Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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

References

    1. American College of Surgeons. Cancer program standards 2012: ensuring patient-centered care. In:2012.
    1. American Cancer Society. National Cancer Survivorship Resource Center systems policy and practice: Clinical Survivorship care overview. Washington, DC: 2011.
    1. Mayer DK, Shapiro CL, Jacobson P, McCabe MS. Assuring quality cancer survivorship care: we’ve only just begun. Am Soc Clin Oncol Educ Book Am Soc Clin Oncol Meeting. 2015:e583–91. - PubMed
    1. Ganz PA. Institute of Medicine report on delivery of high-quality cancer care. J Oncol Pract. 2014;10(3):193–5. - PubMed
    1. Cowens-Alvarado R, Sharpe K, Pratt-Chapman M, Willis A, Gansler T, Ganz PA, et al. Advancing survivorship care through the National Cancer Survivorship Resource Center. CA Cancer J Clin. 2013;63(3):147–50. - PubMed

Publication types

MeSH terms