round of treatment and therefore did not see the need to make any lifestyle changes.
“Patients who developed new habits regularly described specific goals and routines, for example ‘do this activity at this time’ (implementation intentions). In contrast, patients who had more abstract plans, for example to eat healthier, rarely achieved their goals,” de Corte and his colleagues wrote.
Patients tended to lose motivation when their goals did not progress over time or did not have the positive effects they hoped for. However, achieving their goals produced a temporary boost in self-confidence. And when their lifestyle changes had positive effects, such as increased energy, patients reported feeling more motivated and fulfilled in the long term.
“Patients who continually reminded themselves why certain behaviors were important, rather than focusing solely on the outcome, were often more successful in implementing new habits,” the authors wrote.
Supporting patients during follow-up
The researchers reported that these barriers and facilitators are interdependent and all influence patients’ adherence to lifestyle and behavioral changes.
With regard to designing interventions for patients with endometrial cancer, de Korte and colleagues recommended the following approach:
educationInform patients about health implications and provide feedback on the outcomes of actions. For example, clinicians might explain how physical activity reduces cancer-specific fatigue.
PersuasionClinicians are a trusted source of information, so if they can build a good rapport with their patients and communicate well, they are in an ideal position to persuade and motivate them.
trainingGraded challenges and repeated incremental changes may improve patient motivation. The authors also emphasized that some patients may require extensive supportive care or referral to other specialties.
Reconstructing the environmentLifestyle counseling during follow-up may also be helpful. Patients should be encouraged to make changes to their social and physical environment to make them more likely to comply with behavioral changes, for example, by moving an exercise bike to a room that is frequently used and reducing purchases of unhealthy snacks that are not easily available in the home.
EnableSet goals and create clear plans rather than discussing vague promises.
The authors note that the findings will be incorporated into new lifestyle interventions that will then be tested in randomized controlled trials.
“The vast majority of patients with endometrial cancer have a good prognosis. However, most patients are overweight or obese, which increases their risk for other lifestyle-related comorbidities. Therefore, a focus on lifestyle modification is necessary,” De Corte and colleagues concluded. “This study identified barriers and facilitators for improving and maintaining a healthy lifestyle, which can be applied to behavioral methods and strategies for lifestyle counseling.”
