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Journal of Cancer Survivorship
Published in: Journal of Cancer Survivorship 6/2020

01-12-2020 | Care

A structural equation modeling approach to understanding pathways linking survivorship care plans to survivor-level outcomes

Authors: Jessica D. Austin, Marlyn Allicock, Folefac Atem, Simon Craddock Lee, Maria E. Fernandez, Bijal A. Balasubramanian

Published in: Journal of Cancer Survivorship | Issue 6/2020

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Abstract

Purpose

Several high-profile organizations have mandated the delivery of survivorship care plans (SCPs) despite mixed evidence regarding the effectiveness of SCPs on key survivor-level outcomes. There is a need to understand the types of survivor-level outcomes the SCPs are likely to change. Informed by existing frameworks and the literature, the objective of this study was to understand the pathways linking the receipt of a SCP to key survivor-level outcomes including patient-centered communication (PCC), health self-efficacy, changes in health behaviors, and improvements in overall health.

Methods

We used structural equation modeling to test the direct and indirect pathways linking the receipt of an SCP to patient-centered communication (PCC), health self-efficacy, and latent measures of health behaviors and physical health in a nationally representative sample of breast and colorectal cancer survivors from the Health Information National Trends Survey.

Results

The receipt of an SCP did not have a significant effect on key survivor-level outcomes and was removed from the final structural model. The final structural model fit the data adequately well (Chi-square p value = 0.03, RMSEA = 0.07, CFI = .88, and WRMR = 0.73). PCC had a significant direct effect on physical health but not on health behaviors. Health self-efficacy had a significant direct effect on physical health and health behaviors.

Conclusion

The receipt of an SCP alone is unlikely to facilitate changes in PCC, health self-efficacy, health behaviors, or physical health.

Implication for Cancer Survivors

A SCP is a single component of a larger model of survivorship care and should be accompanied by ongoing efforts that promote PCC, health self-efficacy, and changes in health behaviors resulting in improvements to physical health.
Appendix
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Metadata
Title
A structural equation modeling approach to understanding pathways linking survivorship care plans to survivor-level outcomes
Authors
Jessica D. Austin
Marlyn Allicock
Folefac Atem
Simon Craddock Lee
Maria E. Fernandez
Bijal A. Balasubramanian
Publication date
01-12-2020
Publisher
Springer US
Keyword
Care
Published in
Journal of Cancer Survivorship / Issue 6/2020
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI
https://doi.org/10.1007/s11764-020-00896-6

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