Support Care Cancer (2015) 23:651–659 DOI 10.1007/s00520-014-2399-5
ORIGINAL ARTICLE
Rebuilding self-confidence after cancer: a feasibility study of life-coaching Richard Wagland & Deborah Fenlon & Ruth Tarrant & Gilly Howard-Jones & Alison Richardson
Received: 21 October 2013 / Accepted: 11 August 2014 / Published online: 27 August 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract Background Cancer survivors often experience decreased self-confidence which impacts negatively on their ability to self-manage the practical, social and emotional problems frequently faced as they emerge from end of treatment. This was a feasibility study of a life-coaching intervention, designed to rebuild confidence of survivors and support transition to life after cancer treatment. Methods A one group pre-test, post-test design was used, recruiting participants from community organisations. Eligibility criteria are as follows: 18, no metastases, and no mental health problems. Participants received one individualised face-to-face and five telephone coaching sessions over 3 months. Outcome measures are as follows: New General Self-Efficacy Scale, Hope Scale, Personal Well-being Index, Assessment of Survivorship Concerns, Quality of Life in Adult Cancer Survivors, Hospital Anxiety and Depression Scale, Social Difficulties Index, and a goal attainment score.
Interviews explored feasibility, acceptability and impact of life-coaching and research design. Results Nine women and two men were recruited, representing varying cancer diagnoses. All outcome measures were sensitive to change and indicated positive trends postintervention. Participant interviews indicated the intervention was well received and had a positive impact. Lessons were learnt about study design, recruitment and intervention delivery. Conclusions Life-coaching has a potential to enable cancer survivors to manage the transition to life beyond cancer and effect change on a range of outcomes. The intervention was feasible to deliver and acceptable to survivors at a time when many struggle to make sense of life. It merits further evaluation through a randomised controlled trial.
Implications for research/policies: Life-coaching potentially offers an effective way to address the challenging social, personal and economic issues patients experience as they move to a life beyond cancer treatment.
Background
R. Wagland (*) : D. Fenlon Faculty of Health Sciences, University of Southampton, Highfield, Southampton S017 1BJ, UK e-mail: [email protected] R. Tarrant : G. Howard-Jones University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK A. Richardson Faculty of Health Science, Southampton General Hospital, University of Southampton & University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
Keywords Coaching . Cancer survivors . Evaluation . Quality of life
The transition from ‘cancer patient’ to ‘cancer survivor’ is often accompanied by practical, social and emotional problems detrimental to quality of life (QoL), which can remain unresolved for years [1–3]. Self-management of survivorship problems has become a policy priority [4, 5], with selfmanagement in cancer survivorship being defined as awareness and active participation by the person in their recovery, recuperation and rehabilitation, to minimise the consequences of treatment and promote survival, health and wellbeing [5]. However, evidence suggests that the experience of cancer diagnosis and treatment can diminish survivors’ selfconfidence to cope [6]. Rebuilding the confidence of survivors
652
is therefore a key component of self-management [6], and interventions that promote self-confidence are needed. Life-coaching builds on the natural resources of individuals to meet challenges in their lives, providing structured, focussed support to facilitate a clearer understanding of the future a person wants, and enhances their self-confidence through successfully pursuing meaningful, self-selected goals. However, although previous studies have explored ‘coaching’ interventions targeted at issues concerning cancer patients and survivors, including pain control [7–10], dietary patterns [11], fatigue [12], relationships with partners [13] and interaction with oncologists [14], a recent systematic review revealed that most such interventions involved goals that were professionally derived and problem-specific [15]. They were not therefore specifically directed at improving self-confidence. Given that cancer survivors may have a range of needs they need to self-manage, but have decreased confidence to do this, there is a clear role of coaching to increase self-confidence to manage a wide range of problems. Only two cancer coaching studies have involved participants self-selecting goals [16, 17], but these did not report the goal selection process, measure goal achievement or impact on self-confidence. This study was therefore conducted to explore the feasibility of delivering and measuring the impact of a life-coaching intervention specifically designed to rebuild people’s confidence and emotional well-being and enhance QoL by supporting individuals to select and achieve their own post-treatment goals.
Support Care Cancer (2015) 23:651–659
Setting Participants were recruited from community-based local support groups and via cancer information and support centres at four hospitals in southwest England. Sample The intervention was directed at the following: & & &
Those who had completed ‘curative’ treatment (surgery/ radiotherapy/chemotherapy) for any tumour type within the previous 12 months Those who were over 18 years Those who had no metastatic disease or self-reported history of mental illness
Ethical approval Ethical approval was gained from the Faculty of Health Sciences (FoHS) ethics committee at the University of Southampton, England (FoHS-ETHICS-2011-071). NHS ethical approval was not sought as recruitment did not involve NHS staff or take place on NHS property. All participants gave informed consent before inclusion in the study.
Methods
Intervention
Study aims
Life-coaching is underpinned by social cognitive theory (SCT), which views self-efficacy as central to human agency. Self-efficacy comprises an individual’s confidence in their own abilities to take control of their life and to enact and maintain changes in their lives [19, 20]. The main purpose of life-coaching, therefore, is to improve an individual’s selfefficacy, achieved through successfully pursuing self-selected goals. Participants selected three goals with the assistance of a life-coach following a manualised version of standard practice. Participants first reviewed their lives to identify potential areas of change [awareness phase]. They then selected specific goals and devised development plans to achieve them, including galvanising necessary support and rehearsing potential challenges [choice phase]. Finally, participants implemented their plans [execution phase]. As participants progressed, they sometimes became aware of emerging practical and psychological challenges and alternative opportunities leading to goal refinement. The first two phases took place during an initial face-to-face session of up to 2 h in the coach’s office. The execution phase was implemented over five subsequent telephone sessions of up to 60 min, at approximately 2-week
The aims of this study are to explore the feasibility and impact of life-coaching and assess the merit of conducting a followon exploratory randomised trial. The specific objectives were the following: 1. To determine the acceptability and practicality of the intervention for cancer survivors 2. To explore the mechanisms by which coaching facilitates survivors to self-manage problems and achieve self-defined goals 3. To assess the acceptability of the data collection process and inform selection of measures to assess outcomes
Design In keeping with guidance from the Medical Research Council (MRC) [18], a design suitable for use during the initial stages of intervention development and evaluation was utilised: a pre-test, post-test design with a small cohort.
Support Care Cancer (2015) 23:651–659
653
A pre-test, post-test study design was adopted, including the following: questionnaires incorporating seven validated outcome measures and a Goal Attainment Scale (GAS) administered prior to the first life-coaching session and following the end of the last session, records maintained by both researchers and coaches, and participant interviews conducted within 1 month after completion of intervention. Study flyers and information packs were disseminated to both local community cancer support groups and information and support centres within four hospitals, inviting interested individuals to approach the study team. Recruitment ran from November 2011 to March 2012.
Hospital Anxiety and Depression Scale (HADS) [26] uses two subscales (each with seven items) to detect the presence and severity of mild anxiety and depression, summed with higher scores indicating greater anxiety and/or depression. For each subscale, a case is indicated by a score of 11+, and a borderline case by 8–10. Finally, the Social Difficulties Index (SDI) [27] comprises 16 items, with higher scores indicating greater levels of social distress (scores >10 are classified as socially distressed). GAS measurement has previously been used within clinical rehabilitation [28, 29], and there is some evidence for its reliability, validity and sensitivity [30]. Goal attainment is a key variable for the life-coaching intervention. Participants completed a GAS form following their first coaching session, outlining three self-selected goals and indicating their perceived achievement difficulty for each on a score of 1–10. On completion of the intervention, participants were returned their GAS forms to indicate their perceived actual achievement level with respect to each goal, again on a score of 0–10. Thus, perceived achievement of goals was weighted against their perceived difficulty [31, 32].
Outcome measures
Process evaluation
Validated measures were selected to reflect the outcomes lifecoaching sought to impact upon for participants. The New General Self-Efficacy Scale (NGSE) [21], premised upon the theory of self-efficacy ([19], has eight items which are summed, with higher scores indicating greater self-efficacy. The Hope Scale [22] comprises two domains related to goalsetting (an individual’s perception of their ability to generate effective goals and their ability to achieve them), each comprising eight items summed, with higher scores indicating greater hope. The Personal Well-being Index (PWI) [23] is a generic measure of subjective well-being across seven domains (standard of living, health, achievement in life, relationships, personal safety, community connectedness and future security), each with one item and summed to produce a mean satisfaction value. Higher scores denote higher satisfaction (scores
ORIGINAL ARTICLE
Rebuilding self-confidence after cancer: a feasibility study of life-coaching Richard Wagland & Deborah Fenlon & Ruth Tarrant & Gilly Howard-Jones & Alison Richardson
Received: 21 October 2013 / Accepted: 11 August 2014 / Published online: 27 August 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract Background Cancer survivors often experience decreased self-confidence which impacts negatively on their ability to self-manage the practical, social and emotional problems frequently faced as they emerge from end of treatment. This was a feasibility study of a life-coaching intervention, designed to rebuild confidence of survivors and support transition to life after cancer treatment. Methods A one group pre-test, post-test design was used, recruiting participants from community organisations. Eligibility criteria are as follows: 18, no metastases, and no mental health problems. Participants received one individualised face-to-face and five telephone coaching sessions over 3 months. Outcome measures are as follows: New General Self-Efficacy Scale, Hope Scale, Personal Well-being Index, Assessment of Survivorship Concerns, Quality of Life in Adult Cancer Survivors, Hospital Anxiety and Depression Scale, Social Difficulties Index, and a goal attainment score.
Interviews explored feasibility, acceptability and impact of life-coaching and research design. Results Nine women and two men were recruited, representing varying cancer diagnoses. All outcome measures were sensitive to change and indicated positive trends postintervention. Participant interviews indicated the intervention was well received and had a positive impact. Lessons were learnt about study design, recruitment and intervention delivery. Conclusions Life-coaching has a potential to enable cancer survivors to manage the transition to life beyond cancer and effect change on a range of outcomes. The intervention was feasible to deliver and acceptable to survivors at a time when many struggle to make sense of life. It merits further evaluation through a randomised controlled trial.
Implications for research/policies: Life-coaching potentially offers an effective way to address the challenging social, personal and economic issues patients experience as they move to a life beyond cancer treatment.
Background
R. Wagland (*) : D. Fenlon Faculty of Health Sciences, University of Southampton, Highfield, Southampton S017 1BJ, UK e-mail: [email protected] R. Tarrant : G. Howard-Jones University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK A. Richardson Faculty of Health Science, Southampton General Hospital, University of Southampton & University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
Keywords Coaching . Cancer survivors . Evaluation . Quality of life
The transition from ‘cancer patient’ to ‘cancer survivor’ is often accompanied by practical, social and emotional problems detrimental to quality of life (QoL), which can remain unresolved for years [1–3]. Self-management of survivorship problems has become a policy priority [4, 5], with selfmanagement in cancer survivorship being defined as awareness and active participation by the person in their recovery, recuperation and rehabilitation, to minimise the consequences of treatment and promote survival, health and wellbeing [5]. However, evidence suggests that the experience of cancer diagnosis and treatment can diminish survivors’ selfconfidence to cope [6]. Rebuilding the confidence of survivors
652
is therefore a key component of self-management [6], and interventions that promote self-confidence are needed. Life-coaching builds on the natural resources of individuals to meet challenges in their lives, providing structured, focussed support to facilitate a clearer understanding of the future a person wants, and enhances their self-confidence through successfully pursuing meaningful, self-selected goals. However, although previous studies have explored ‘coaching’ interventions targeted at issues concerning cancer patients and survivors, including pain control [7–10], dietary patterns [11], fatigue [12], relationships with partners [13] and interaction with oncologists [14], a recent systematic review revealed that most such interventions involved goals that were professionally derived and problem-specific [15]. They were not therefore specifically directed at improving self-confidence. Given that cancer survivors may have a range of needs they need to self-manage, but have decreased confidence to do this, there is a clear role of coaching to increase self-confidence to manage a wide range of problems. Only two cancer coaching studies have involved participants self-selecting goals [16, 17], but these did not report the goal selection process, measure goal achievement or impact on self-confidence. This study was therefore conducted to explore the feasibility of delivering and measuring the impact of a life-coaching intervention specifically designed to rebuild people’s confidence and emotional well-being and enhance QoL by supporting individuals to select and achieve their own post-treatment goals.
Support Care Cancer (2015) 23:651–659
Setting Participants were recruited from community-based local support groups and via cancer information and support centres at four hospitals in southwest England. Sample The intervention was directed at the following: & & &
Those who had completed ‘curative’ treatment (surgery/ radiotherapy/chemotherapy) for any tumour type within the previous 12 months Those who were over 18 years Those who had no metastatic disease or self-reported history of mental illness
Ethical approval Ethical approval was gained from the Faculty of Health Sciences (FoHS) ethics committee at the University of Southampton, England (FoHS-ETHICS-2011-071). NHS ethical approval was not sought as recruitment did not involve NHS staff or take place on NHS property. All participants gave informed consent before inclusion in the study.
Methods
Intervention
Study aims
Life-coaching is underpinned by social cognitive theory (SCT), which views self-efficacy as central to human agency. Self-efficacy comprises an individual’s confidence in their own abilities to take control of their life and to enact and maintain changes in their lives [19, 20]. The main purpose of life-coaching, therefore, is to improve an individual’s selfefficacy, achieved through successfully pursuing self-selected goals. Participants selected three goals with the assistance of a life-coach following a manualised version of standard practice. Participants first reviewed their lives to identify potential areas of change [awareness phase]. They then selected specific goals and devised development plans to achieve them, including galvanising necessary support and rehearsing potential challenges [choice phase]. Finally, participants implemented their plans [execution phase]. As participants progressed, they sometimes became aware of emerging practical and psychological challenges and alternative opportunities leading to goal refinement. The first two phases took place during an initial face-to-face session of up to 2 h in the coach’s office. The execution phase was implemented over five subsequent telephone sessions of up to 60 min, at approximately 2-week
The aims of this study are to explore the feasibility and impact of life-coaching and assess the merit of conducting a followon exploratory randomised trial. The specific objectives were the following: 1. To determine the acceptability and practicality of the intervention for cancer survivors 2. To explore the mechanisms by which coaching facilitates survivors to self-manage problems and achieve self-defined goals 3. To assess the acceptability of the data collection process and inform selection of measures to assess outcomes
Design In keeping with guidance from the Medical Research Council (MRC) [18], a design suitable for use during the initial stages of intervention development and evaluation was utilised: a pre-test, post-test design with a small cohort.
Support Care Cancer (2015) 23:651–659
653
A pre-test, post-test study design was adopted, including the following: questionnaires incorporating seven validated outcome measures and a Goal Attainment Scale (GAS) administered prior to the first life-coaching session and following the end of the last session, records maintained by both researchers and coaches, and participant interviews conducted within 1 month after completion of intervention. Study flyers and information packs were disseminated to both local community cancer support groups and information and support centres within four hospitals, inviting interested individuals to approach the study team. Recruitment ran from November 2011 to March 2012.
Hospital Anxiety and Depression Scale (HADS) [26] uses two subscales (each with seven items) to detect the presence and severity of mild anxiety and depression, summed with higher scores indicating greater anxiety and/or depression. For each subscale, a case is indicated by a score of 11+, and a borderline case by 8–10. Finally, the Social Difficulties Index (SDI) [27] comprises 16 items, with higher scores indicating greater levels of social distress (scores >10 are classified as socially distressed). GAS measurement has previously been used within clinical rehabilitation [28, 29], and there is some evidence for its reliability, validity and sensitivity [30]. Goal attainment is a key variable for the life-coaching intervention. Participants completed a GAS form following their first coaching session, outlining three self-selected goals and indicating their perceived achievement difficulty for each on a score of 1–10. On completion of the intervention, participants were returned their GAS forms to indicate their perceived actual achievement level with respect to each goal, again on a score of 0–10. Thus, perceived achievement of goals was weighted against their perceived difficulty [31, 32].
Outcome measures
Process evaluation
Validated measures were selected to reflect the outcomes lifecoaching sought to impact upon for participants. The New General Self-Efficacy Scale (NGSE) [21], premised upon the theory of self-efficacy ([19], has eight items which are summed, with higher scores indicating greater self-efficacy. The Hope Scale [22] comprises two domains related to goalsetting (an individual’s perception of their ability to generate effective goals and their ability to achieve them), each comprising eight items summed, with higher scores indicating greater hope. The Personal Well-being Index (PWI) [23] is a generic measure of subjective well-being across seven domains (standard of living, health, achievement in life, relationships, personal safety, community connectedness and future security), each with one item and summed to produce a mean satisfaction value. Higher scores denote higher satisfaction (scores
