Feasibility Of Lifestyle Counseling For Cancer Survivors In Nigeria

BackgroundCancer is a menace that is wreaking havoc in many countries and Nigeria is no exception. Cancer statistics for the country is dismal to say the least, with little or no survival estimated for most cancer types. Lifestyle behavior changes have proven to be a lifeline in the management of cancers, having been evidenced to enhance physiological outcomes, palliate symptoms and increase chances of long-term survival.AimThis study aimed to recommend feasible self-management strategies for cancer control in Nigeria and identify factors associated with doctors’intention to provide lifestyle counseling to cancer survivors. This would provide evidence for the development of an intervention to improve chances of survival.MethodsThe contents of this study is as follows:(1) the necessity and feasibility of self-management to improve the quality of life and chances of survival of cancer patients;(2) the importance of doctor’s counseling in improving the self-management skills of cancer patients;(3) factors that may influence Nigerian doctors intention to provide counseling to cancer patients;(4) the suitability of the Theory of Planned Behavior (TPB) as a theoretical model for this study.Data Sources and methods:(1) Literature review:this was conducted to assess lifestyle counseling as a possible self-management strategy for Nigerian cancer patients. It involved:(1) review of evidence on self-management strategies that may improve cancer care;(2) review of literature on lifestyle counseling as a cost-effective method of implementing self-management strategies;(3) identification of the TPB model as an appropriate behavior change model for the study.(2) Questionnaire development: the TPB was applied to explore the possibility of Nigerian doctors provision of counseling for cancer survivors. It involved:(1) questionnaire design on doctor’s intention and behavior based on the TPB model;(2) pre-test of reliability and validity of the questionnaire for quality analysis;(3) cross-sectional survey:self-administered questionnaires given to Nigerian doctors working at two tertiary hospitals in Enugu state, Nigeria.(3) Statistical Analysis:Application of structural equation modeling (SEM) and SPSS for data analysis.ResultsThe results obtained at each step of this study are as follows:(1) The literature review identified lifestyle behavior change as an effective self-management strategy for cancer control. Due to poverty and lack of government funding, lifestyle counseling was identified as a cost-effective strategy for cancer control in Nigeria.(2) The TPB-based questionnaire designed to assess doctor’s willingness to provide counseling, proved to be valid and reliable with significant Intraclass correlation coefficient and Cronbach’s alpha coefficients>0.7for most variables. (3)210medical doctors participated in the cross-sectional survey and were made up of7.1%oncologists,16.2%general practitioners (GP) and76.7%from other specialties.(4) For the SEM analysis, goodness-of-fit indices indicated adequate fit for the final structural models. Attitude (standardized estimate=0.44, p<0.001) was the only statistically significant predictor of intention to provide lifestyle counseling in the final direct TPB model, while subjective norm and PBC were insignificant. In the indirect TPB model, both behavioral belief (standardized estimate=0.40, p<0.001) and normative belief (standardized estimate=0.27, p=0.004), significantly predicted intention while control belief was still insignificant. Also, intention (OR=2.231and95%CI1.058to4.706) significantly predicted counseling behavior.ConclusionBased on the TPB results obtained in this study, Nigerian doctors’intention to provide lifestyle counseling to cancer patients is dependent on their attitude and subjective norm. This evidence attests to the feasibility of lifestyle counseling in Nigeria and informs the design of a behavioral intervention to improve lifestyle counseling behavior in the country’s cancer management programs. Measures to promote physician’s attitudes and subjective norm, will improve doctor’s willingness to provide lifestyle counseling as well as improve the cancer patient’s self-management skills.Study Innovation and limitationsTo our knowledge, this study is the first to assess the importance and feasibility of Nigerian doctor’s provision of lifestyle counseling for cancer survivors. The study on the Theory of Planned Behavior and lifestyle counseling provided evidence that attitude and subjective norm are factors which may serve as potential barriers to doctors’provision of counseling.This study was limited by financial and time constraints hence; the current study population consisted of doctors in one city in Nigeria and may require replication in several other major cities to enhance generalizability of the results.