Photo Credit: Boonyachoat
Patients with endometrial cancer reported not receiving information about lifestyle improvements and behavior changes during their follow-up care.
Authors of a qualitative study published in the Journal of Psychosomatic Obstetrics & Gynecology identified behavior change techniques and intervention targets that could improve adherence to healthy lifestyle recommendations among patients with endometrial cancer.
PhD-candidate Anne M. de Korte, MSc, and colleagues explained that a cancer diagnosis can be considered “a teachable moment” wherein patients gain motivation to change their health behaviors.
“However, HCPs perceive various barriers for lifestyle support, e.g. a lack of knowledge of behavior change techniques and strategies for lifestyle counseling. Therefore, an evidence-based intervention targeting the barriers for HCPs is needed to improve follow-up care consultations for patients that utilizes the teachable moment and supports patients’ lifestyle improvement,” the authors wrote.
Identifying Barriers and Facilitators to a Healthy Lifestyle
For the study, de Korte and colleagues conducted semi-structured interviews with 18 patients in the Netherlands who had stage 1 or 2 endometrial cancer. The patients were at least 18 years of age, had finished their primary treatment, and had no recurrence.
The interviews explored four main topics: current lifestyle, lifestyle changes, the need to talk about lifestyle during treatment or follow-up, and preferences for help and lifestyle interventions.
Capability
Patients found success in using small steps to gradually form new habits rather than pursuing specific goals or quick fixes. Past experiences also influenced patients’ current motivation, including past failures to change behaviors.
Patients frequently reported lacking knowledge on appropriate lifestyle and behavior changes in relation to their cancer diagnosis. In addition, interviewees perceived that their physicians were hesitant to share information or advice that could potentially harm the patient-physician relationship.
Physical discomfort and limitations were common and tended to reduce patients’ confidence and increase stress. Patients were more likely to perceive themselves as physically active if they thought in terms of possibilities instead of barriers.
Opportunity
Social support was a positive motivator for behavior changes, according to the findings.
“Sharing their intentions and goals provided support and led to more follow-up on their goals since they felt more obliged to do so. Besides, information about healthy habits or successful behavior regulation was commonly shared among friends and family,” de Korte and colleagues wrote.
Patients were less motivated to change unhealthy habits when the people closest to them held similar or worse habits. In addition, patients felt disrespected when they were not offered the same care as others due to their weight.
The researchers also identified the physical environment as an important contributor. Positive influences included changing the environment to promote new behavior cues or limit exposure to unwanted cues, and having sporting or healthcare facilities nearby.
Patients also reported that having a good relationship with clinicians could motivate them to focus more on lifestyle changes.
“The most important factor mentioned was good, open communication. Though, when a relationship was compromised, patients tended to be more closed off and less likely to take away important information,” the researchers said.
Several patients reported having no conversations with their physicians about lifestyle during their treatment or follow-up. Most patients also did not receive referrals to supportive care.
Of note, “some patients said that receiving more information shortly after their diagnosis or primary treatment would probably be overwhelming and that it was likely they would forget this information or would not be open to discuss the topic further. This underlines the importance of the right timing and counseling techniques,” de Korte and colleagues explained.
Patients did not cite lack of access to dieticians or physical therapists; however, patients who did see a dietician said they were hoping for more information on how to lose weight and improve health. Patients often focused on short-term solutions rather than long-term changes.
Motivation
The researchers went on to explain that identity contributed to motivation. For example, patients who experienced multiple setbacks began to believe they were not capable of changing.
Not all patients were convinced that losing weight could be beneficial when they were sick. Several patients also thought they were completely clear of cancer after finishing their primary treatment, so they did not view lifestyle changes as necessary.
“Patients who build new habits regularly mentioned specific goals and routines, e.g. ‘at this time I will do this activity’ (implementation intention). Contrary to this, patients who had more abstract plans, e.g. eating healthier, rarely accomplished their goal,” de Korte and colleagues wrote.
When goals did not evolve over time or did not produce the positive effect they expected, patients tended to lose motivation. However, reaching a goal temporarily boosted confidence. Patients also reported feeling motivated and fulfilled for an extended period if a lifestyle change brought about positive effects such as having more energy.
“Patients who kept reminding themselves why a specific behavior was important instead of solely focusing on the results were often more successful in implementing new habits,” the authors wrote.
Supporting Patients During Follow-Up
The researchers reported that these barriers and facilitators appeared to be dependent on one another and all influenced patients’ adherence to lifestyle and behavior changes.
In regard to designing interventions for patients with endometrial cancer, de Korte and colleagues recommended the following techniques:
- Education. Inform patients of health consequences and provide feedback on the outcomes of their behavior. For example, clinicians might explain how physical activity can reduce cancer-specific fatigue.
- Persuasion. Due to being a credible source, clinicians are ideally positioned to persuade and motivate patients if they have a positive relationship and good communication.
- Training. Graded tasks and repetitive incremental changes could improve patients’ motivation. The authors also emphasized that some patients might require extensive supportive care or referrals to other specialties.
- Environmental restructuring. Lifestyle counseling during follow-up could be helpful. Patients should also be encouraged to alter their social or physical environment to make it easier to adhere to behavior changes; this might include moving an exercise bike to a room they frequent or purchasing fewer unhealthy snacks so they do not have easy access to them at home.
- Enablement. Set goals and make clear plans instead of discussing vague promises.
The authors wrote that their findings will be incorporated into a new lifestyle intervention, which should then be tested in a randomized controlled trial.
“The majority of patients with [endometrial cancer] have a good prognosis; however, most patients are overweight or obese which increases lifestyle-related risk for other comorbidities. Therefore, focusing on lifestyle improvement is necessary,” de Korte and colleagues concluded. “This study identified barriers and facilitators to improve and sustain a healthy lifestyle…that can be translated to behavioral methods and strategies for lifestyle counseling.”
