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Cited by 950Cancer survivorship and careNursing care and researchPatient-Provider Communication in Healthcare

Self-management: Enabling and empowering patients living with cancer as a chronic illness

Open access
McCorkle, Ruth, Ercolano, Elizabeth, Lazenby, Mark, Schulman-Green, Dena, Schilling, Lynne S., Lorig, Kate, Wagner, Edward H.·2011·CA: A Cancer Journal for Clinicians
DOI 10.3322/caac.20093PMC PMC3058905
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Abstract

With recent improvements in the early detection, diagnosis, and treatment of cancer, people with cancer are living longer, and their cancer may be managed as a chronic illness. Cancer as a chronic illness places new demands on patients and families to manage their own care, and it challenges old paradigms that oncology's work is done after treatment. As a chronic illness, however, cancer care occurs on a continuum that stretches from prevention to the end of life, with early detection, diagnosis, treatment, and survivorship in between. In this article, self-management interventions that enable patients and families to participate in managing their care along this continuum are reviewed. Randomized controlled trials of self-management interventions with cancer patients and families in the treatment, survivorship, and end-of-life phases of the cancer care continuum are reviewed, and the Chronic Care Model is presented as a model of care that oncology practices can use to enable and empower patients and families to engage in self-management. It is concluded that the need for a common language with which to speak about self-management and a common set of self-management actions for cancer care notwithstanding, oncology practices can now build strong relationships with their patients and formulate mutually agreed upon care plans that enable and empower patients to care for themselves in the way they prefer.

Integrity signals

Registry

Crossref · 10.3322/caac.20093

Cites

49 of 49 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 85 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The systematic review suggests that self-management interventions among cancer patients positively affect uncertainty.

    “This systematic review suggests that SM interventions among cancer patients positively affect symptom distress, uncertainty, problem-solving, communication, and general QOL domains, and potentially survival.”
    Quote in the paperSubstantial claim
  • Findingnone given

    The systematic review suggests that self-management interventions among cancer patients potentially affect survival.

    “This systematic review suggests that SM interventions among cancer patients positively affect symptom distress, uncertainty, problem-solving, communication, and general QOL domains, and potentially survival.”
    Quote in the paperSubstantial claim
  • Findingown data

    The systematic review suggests that self-management interventions among cancer patients positively affect symptom distress.

    “This systematic review suggests that SM interventions among cancer patients positively affect symptom distress, uncertainty, problem-solving, communication, and general QOL domains, and potentially survival.”
    Quote in the paperSubstantial claim
  • Findingown data

    The systematic review suggests that self-management interventions among cancer patients positively affect problem-solving.

    “This systematic review suggests that SM interventions among cancer patients positively affect symptom distress, uncertainty, problem-solving, communication, and general QOL domains, and potentially survival.”
    Quote in the paperSubstantial claim
  • Findingnone given

    All studies in Table 1 included interventions for improving communication with health care providers.

    “All of the studies in Table 1 included interventions for improving communication with health care providers; for example, managing symptoms, expressing feelings, asking questions, and requesting help.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 32
  • May combine two claims. 24
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given

    Over the last two decades, a number of intervention studies have demonstrated significant improvements in patients' outcomes at different phases of the cancer-care continuum.

    “Over the last two decades, a number of intervention studies have demonstrated significant improvements in patients' outcomes at different phases on the cancer-care continuum.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    Research on self-management interventions in cancer care has increased over the last decade.

    “Research related to SM interventions in cancer care has increased over the last decade.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    A major limitation in establishing self-management and the Chronic Care Model in cancer care has been the lack of a common language.

    “A major limitation in establishing SM and the CCM in cancer care heretofore has been the lack of a common language.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In the EC Program, participants' pre- and post-test measures of depression (p=.03), anxiety (p=.02), and self-confidence (p=.006) improved significantly.

    “Participants' pre- and post-test measures of depression (p=.03), anxiety (p=.02), and self-confidence (p=.006) improved significantly.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Sikorskii, 2007, Symptom management for cancer patients: a trial comparing two multimodal interventions, J Pain Symptom Manage source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Cancer as a chronic illness creates new demands on patients and families to manage their own care and challenges the old paradigm that oncology's work ends after treatment.

    “Cancer as a chronic illness places new demands on patients and families to manage their own care, and it challenges old paradigms that oncology's work is done after treatment.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Improvements in early detection, diagnosis, and treatment have led to more people living longer with cancer and cancer being managed as a chronic illness.

  • May combine two claims. The quote only partly states this claim.

    Interpretationcitation

    The effect sizes for NASM and ATSM are just above the median in Cohen's classification, yielding clinically significant improvement over baseline.

    “The effect sizes are just above the median in Cohen's classification, thus yielding clinically significant improvement over baseline.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Patients in the specialized oncology home care intervention had less distress (p=.03) and greater independence (p=.02) than participants in the usual care group, even in the context of advancing disease.

    “We found that even in the context of advancing disease, patients in the specialized oncology home care intervention had less distress (p=.03) and greater independence (p=.02) than participants in the usual care group.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [14] McCorkle, 1989, A randomized clinical trial of home nursing care for lung cancer patients, Cancer source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The SHIP study found participants demonstrated increased levels of self-care, self-help, psychological adjustment, and confidence in cancer knowledge (p≤.003).

    “Their study found that participants demonstrated increased levels of self-care, self-help, psychological adjustment, and confidence in cancer knowledge (p=≤.003).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Braden, 1998, Self-Help Intervention Project. Women receiving breast cancer treatment, Cancer Pract source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    The Chronic Care Model can be used by oncology practices to enable and empower patients and families to engage in self-management.

    “We also present the Chronic Care Model as a model of care that oncology practices can use to enable and empower patients and families to engage in self-management.”
    • Also stated in: § Introduction · plain
      “We use the Chronic Care Model as a paradigm for oncology practices to use in order to enable and empower patients to engage in SM.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The initial PRO-SELF intervention did not show a statistically significant difference between experimental and control groups in reducing symptom severity, but participants reported benefit.

    “Although the initial intervention did not demonstrate a statistically significant difference between the experimental and control groups in reducing symptom severity, participants reported benefit.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Dodd, 2000, The PRO-SELF Program: a self-care intervention program for patients receiving cancer treatment, Semin Oncol Nurs source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Participants in the experimental arm of the PSPC reported significantly less pain intensity than control participants (p≤.001) and used more appropriate pain medications over time.

    “Participants in the experimental arm of the PSPC reported significantly less pain intensity than control participants (p=≤.001) and used more appropriate pain medications than control group participants over time11.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Miaskowski, 2004, Randomized clinical trial of the effectiveness of a self-care intervention to improve cancer pain management, J Clin Oncol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Women who participated in the FOCUS intervention reported significantly less hopelessness (p=.002) and less negative appraisal (p=.04) than women who did not receive the intervention.

    “Women who participated in the FOCUS intervention reported significantly less hopelessness (p=.002) and less negative appraisal (p=.04) than women who did not receive the intervention”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Lewis, 2006, The enhancing connections program: pilot study of a cognitive-behavioral intervention for mothers and children affected by breast cancer, Psychooncology source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Braden, Mishel & Longman tested a self-help intervention protocol (SHIP) with women with breast cancer undergoing adjuvant treatment to increase knowledge, improve problem-solving, redirect negative thinking, promote communication, and minimize uncertainty.

    “To address these issues Braden, Mishel & Longman12 tested the effects of a self-help intervention protocol (SHIP) with women with breast cancer undergoing adjuvant treatment, the purpose of which was to increase knowledge about cancer, improve problem-solving, redirect negative thinking, promote effective communication with health care professionals, and to minimize uncertainty.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] Braden, 1998, Self-Help Intervention Project. Women receiving breast cancer treatment, Cancer Pract source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Thirty-two intervention studies were identified; after exclusions, 16 studies were reviewed.

    “Thirty-two intervention studies were identified. Of the 32 intervention studies, ten either mixed or did not report phase of treatment, did not include description of the intervention, or were not randomized; these were excluded. Of the remaining 22, six studies were co-authored by the investigators included in this review; only one example of their work was included. The remaining 16 reviewed”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Oncology practices can now build strong relationships with patients and formulate mutually agreed care plans that enable and empower patients to care for themselves as they prefer.

    “We conclude that, the need for a common language by which to speak about self-management and a common set of self-management actions for cancer care notwithstanding, oncology practices can now build strong relationships with their patients and formulate mutually-agreed upon care plans that enable and empower patients to care for themselves in the way they prefer.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: There is a need for a common language for discussing self-management and a common set of self-management actions for cancer care.

  • May combine two claims.

    Premisecitation

    A later modification compared a nurse-assisted symptom management protocol (NASM) with an automated-telephone symptom-management protocol (ATSM); both resulted in clinically significant reduction in symptom severity with nearly identical effect sizes (0.56 NASM, 0.59 ATSM).

    “Both the NASM and ATSM interventions resulted in a clinically significant reduction in symptom severity. The effect sizes were basically identical (0.56 NASM, 0.59, ATSM) 17.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Given, 2004, Effect of a cognitive behavioral intervention on reducing symptom severity during chemotherapy, J Clin Oncol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The FOCUS study tested whether women with advanced breast cancer and their family caregivers reported better QOL compared to other patients and families not participating in FOCUS.

    “In another study, the FOCUS (family involvement, optimistic attitude, coping, effectiveness, uncertainty reduction, and symptom management) study19 tested whether women with advanced breast cancer and their family caregivers reported better QOL compared to other patients and families not participating in FOCUS.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Lewis, 2006, The enhancing connections program: pilot study of a cognitive-behavioral intervention for mothers and children affected by breast cancer, Psychooncology source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Taking Charge intervention, based on self-management principles, aimed to help women with breast cancer address concerns associated with the end of primary treatment and post-treatment life experiences.

    “The aim of the Taking Charge intervention22, based on principles inherent in SM, was to help a group of women with breast cancer address and overcome concerns associated with the end of primary treatment and concerns about life experiences in the post-treatment phase.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] Cimprich, 2005, Taking CHARGE: a self-management program for women following breast cancer treatment, Psychooncology source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the EC Program, mothers and fathers reported significant decreases in their children's behavioral problems, and children reported less cancer-related worry (p=.04).

    “Mothers and fathers also reported significant decreases in their children's behavioral problems. The children themselves reported less cancer-related worry (p=.04).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Sikorskii, 2007, Symptom management for cancer patients: a trial comparing two multimodal interventions, J Pain Symptom Manage source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    New models of cancer care must enable oncology providers to form partnerships with patients, families, and other providers such as primary care clinicians.

    “New models must enable oncology providers to form partnerships with patients and families, and other providers, such as primary care clinicians.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The aim of self-management is keeping wellness in one's psychological foreground.

    “Lorig and Holman identify the aim of SM as keeping wellness in one's psychological foreground.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Lorig, 2003, Self-management education: history, definition, outcomes, and mechanisms, Ann Behav Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Self-management has come of age after more than four decades of scientific consideration.

    “The concept of SM has come of age after more than four decades of scientific consideration2.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Ryan, 2009, The Individual and Family Self-Management Theory: background and perspectives on context, process, and outcomes, Nurs Outlook source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    To accomplish self-management tasks, people with chronic illness need core skills: problem-solving, decision-making, resource utilization, forming partnerships with health care providers, and taking action.

    “To accomplish these tasks, people with chronic illness need the following core SM skills: problem-solving, decision-making, resource utilization, forming partnerships with health care providers, and taking action4.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Lorig, 2003, Self-management education: history, definition, outcomes, and mechanisms, Ann Behav Med source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    The management of care overlaps among patients, providers, and health care systems, and these complexities demand new models of care.

    “Because of this, the management of care overlaps among patients, providers, and health care systems. The complexities of these overlaps demand new models of care.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Wagner developed the Chronic Care Model in the 1990s to help medical practices improve the quality of care for patients with chronic illness.

    “Based on this evidence, we (Wagner) developed the Chronic Care Model in the 1990s to help medical practices improve the quality of their care to patients with chronic illness30.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Tsai, 2005, A meta-analysis of interventions to improve care for chronic illnesses, Am J Manag Care

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    People with chronic illness have three self-management tasks: managing medical aspects, managing life roles including changes brought on by illness, and managing psychological consequences.

    “To do this, the person with chronic illness has three SM tasks, which were originally described by Corbin and Strauss5: managing the medical aspects of the illness; managing life roles, including changes in roles brought on by the illness; and managing the psychological consequences of chronic illness6.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [5] Corbin, 1988

      Not checked in the free run.

    • cites [6] 2004

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    Long-term cancer care necessitates discussing patients' short-term and long-term goals and including these goals in action plans to the degree they are medically realistic.

    “This longer term necessitates discussing patients' short-term and long-term goals and including these goals in action plans to the degree they are medically realistic.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Clinical care management includes clinical assessment, medication management, self-management support, and care coordination, including among post-surgical cancer patients.

    “Clinical care management, generally provided by a health care professional such as a nurse or clinical pharmacist, includes clinical assessment, medication management, self-management support, and care coordination28,39-44, including among post-surgical cancer patients14,15,45.”
    Quote in the paperNot a substantial claim0 of 10 sources checked
    • cites [28] Bodenheimer, 2002, Improving primary care for patients with chronic illness: the chronic care model, Part 2, JAMA source

      Not checked in the free run.

    • cites [39] Norris, 2002, Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control, Diabetes Care source

      Not checked in the free run.

    • cites [40] Bodenheimer, 2007, The teamlet model of primary care, Ann Fam Med source

      Not checked in the free run.

    • cites [41] Coleman, 2006, The care transitions intervention: results of a randomized controlled trial, Arch Intern Med source

      Not checked in the free run.

    • cites [42] Naylor, 2004, Transitional care for older adults: a cost-effective model, LDI Issue Brief

      Not checked in the free run.

    • cites [43] Phillips, 2004, Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure: a meta-analysis, JAMA source

      Not checked in the free run.

    • cites [44] Boyd, 2010, The effects of guided care on the perceived quality of health care for multi-morbid older persons: 18-month outcomes from a cluster-randomized controlled trial, J Gen Intern Med source

      Not checked in the free run.

    • cites [14] McCorkle, 1989, A randomized clinical trial of home nursing care for lung cancer patients, Cancer source

      Not checked in the free run.

    • cites [15] McCorkle, 2000, A specialized home care intervention improves survival among older post-surgical cancer patients, J Am Geriatr Soc source

      Not checked in the free run.

    • cites [45] Gensichen, 2009, Case management for depression by health care assistants in small primary care practices: a cluster randomized trial, Ann Intern Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Long-term planning requires an ongoing collaborative relationship between patients and providers instead of an acute, prescriptive relationship.

    “This kind of long-term planning requires an ongoing collaborative relationship between patients and providers instead of an acute, prescriptive relationship.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The cancer-care continuum challenges the paternalistic paradigm in which providers tell patients what to do and expect adherence.

    “The notion of the cancer-care continuum challenges this paternalistic paradigm.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    All definitions of self-management are broader than merely following medical advice.

    “SM has been variously defined, but all definitions are broader than the mere following of medical advice.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [3] Barlow, 2002, Self-management approaches for people with chronic conditions: a review, Patient Educ Couns source

      Not checked in the free run.

    • cites [4] Lorig, 2003, Self-management education: history, definition, outcomes, and mechanisms, Ann Behav Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The 2005 IOM report emphasized the importance of explicit care plans.

    “The 2005 IOM report emphasized the importance of explicit care plans1.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Hewitt, 2005

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Self-management is defined by being set within the context of the family, being a lifelong dynamic process of self-monitoring and self-evaluation, and involving a perspectival shift from illness to wellness.

    “In addition to core tasks and skills, SM is defined by its being set within the context of the family7,8, by being a lifelong dynamic process of self-monitoring and self-evaluation2, and by involving a perspectival shift from illness to wellness4.”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [2] Ryan, 2009, The Individual and Family Self-Management Theory: background and perspectives on context, process, and outcomes, Nurs Outlook source

      Not checked in the free run.

    • cites [4] Lorig, 2003, Self-management education: history, definition, outcomes, and mechanisms, Ann Behav Med source

      Not checked in the free run.

    • cites [7] Dunbar, 2008, Family influences on heart failure self-care and outcomes, J Cardiovasc Nurs source

      Not checked in the free run.

    • cites [8] Grey, 2006, A framework for the study of self- and family management of chronic conditions, Nurs Outlook source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Premisecitation

    It is impossible not to manage one's health, and for those with a chronic illness, self-management is a lifetime task.

    “Lorig and Holman4 point out that, even if one does not have a chronic condition, it is impossible not to manage one's health; however, if one does have a chronic illness, SM is a “lifetime task” (p. 1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Lorig, 2003, Self-management education: history, definition, outcomes, and mechanisms, Ann Behav Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A variety of interventions and changes to the organization and functioning of medical practice have proven to help patients meet their needs and improve care and outcomes across chronic diseases.

    “A variety of interventions and changes to the organization and functioning of medical practice have proven to help patients meet their needs and to improve care and outcomes across chronic diseases26-29.”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [26] Ganz, 2004, Quality of life at the end of primary treatment of breast cancer: first results from the moving beyond cancer randomized trial, J Natl Cancer Inst source

      Not checked in the free run.

    • cites [27] Renders, 2001, Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings, Cochrane Database Syst Rev

      Not checked in the free run.

    • cites [28] Bodenheimer, 2002, Improving primary care for patients with chronic illness: the chronic care model, Part 2, JAMA source

      Not checked in the free run.

    • cites [29] Shojania, 2006, Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis, JAMA source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Community-based programs and organizations are another way to enable and empower patients and often most effectively meet many needs of chronically ill patients.

    “Another way to enable and empower patients is to use community-based programs and organizations, which often most effectively meet many of the needs of chronically ill patients.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Many clinical practices lack sufficient time and information to help patients with community-based services.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationnone given

    Care plans form the bond that holds together the partnership between patients and practice teams, and they must be mutually determined.

    “Care plans form the bond that holds together the partnership between patients and practice teams, but they must be mutually determined.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Developing and maintaining care plans makes it possible for practice teams to serve as patients' champions.

    “Developing and maintaining care plans make it possible.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    The oncology setting presents many more challenges because of the number of specialties that must be organized and integrated into care.

    “In particular, there are many more challenges in the oncology setting given the number of specialties that have to be organized and integrated into the care.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    Self-management interventions are fundamental to enabling and empowering patients to care for themselves along the cancer-care continuum in the way they prefer.

    “SM interventions are fundamental to enabling and empowering patients so they can take care of themselves along the cancer-care continuum in the way they prefer.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Patients may become more passive during active, aggressive treatment because they are physically or emotionally overwhelmed, while during the post-treatment phase they may feel better and want to manage treatment and surveillance demands independently.

    “Patients may become more passive during active, aggressive treatment due to being physically or emotionally overwhelmed; whereas during the post-treatment phase they may feel better physically and may want to manage the demands associated with their cancer treatment and surveillance schedule independently.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationnone given

    The disease itself may increase patients' distress, but fragmentation of care adds to it.

    “The disease itself may increase patients' distress, but this fragmentation of care adds to it.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Primary care providers often feel they lack enough information to answer cancer patients' questions.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    To be competent and confident managers, patients must have the relevant information and skills to set priorities and manage their illness.

    “To be competent and confident managers, patients must have the relevant information and skills to set priorities and manage their illness.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Patients' self-management needs are met through productive interactions between patients and families and their practice team.

    “Patients' SM needs are met through productive interactions between patients and families and their practice team.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Care plans developed collaboratively with patients produce informed and enabled patients and contribute to better coordination of care.

    “Care plans developed collaboratively with patients make for informed and enabled patients, and they contribute to better coordination of care.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Productive interactions are more likely when patients actively participate, are invested in their own care, and are competent and confident managers of their health and illness.

    “Productive interactions are more likely to occur when patients actively participate and are invested in their own care and are competent, confident managers of their health and illness.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The delivery of quality cancer care depends on productive interactions between patients and providers.

    “The delivery of quality cancer care is dependent on productive interactions between patients and providers.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    The specialties involved may change as patients progress along the cancer-care continuum.

    “These specialties may change as patients progress along the cancer-care continuum.”
    Quote in the paperNot a substantial claim
48 of 48

  • The paper relies on this without support.

    Improvements in early detection, diagnosis, and treatment have led to more people living longer with cancer and cancer being managed as a chronic illness.

    “With recent improvements in early detection, diagnosis and treatment of cancer, people with cancer are living longer, and their cancer may be managed as a chronic illness.”

  • The paper relies on this without support.

    Patients are expected to assume a greater role in managing their follow-up care because of ongoing survivorship and insurance coverage shifts that limit time with providers.

    “With ongoing survivorship and current shifts in insurance coverage that limit time with providers, patients are expected to assume a greater role in managing their follow-up care.”

  • The paper relies on this without support.

    There is a need for a common language for discussing self-management and a common set of self-management actions for cancer care.

    “the need for a common language by which to speak about self-management and a common set of self-management actions for cancer care notwithstanding”

  • The paper relies on this without support.

    Cancer treatments such as chemotherapy and radiation therapy have become safe enough to require less intensive monitoring by health care professionals, leading outpatient clinics to replace hospitals as delivery settings.

    “When cancer treatments such as chemo- and radiation-therapy proved to be safe enough so as to require less intensive monitoring by health care professionals, the outpatient clinic replaced the hospital as the delivery setting.”

  • The paper relies on this without support.

    The needs of patients and families living with advanced cancer intensify as death grows closer, and physical changes result in loss of capacity to manage medical regimens and activities of daily living.

    “The needs of patients and families living with advanced cancer intensify as death grows closer. The physical changes associated with a disease that is unable to be controlled results in loss of the capacity to manage aspects of medical regimens and activities of daily living.”

  • The paper relies on this without support.

    Health care professionals and researchers recognize that increasing symptom burden does not preclude patients from acting on their own behalf to maintain QOL, independence, and support for preferences about dying.

    “Health care professionals and researchers recognize that the inevitable increasing symptom burden does not preclude patients acting on their own behalf in terms of maintaining a reasonable QOL, maintaining their current level of independence, and obtaining support for their preferences about their dying course and letting go.”

  • The authors state this as an assumption.

    Most people want to take care of themselves and remain independent, though these preferences may change over time.

    “It is assumed that most people want to take care of themselves and remain independent, but these preferences may change over time.”

  • The paper relies on this without support.

    Many problems cancer survivors face involve stress, depression, sleeplessness, fear, and a lack of decision-making skills about resuming a changed life.

    “Many of the problems survivors face involve stress, depression, sleeplessness, fear, and lack of skills in making decisions about how to resume a normal-but-changed life.”

  • The paper relies on this without support.

    Many cancer survivors must cope with changes in body image or treatment side-effects such as incontinence or lymphedema.

    “In addition, many survivors must cope with changes in body image or side-effects of treatment, such as incontinence or lymphedema.”

  • The paper relies on this without support.

    Cancer often changes survivors' relationships with family and friends.

    “Finally, cancer often causes changes in relationships with family and friends.”

  • The paper relies on this without support.

    Many clinicians lack the time and expertise needed to train and counsel patients effectively.

    “Yet many clinicians have neither the time nor the expertise necessary to train and counsel patients effectively.”

  • The paper relies on this without support.

    Many clinical practices lack sufficient time and information to help patients with community-based services.

    “Many clinical practices, however, do not have enough time and information to assist patients with such services.”

  • The paper relies on this without support.

    Primary care providers often feel they lack enough information to answer cancer patients' questions.

    “While it is true that PCPs must play a major role in coordinating care, PCPs often feel as if they do not have enough information to answer cancer patients' questions.”
13 of 13

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Cites

Flagged first, then by citations

4 of the 53 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. Hewitt, 2005, Committee on Cancer Survivorship: Improving Care and Quality of Life. From Cancer Patient to Cancer Survivor: Lost in Transition, 506
  2. Corbin, 1988, Understanding Work and Care: Managing Chronic Illness at Home
  3. 2004, Report of a Summit. The 1st Annual Crossing the Quality Chasm Summit- A Focus on Communities
  4. 2003, Institute of Medicine: Priority Areas for National Action: Transforming Health Care Quality

Cited by

Sorted by citations

Related

Authors
McCorkle, R., Ercolano, E., Lazenby, M., Schulman-Green, D., Schilling, L. S., Lorig, K., & Wagner, E. H.
Affiliations
  • Yale University (US)
  • Stanford University (US)
  • Group Health Cooperative (US)
Corresponding author
McCorkle, Ruth
ORCID
Venue
CA: A Cancer Journal for Clinicians
Publisher
Wiley
Published
2011-01
Volume
61
Issue
1
Pages
50-62
ISSN
0007-9235 (ISSN-L)
DOI
10.3322/caac.20093
PMC
PMC3058905
OpenAlex
W2113970081
Semantic Scholar
deab4e44ad96caf2a337cc1bae05befe8fbafd71
Cited by
950
References
53
Citations by year
2026: 24 · 2025: 62 · 2024: 60 · 2023: 76 · 2022: 86 · 2021: 92 · 2020: 73 · 2019: 75 · 2018: 85 · 2017: 88 · 2016: 74 · 2015: 67 · 2014: 31 · 2013: 26 · 2012: 24
FWCI
2.47
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 1704 d)
Locations
  • CA A Cancer Journal for Clinicians (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Nursing Research (R01NR007778, R01NR011872, P30NR004000, P30NR008999)
Topics
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Health Professions › Pharmacy › Nursing care and research
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
Keywords
self-management, Chronic Care Model, patient empowerment, family caregivers, cancer survivorship, end-of-life care, cancer care continuum, self-management interventions, shared decision-making, care planning, patient-provider relationship
MeSH terms
Chronic Disease, Humans, Neoplasms, Self Care

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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