Self-efficacy in cancer survivors
Self-efficacy was first introduced in the seventies by Stanford psychologist Albert Bandura, Ph.D. Self-efficacy refers to the confidence a person has in his/her abilities to perform a particular behavior or task with success. If you are certain that you can do a certain activity without any struggle, then your self-efficacy level is high. On the other hand, if you are certain you will not succeed in the activity, then your self-efficacy level is low. Self-efficacy can be seen as intrinsic motivation for a certain behavior or task: if you believe that you can perform a task with success, you will be more likely to engage in that task (or behavior). The construct of self-efficacy has important implications for healthy behavior and behavior change. Self-efficacy beliefs have been demonstrated to influence the adoption of new health practices, their generalization to different situations, and long-term maintenance.(1)
In cancer patients and survivors self-efficacy for coping with cancer was found to be inversely related with distress, and positively related with quality of life. (2) (3) In a study with breast cancer survivors, participants with higher levels of physical activity engagement exhibited greater self-efficacy. In turn, more efficacious women reported higher levels of physical self-worth, and greater physical self-worth was associated with greater global self-esteem. (4) Furthermore, higher levels of self-efficacy were associated with lower levels of fatigue. (5)
Although good quality research is lacking, it seems that the prevalence of lower levels of self-efficacy in cancer survivors does not seem to differ much from the general population. (6) (7) This however does not imply that lower levels of self-efficacy cannot be present. It is therefore crucial that clinicians should remain vigilant, and/or screen for low levels of self-efficacy in cancer survivors.
Cancer survivors are often faced with fatigue, pain and cognitive disorders.(8) These factors can decrease self-efficacy, but consequently can also be improved by increasing self-efficacy. Improving cancer patients' self-confidence in self-care behaviors has a favorable impact on their ability to implement cognitive and behavioral fatigue management techniques, as well as improve their quality of life.(9) Also, self-efficacy, together with physical activity, familial toughness, and social support all have a favorable impact on a cancer survivors’ resilience, improving recovery and quality of life.(10)
The question remains, how do we improve self-efficacy in cancer survivors?
The concept of self-efficacy is central to the social cognitive theory. The importance of self-efficacy in patients' adaptability to their condition and self-care behavior has been highlighted.(11) The theory of self-efficacy was developed on four principles: performance attainment (direct mastery experiences), vicarious experiences (observing the performance of others), verbal persuasion, and arousal state (physiological states to partly judge their capability, strength, and vulnerability).
Performance attainment is considered one of the most powerful methods of developing or improving self-efficacy. This experience can be utilized to establish efficacy in other tasks depending on past performance. Previous failures, on the other hand, can be disheartening and reduce efficacy levels. Vicarious experiences or observing others perform can also be effective. If a client has seen a peer perform a certain task, he/she may feel more confident in his/her own ability to perform the same task. The similar the peer is to the person, the more persuasive this person will be. It is therefore suggested that group classes can be effective for improving self-efficacy. One caveat is that a person can be comparing him/herself too much with a peer, which in term could have a negative effective on self-efficacy (e.g. feeling of injustice etc.).
Verbal or social persuasion involves the stimulation from others. Encouragement and positive feedback are common techniques. Overall, verbal or social persuasion has a less impact on self-efficacy development than performance attainment or vicarious experiences, and it must be paired with actual successes. Obviously, the efficiency of this strategy is determined by the persuader's credibility, trustworthiness, and skill.
The arousal state, influenced by anxiety, stress and other emotions, can negatively impact self-efficacy, however, this is less influential than the other sources. Learning on how to cope with stress, anxiety or even depression can increase self-efficacy.
Self-efficacy can be improved with some practical strategies like goal setting, self-monitoring, problem-solving barriers and implementing solutions. An additional supportive network of peers, together with some positive self-talk and a journal can also be helpful. A clinician that functions as a guide and gives feedback can also increase the success rate of improving self-efficacy. Even though robust research is lacking on the effectiveness and efficacy of modalities for improving self-efficacy, it is known that these domains are similarly used in graded exposure and graded activity programs, and in cognitive behavioral therapies for the treatment of fatigue and chronic pain.
As a clinician I think it’s important to guide patients to a life with improved self-efficacy and robustness. To the best of my knowledge, I have not come across studies who show adverse effects on improving self-efficacy or having high self-efficacy. So therefore I can only conclude that when you are psychologically robust, it can be easy to adjust!