With recent improvements in the early detection, diagnosis, and treatment of cancer, people with cancer are living longer, and their cancer may be managed as a chronic illness. Cancer as a chronic illness places new demands on patients and families to manage their own care, and it challenges old paradigms that oncology's work is done after treatment. As a chronic illness, however, cancer care occurs on a continuum that stretches from prevention to the end of life, with early detection, diagnosis, treatment, and survivorship in between. In this article, self-management interventions that enable patients and families to participate in managing their care along this continuum are reviewed. Randomized controlled trials of self-management interventions with cancer patients and families in the treatment, survivorship, and end-of-life phases of the cancer care continuum are reviewed, and the Chronic Care Model is presented as a model of care that oncology practices can use to enable and empower patients and families to engage in self-management. It is concluded that the need for a common language with which to speak about self-management and a common set of self-management actions for cancer care notwithstanding, oncology practices can now build strong relationships with their patients and formulate mutually agreed upon care plans that enable and empower patients to care for themselves in the way they prefer. CA Cancer J Clin 2011;61:50-62.

The definition of malnutrition in the elderly is defined as following: faulty or inadequate nutritional status; undernourishment characterized by insufficient dietary intake, poor appetite, muscle wasting and weight loss. In the elderly, malnutrition is an ominous sign. Without intervention, it presents as a downward trajectory leading to poor health and decreased quality of life. Malnutrition in the elderly is a multidimensional concept encompassing physical and psychological elements. It is precipitated by loss, dependency, loneliness and chronic illness and potentially impacts morbidity, mortality and quality of life.

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It is hoped that a more uniform definition of the concept will enable researchers to continue investigating antecedents and consequences of the concept in a way that allows for aggregating results.

Background The development of instruments to measure self-management in youth with type 1 diabetes has not kept up with current understanding of the concept. Objective To report the development and testing of a new self-report measure to assess self-management of type 1 diabetes in adolescence (SMOD-A). Methods Following a qualitative study, items were identified and reviewed by experts for content validity. A total of 515 adolescents, 13 to 21 years old, participated in a field study by completing the SMOD-A (either once or twice) and additional measures of diabetes related self-efficacy (SEDS), quality of life (DQOL), self-management (DSMP), and adherence (SCI). Data were collected also on metabolic control (HbA1c). Results The content validity of the scale (CVI) was .93. Exploratory alpha factor analyses revealed five subscales: Collaboration with Parents, Diabetes Care Activities, Diabetes Problem-Solving, Diabetes Communication, and Goals (α = .71 to .85). The stability of the SMOD-A ranged from .60 to .88 at 2 weeks (test-retest) to .59 to .85 at 3 months. Correlations of SMOD-A subscales with SEDS-Diabetes; DQOL satisfaction, impact, and worry; DSMP; and SCI were generally significant and in the expected direction. Collaboration with Parents and HbA1c values were related significantly and positively (r =.11); all other SMOD-A subscales were related significantly and negatively to HbA1c (r = −.10 to −.26), demonstrating that better self-management is associated somewhat with better metabolic control and supporting construct validity of the new measure. Discussion The SMOD-A has been found to be a reliable, stable, and valid measure of self-management of type 1 diabetes in adolescence.

Using experiential content validity experts (adolescents and parents) and critically evaluating their recommendations regarding items can result in further elimination and revision of items beyond what is suggested by content validity assessment done by professional experts. The result may be a more thorough content validity assessment of the instrument, leading to an instrument with greater relevance for the target population.

Clinicians should consider the influence of adolescent stage and development on self-management when educating adolescents. Youth and their families should be educated to consider the implications that regimen will have on daily self-management when making treatment decisions. Furthermore, gender variations can necessitate different educational approaches to meet different needs. Future research should identify other variables that can influence self-management at different points across adolescence.

Instrument development has been hindered by the lack of clarity concerning the concept of self-management of type 1 diabetes in children and adolescents. Existing measures need to be further developed and new measures need to be designed.