The paper by Kidd et al. (2009) demonstrates changes in perceived control and the relationship between levels of perceived control and self-care behaviours in patients with colorectal cancer undergoing chemotherapy. The patients with control perceived as ‘high’ were defined as those who were significantly engaged in self-care and who showed poor participation or let health staff organise their care were defined as having a ‘low’ perception of control.
Chemotherapy is an important treatment in cancer care and is associated with numerous side effects – the severity and frequency of which differ between patients (Akin et al. 2008). Complications may vary from the minor to significant such as bone marrow suppression, increased susceptibility to infection, oral mycosis, nephrotoxicity, anorexia, alopecia, diarrhoea, nausea and vomiting (Bergkvist & Wengström 2006, Vincent et al. 2001). However, it is not clear how frequently and consistently the patients in Kidd et al.’s (2009) study, who participated in their self-care more easily, experienced side effects. This poses questions, such as, did the ‘high’ perceived control levels in these patients result from facing less intense and less frequent side effects compared with other patients with ‘low’ perceived control? Furthermore, did the experience of minor and inconsistent side effects of chemotherapy actually result in a perception of ‘high’ perceived control?
Certainly, participation in one’s own care can contribute to raised levels of perceived control and lessen side effects (Brody et al. 1989). It can also enhance feelings of well-being (Scharloo & Kaptein 1997). The severity of the illness appears to be an important factor in patients perceived control and adaptation to their illness (Endler et al. 2001). That is why patients experiencing severe and more frequent symptoms and complications may be expected to lessen their participation in care.
The definition of ‘self-care’ by Kidd et al. (2009) is clearly defined in their paper, but it is less evident what roles a cancer patient may play to be seen as participating in self-care. For instance, can participation in decisions related to treatment alternatives be considered as participation in self-care? Or does participation in self-care mean performing procedures to protect from oral infections, avoid nausea, vomiting, etc.? As stated, chemotherapy-related complications have different effects and may vary from one to another. This is another important aspect that must be taken into account within the evaluation of participation in self-care and levels of perceived control.
Research has shown that an increase in the level of self-efficacy has a positive effect on health conditions, eases symptom control in chemotherapy, and helps the patient to reconcile with the challenges of cancer treatment (Cunningham et al. 1991, Lev et al. 2001). Lev and Owen (1996) found a significant negative correlation between psychological distress and symptom distress in cancer patients and self-care/self-efficacy and a significantly positive correlation was found between quality of life and the perception of self-efficacy (Lev & Owen 1996). Self-efficacy is actually an individual’s self-judgment ability on his or her capacity to organise the necessary activities to successfully undertake a specific performance (Aksayan & Gozum 1998). Perceived control is another factor that may also be related to self-efficacy and self-care. Self-care is a concept gaining a growing recognition for its positive effects on many patient care–related behaviours (Lev et al. 2001). Because a perception of high self-efficacy can improve cancer patients’ adaptation to their disease, psychological wellness and quality of life, and can decrease chemotherapy complications, it is vital to be aware of the characteristics that might influence it.
There are some important and interesting issues related to patient perception of control in Kidd et al.’s (2009) paper that require further study. For example, how do past experiences, disease stage, quality of life and personality influence perceived control? Indeed, a positive personality and optimistic outlook have been found to decrease the perceived severity of complications in some patients (Jones et al. 1989). Further research into the effects of personality characteristics on patient’s perceived control and participation in self-care may be helpful for caregivers and patients. Finally, studies that explore how nurses can build the development of self-control and self-care into care planning with patients at the beginning of the treatment are needed.