title: Avoidant coping and self-efficacy mediate relationships between perceived social constraints and symptoms among long-term breast cancer survivors.
abstract: Many breast cancer survivors feel constrained in discussing their cancer experience with others. Limited evidence suggests that social constraints (e.g., avoidance and criticism) from loved ones may negatively impact breast cancer survivors' global health, but research has yet to examine relationships between social constraints and common physical symptoms. Informed by social cognitive processing theory, this study examined whether perceived social constraints from partners and healthcare providers (HCPs) were associated with fatigue, sleep disturbance, and attentional functioning among long-term breast cancer survivors (N = 1052). In addition, avoidant coping and self-efficacy for symptom management were examined as potential mediators of these relationships.
  
  
  
  Long-term breast cancer survivors (mean years since diagnosis = 6) completed questionnaires assessing social constraints from partners and HCPs, avoidant coping, self-efficacy for symptom management, and symptoms (i.e., fatigue, sleep disturbance, and attentional functioning). Structural equation modeling was used to evaluate the hypothesized relationships among variables in two models: one focused on social constraints from partners and one focused on social constraints from HCPs.
  
  
  
  Both models demonstrated good fit. Consistent with theory and prior research, greater social constraints from both partners and HCPs were associated with greater symptom burden (i.e., greater fatigue and sleep disturbance, poorer attentional functioning). In addition, all relationships were mediated by avoidant coping and self-efficacy for symptom management.
  
  
  
  Findings are consistent with social cognitive processing theory and suggest that symptom management interventions may be enhanced by addressing the impact of social constraints from survivors' partners and HCPs on their coping and self-efficacy. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
authors.forename: Rebecca N
authors.initials: RN
authors.lastname: Adams
authors.affiliation: Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Mosher
authors.affiliation: Indiana University School of Nursing, Indianapolis, IN, USA.
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Cohee
authors.affiliation: Department of Biostatistics, Indiana University School of Medicine and School of Public Health, Indianapolis, IN, USA.
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Stump
authors.affiliation: Department of Biostatistics, Indiana University School of Medicine and School of Public Health, Indianapolis, IN, USA.
authors.forename: Patrick O
authors.initials: PO
authors.lastname: Monahan
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: George W
authors.initials: GW
authors.lastname: Sledge
authors.affiliation: Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA.
authors.forename: David
authors.initials: D
authors.lastname: Cella
authors.affiliation: Indiana University School of Nursing, Indianapolis, IN, USA.
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Champion
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001288:Attention / Q000502:physiology; D001362:Avoidance Learning; D001943:Breast Neoplasms / Q000150:complications* / Q000523:psychology* / Q000628:therapy; D000073116:Cancer Survivors / Q000523:psychology* / Q000706:statistics & numerical data; D005221:Fatigue / Q000209:etiology; D005260:Female; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D008875:Middle Aged; D020377:Self Efficacy; D012747:Sexual Partners / Q000523:psychology; D012893:Sleep Wake Disorders / Q000209:etiology; D012938:Social Perception; D066269:Social Theory; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: breast cancer; coping; oncology; self-efficacy; social constraints; symptoms