Self-Management Needs among Patients Suffering from Breast Cancer during Transition from Active to Maintenance Phases of Systemic Therapy at Kenyatta National Hospital

Abstract

Self-management benefits all patients in the cancer care trajectory from diagnosis, treatment, survivorship to the end of life. The study aimed at assessing self-management needs among breast cancer patients during transition from active to maintenance phase of systemic therapy at Kenyatta National Hospital. The study utilized explanatory sequential mixed methods (Analytical cross-sectional and phenomenological research designs). Cochran (1977) formula was used to determine the number of respondents, which was (169) on systemic therapy only and met the inclusion criteria, sampling technique utilized was census. Respondents gave informed consent to participate. Quantitative data was collected using a questionnaire and Supportive Care Needs Survey-Short Form 34 tool (SCNS SF 34). Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 23.0) to derive descriptive and inferential statistics. Core factors behind interdependence between correlated variables were identified using Principal Component Analysis via Rotated Component Matrix. Findings are presented in the form of tables, bar graphs and charts as appropriate. Qualitative data were collected through Focus group discussions (FGD) among patients with breast cancer who had not participated in quantitative study. NVIVO software version was utilized in thematic data analysis. Qualitative data from 3 focus group discussions. Findings were used to complement and explain quantitative results. A total of 169 participants took part in the study, (99.4%, n=168) were female, Majority were married (68.26%, n=115) and were from rural (63.9%, n=108) set up and n=73 (43.2%, n=73) had secondary level education. Majority (81%, n=137) had information about self-management. In psychological needs domain, the outstanding aspects for which additional help was needed was concerns about the worries of close relatives (20%, n=34). In the informational need’s domain, items that patients expressed needed additional support was member of staff whom you can share with about your condition and follow-up (74%, n=125) and information about sexual relationships (62% n=105) Patient centered factor identified was financial constrains (87%, n=147). The study concludes that breast cancer patients at KNH had knowledge on self-management. However, they experienced psychological and informational needs during transition period. In addition, qualitatively; Physical and psychological symptoms, (2) Lack of information (3) Financial constraints are among the themes were created to support factors affecting self-; management. The principal component analysis rotation sums of squared loadings collectively explain 55.3% of total variance observed in the study and three major themes psychological needs accounted for 20%, informational needs accounted for 12.3% and staff related at 10%of the total variance. The study recommends that the psychological and informational health system needs to be addressed.