All ETDs from UAB

Advisory Committee Chair

Karen Meneses

Advisory Committee Members

Karen Heaton

Nataliya Ivankova

Kristen Triebel

David E Vance

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Nursing


Advancements in screening, early detection, and treatment have increased breast cancer survival. In the United States, the 5-year relative survival rate for breast cancer is 89%. With more women surviving breast cancer, there are now more than 3.5 million breast cancer survivors (BCS), a figure estimated to increase to 4.3 million by 2020. Survivors experience long-term symptoms of their cancer and treatment which may last years and even decades after diagnosis and treatment. This symptom experience may potentially have exacerbating effects on BCS’ cognitive function as well as their ability to adhere to interventions aimed at improving cognitive function. The intent of this study was to explore the relationship between selected cancer-related symptoms and adherence to the Speed of Processing in Middle Aged and Older Breast Cancer Survivors (SOAR) web-based cognitive training intervention among BCS residing in Alabama by using a sequential Quan → QUAL mixed methods design. The goal of the quantitative phase of this study was to identify the relationship between selected cancer-related symptoms (i.e., perceived cognitive impairment, poor sleep quality, and depressive symptoms) and adherence to the SOAR intervention among BCS (n = 30) through self-reported questionnaire data (i.e., sociodemographic, Cognitive Failures Questionnaire (CFQ), Pittsburg Sleep Quality Index (PSQI), and Center for Epidemiologic Studies-Depression Scale (CES-D)). Data were analyzed using R Studio 3.3.1 software. Spearman’s rho correlation suggested realtionships between adherence and perceived cognitive impairment, depressive symptoms, and sleep quality. Results of the quantitative phase were used to inform the development of the interview protocol and participant selection for the second phase. The goal of the qualitative phase of this study was to better understand how identified selected cancer-related symptoms contribute to or impede BCS’ adherence to the SOAR intervention by conducting semistructured interviews with 15 purposefully selected SOAR intervention participants. Inductive thematic analysis yielded four themes that describe how cancer-related symptoms are related to adherence to SOAR among BCS, differences between adherent and non-adherent participants, and cultural aspects: 1) experiences of cancer-related symptoms; 2) influences of cognitive training; 3) adherence to cognitive training; and 4) environment for cognitive training. To describe the interrelationship of the emergent themes in their joint influence on BCS’ adherence to cognitive training, a model was developed. Integration of the findings identified that response to awareness of perceived cognitive impairment is critical to cognitive training adherence and that cognitive training exacerbates depressive symptoms among some BCS. Moreover, poor sleep quality can aggravate cognition and mood and negatively influenced cognitive training motivation and performance, creating a snowball effect. Yet, continued cognitive training may improve sleep, mood, and cognition among BCS. Findings from this study illuminated the participant experience of cognitive training and cancer-related symptoms and their dynamic relationships with adherence. Experiences of and responses to cognitive training and cancer-related symptoms shape adherence to cognitive training among BCS. BCS in this study who continued cognitive training experienced improved sleep, mood, and cognition. Further study and application of findings may potentially aid in self-management of concurrent cancer-related symptoms, delivery of cognitive interventions, and improved cognition and ultimately quality of life among BCS.

Included in

Nursing Commons



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