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. 2020 Dec;14(6):834-846.
doi: 10.1007/s11764-020-00896-6. Epub 2020 May 30.

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

Jessica D Austin  1 , Marlyn Allicock  2   3   4 , Folefac Atem  5 , Simon Craddock Lee  3   6 , Maria E Fernandez  2   4 , Bijal A Balasubramanian  3   4   7
Affiliations

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

Jessica D Austin et al. J Cancer Surviv. 2020 Dec.

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.

Keywords: Cancer survivors; Patient care planning; Patient relevant outcome; Patient-provider communication; Structural equation modeling.

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Conflict of interest statement

Conflicts of interest The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Hypothesized pathways linking SCPs to proximal and distal outcomes
Fig. 2
Fig. 2
Standardized results for the final structural model. A single asterisk indicates significance at p < 0.05
Fig. 3
Fig. 3
HINTS Sample 1 Model
See this image and copyright information in PMC

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