The multi-causal nature of health behaviors calls for multifaceted interventions especially when trying to increase complex self-care behaviors under the adverse conditions of side effects from chemotherapy. The present study proposes to examine the effects of an intervention designed to increase self-efficacy in controlling responses to chemotherapy, to teach problem-solving regarding self-care, and to enable patients to control emotional responses to the side effects. The outcome sought is reduction in morbidity and enhanced quality of life because of increased self-care and increased perceptions of control. The major psycho-social intervening variables include health locus of control, health self-efficacy, and motivation of self-care. The key descriptive intervening variables are age, sex, place of residence (urban, rural) and availability of a self-care support person. Three study sites in central Illinois, serving both urban and rural patients, will provide participants for the study. Because of the widely varying levels of health care resources available to patients, this study provides a unique opportunity to determine the effects of a community-based intervention and the effects of self-care on morbidity as well as on health care utilization among a sample of cancer patients receiving their first cycles of highly emetic and hematologically toxic chemotherapy. A randomized clinical trial with two groups will be conducted. The experimental group will receive, in addition to a standard set of informational materials and the standard nursing and medical care received by all patients, a repeated intervention intended to increase self-efficacy, problem-solving and control of negative emotions. The intervention will begin two weeks after the initial chemotherapy cycle at the patient's home and will be continued before and after the next three cycles via telephone. The control group will receive only the standard information and usual nursing and medical care. Measurements of all baseline information will be obtained from all participants at a home visit two weeks after the first chemotherapy cycle. Subsequent measurement will occur following the next three cycles using health diaries, self- report via telephone calls and medical records of the oncologists. Dependent variables include measures of self-care actions; morbidity, defined as physical and psycho-social functioning; and health care utilization, defined in terms of contact with any health professionals, emergency room visits, number of hospitalizations, and days hospitalized. Multi-variate analyses will be used to test the effects of the intervention and the intervening variables.
