Avoidant coping and self-efficacy mediate relationships between perceived social constraints and symptoms among long-term breast cancer survivors

Abstract

Objective: Many breast cancer survivors feel constrained in discussing their cancer experience with others. Limited evidence suggests that social constraints (e.g., avoidance and criticism) from loved ones may negatively impact breast cancer survivors' global health, but research has yet to examine relationships between social constraints and common physical symptoms. Informed by social cognitive processing theory, this study examined whether perceived social constraints from partners and healthcare providers (HCPs) were associated with fatigue, sleep disturbance, and attentional functioning among long-term breast cancer survivors (N = 1052). In addition, avoidant coping and self-efficacy for symptom management were examined as potential mediators of these relationships.

Methods: Long-term breast cancer survivors (mean years since diagnosis = 6) completed questionnaires assessing social constraints from partners and HCPs, avoidant coping, self-efficacy for symptom management, and symptoms (i.e., fatigue, sleep disturbance, and attentional functioning). Structural equation modeling was used to evaluate the hypothesized relationships among variables in two models: one focused on social constraints from partners and one focused on social constraints from HCPs.

Results: Both models demonstrated good fit. Consistent with theory and prior research, greater social constraints from both partners and HCPs were associated with greater symptom burden (i.e., greater fatigue and sleep disturbance, poorer attentional functioning). In addition, all relationships were mediated by avoidant coping and self-efficacy for symptom management.

Conclusions: Findings are consistent with social cognitive processing theory and suggest that symptom management interventions may be enhanced by addressing the impact of social constraints from survivors' partners and HCPs on their coping and self-efficacy. Copyright © 2016 John Wiley & Sons, Ltd.

Keywords: breast cancer; coping; oncology; self-efficacy; social constraints; symptoms.

Figure 1

Final mediation models Note. Standardized coefficients for the final model. All paths are statistically significant. HCP = health care provider. Select demographic and medical factors were also included: age, education, income, time since diagnosis, and marital status. Specifically, in Figure 1a, there are paths from age to avoidant coping, self-efficacy, and each symptom. In addition, in Figure 1a, there are paths from education to self-efficacy and each symptom. Finally, in Figure 1a, there are paths from income to avoidant coping and each symptom. In Figure 1b, there are paths from age to avoidant coping, self-efficacy, and each symptom. In addition, in Figure 1b, there are paths from education to self-efficacy and each symptom. Finally, in Figure 1b, there are paths from income to avoidant coping, self-efficacy, and each symptom. Parameter estimates for these pathways are included in online supporting information 2 and 3.