Date of Degree

9-2021

Document Type

Dissertation

Degree Name

Ph.D.

Program

Nursing

Advisor

Elizabeth Capezuti

Committee Members

Steven Baumann

Elizabeth Cohn

Daniel Gardner

Dena Schulman-Green

Judith Nelson

Subject Categories

Palliative Nursing

Keywords

transition, self-management, distress, pancreatic cancer

Abstract

Pancreatic cancer is one of the most commonly diagnosed cancers and is associated with a poor prognosis measured in terms of months and with significant palliative care needs, including psychological distress. Self-management describes a patient’s ability to manage the sequelae of serious illness, which can have an impact on quality of life and psychological health. One of the fundamental self-management skills is the management of transitions. A transition is a change in life situation or status that causes a shift in a patient’s identity, role, behavior, or interpersonal relationships. Patients with cancer experience multiple, often overlapping transitions that can influence their ability to self-manage.

The aim of this dissertation was to identify transitions experienced by patients with pancreatic cancer and to measure their management of these transitions. This study was guided by the Self- and Family Management Framework and Transitions Theory. In this prospective longitudinal multi-method correlational study, a convenience sample of 55 patients with pancreatic cancer from one medical oncology clinic at Memorial Sloan Kettering Cancer Center were asked to report on their health-illness transition experiences at two time-points with the Measurement of Transitions in Cancer Scale (MOT-CA) and the Distress Thermometer (DT).

Patients reported experiencing multiple health-illness transitions and managed these transitions moderately well. The patients experienced emotional distress, and there was a correlation between unmanaged transitions and distress at both time points. Patients reported several new transition domains, including financial and caregiver transitions, and described the impact of COVID-19 on their experience. Transitions were found to influence the self-management practices of the patients. Barriers and facilitators to active self-management were identified. Future research is needed to better understand the transition experiences of patients with different tumor types and disease course, and of family caregivers.

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