TREATMENT SUMMARIES AND FOLLOW-UP CARE INSTRUCTIONS FOR CANCER SURVIVORS: IMPROVING SURVIVOR SELF-EFFICACY AND HEALTH CARE UTILIZATION
Method: 461 cancer survivors from 12 cancer centers across AL, MS, GA, FL, and TN completed telephone surveys. Participants were ≥65 years old, had completed treatment, and were ≥2 years post-diagnosis. We assessed whether they had received a written treatment summary and whether a health care professional explained their follow-up care plan. Respondents completed the Stanford Chronic Illness Management Self-Efficacy Scale and self-reported ER visits and hospitalizations in the past year. Multiple linear regression models estimated the association of 1) treatment summary and 2) follow-up care plan explanation with total self-efficacy score, controlling for race, age, sex, years since diagnosis, disease severity, and enrollment status in a navigation program. Multiple logistic regression models examined the association of self-efficacy scores with 1) ER visits and 2) hospitalizations (yes/no) while adjusting for covariates. We explored mediation and moderation analyses to examine the potential relationship between treatment summaries, self-efficacy, and ER/hospitalizations.
The majority of survivors were female (53%) and 21% were minorities. Survivors were on average 75 years old and 4.6 years from diagnosis. The most frequent diagnoses were breast (15%), prostate (17%), or lung (11%). Approximately 38% reported receiving a written treatment summary plan and 75% reported that a health care professional explained their follow-up care plan. In the adjusted models, receiving treatment summaries and follow-up care instructions were significantly associated with higher self-efficacy scores (B=0.47, SD=0.23, p=0.04 and B=0.75, SD=0.27, p=0.007, respectively). In the adjusted logistic regression models, higher self-efficacy scores were significantly associated with decreased odds of ER visits (OR:0.85; 95% CI:0.77, 0.93) and hospitalizations (OR:0.87 95% CI:0.79, 0.96) in the past year. Self-efficacy mediated the relationship between follow-up care instructions and ER use.
Conclusion: Verbal explanations of the follow-up care plan by a health care professional to older cancer survivors, beyond the written component of the care plan, may enhance survivor self-efficacy for managing cancer as a chronic condition. Self-efficacy may be associated with lower odds of health care utilization, but the mechanism through which self-efficacy is associated with ER/hospitalizations needs further examination.