Graduation Year

2024

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Nursing

Major Professor

Theresa Beckie, Ph.D., MN, RN, FAHA, FAAN

Co-Major Professor

Hsiao-Lan H. Wang, Ph.D., RN, CMSRN, ACSM C-EP, FAAN

Committee Member

Brent Small, Ph.D.

Committee Member

Amanda Floetke Elliott, Ph.D.

Committee Member

Victoria Marshall, Ph.D., RN

Committee Member

Danielle Tometich, Ph.D.

Keywords

Mechanism, Structural Equation Model, Self-Efficacy, Symptom Management, Mediation

Abstract

Cancer symptoms significantly impact the quality of life (QOL) among cancer patients. Self-efficacy plays a key role in managing symptoms and improving QOL. Also, as a suffering from symptom occurrence, symptom distress predicts QOL. However, it is not clear whether self-efficacy and/or symptom distress mediate the effects of symptoms on QOL. This dissertation seeks to explore if and how self-efficacy and symptom distress mediate the relationship between symptom occurrence and QOL among 534 cancer patients. The specific aims were to: 1) test the factor structure and the longitudinal invariance of the Cancer Behavioral Inventory in our sample of cancer patients and 2) examine the mediating effects of self-efficacy and symptom distress on the relationship between symptom occurrence and QOL. The results from factor analysis confirmed the four-factor structure of the CBI-B development study and resulted in 12 items (items 5 and 14 deleted) with items 1 and 6 moderately correlated. Then, a series of hierarchical models were tested for the longitudinal invariance of this factor structure. The results showed that strong invariance over 13 weeks holds for the four-factor structure (CFI = 0.938, RMSEA = 0.043, SRMR = 0.053). The four-factor solution maintained the same factor structure across four-time points, demonstrating the stability of measuring the same construct on four occasions. Finally, the results from the final structural equation model revealed two mediating routes: cancer coping self-efficacy (week 4) (β = -0.035, B = -0.161, p = 0.000, CI95 = [-0.050, -0.021]) mediated the relationship between symptom occurrence (week 1) and QOL (week 10); cancer coping self-efficacy (week 4) and symptom distress (week 4) also work as serial mediators (β = -0.003, B = -0.013, p = 0.041, CI95 = [-0.006, -0.000]) between symptom occurrence (week 1) and QOL (week 10). This study is only a start to investigate the causal mechanism of change, and a series of investigations are needed to establish such a mediating influence to explain the change.

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