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Manne SL, Hudson SV, O'Malley D, Devine KA, Matasar M, Peram J, Solleder J, Handorf E, Evens AM. Survivorship preparedness and activation among survivors of lymphoma. J Cancer Surviv 2024:10.1007/s11764-024-01664-6. [PMID: 39190132 DOI: 10.1007/s11764-024-01664-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 08/15/2024] [Indexed: 08/28/2024]
Abstract
OBJECTIVES Taking an active role in managing post-treatment care has emerged as a key aspect of promoting a successful transition into survivorship and is associated with better patient outcomes. In this study, we focus on two key aspects of active self-management, activation and preparedness. Activation was defined as understanding one's role in the care process and having the knowledge, skill, and confidence to take on a role in managing self-care. Preparedness was defined as the extent to which individuals perceived they had sufficient information about what to expect after cancer treatments are completed. The study goal was to characterize survivorship preparedness and activation among lymphoma survivors within 5 years of treatment completion in New Jersey and examine the association of sociodemographic, medical, care transition experiences, practical concerns, and psychosocial factors with activation and preparedness. METHODS One hundred and one Hodgkin lymphoma or non-Hodgkin lymphoma survivors who had completed treatment within 5 years completed a survey of survivorship care experiences (response rate = 34.12%). RESULTS Approximately 60% of survivors reported high activation, with similar percentages for higher preparedness. Less activated survivors were significantly (p < .05) younger, married, resided in a more deprived geographic area, and reported more fatigue and information needs. Less activated survivors reported recalling that their providers were significantly (p < .05) less likely to discuss long-term side effects, psychosocial needs, risk-reducing lifestyle recommendations, and how to manage other medical concerns. Fewer care transition practices were most strongly associated with lower preparedness. CONCLUSIONS A significant proportion were not activated for survivorship, and both activation and preparedness were strongly associated with providers' survivorship transition practices. IMPLICATIONS FOR CANCER SURVIVORS Implementing programs to foster more activation and preparedness for lymphoma survivorship care would benefit from education about recommended follow-up care and healthy lifestyle practices. Providers should routinely ask about their patients' confidence and preparedness for survivorship and provide referrals for appropriate care as needed.
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Affiliation(s)
- Sharon L Manne
- Rutgers Cancer Institute of New Jersey, 120 Albany Street, Tower 2 Floor 8, New Brunswick, NJ, 08901, USA.
| | - Shawna V Hudson
- Dept Family Medicine and Community Health, Rutgers RWJ Medical School, 303 George Street, Rm 309, New Brunswick, NJ, 08901, USA
| | - Dena O'Malley
- Dept Family Medicine and Community Health, Rutgers RWJ Medical School, 303 George Street, Rm 309, New Brunswick, NJ, 08901, USA
| | - Katie A Devine
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA
| | - Matthew Matasar
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA
| | - Jacintha Peram
- Rutgers Cancer Institute of New Jersey, 120 Albany Street, Tower 2 Floor 8, New Brunswick, NJ, 08901, USA
| | - Justin Solleder
- Rutgers Cancer Institute of New Jersey, 120 Albany Street, Tower 2 Floor 8, New Brunswick, NJ, 08901, USA
| | - Elizabeth Handorf
- Rutgers School of Public Health, 120 Albany Street, Tower 2 Floor 5, New Brunswick, NJ, 08901, USA
| | - Andrew M Evens
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA
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Yiran Z, Yan Z, Lijun X, Xizheng L, Xinjie Z, Yutong T. Current status and influencing factors of activation of older patients with chronic disease. Front Public Health 2024; 11:1308196. [PMID: 38328547 PMCID: PMC10847314 DOI: 10.3389/fpubh.2023.1308196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/26/2023] [Indexed: 02/09/2024] Open
Abstract
Objective We aimed to investigate the status and influencing factors of activation of older patients with chronic disease. Methods We conducted a cross-sectional study, using the general information questionnaire, Patient Activation Measure, the Chinese version of the e-Health Literacy Scale, and the Health Empowerment Scale for the Elderly with Chronic Disease. By the convenience sampling method, 289 older patients with chronic disease were selected from January to April 2023 in a Class A tertiary hospital in Zhengzhou. Results The mean score of the Patient Activation Measure for older patients with chronic disease was 65.94 ± 13.35. The association of influencing factors such as religion, family income, health empowerment, e-health literacy, and patient activation was investigated. Conclusion The patient activation of older patients with chronic disease was at a middle level. Patients without religion and from high-income families tended to have a higher level of patient activation. Improving health empowerment and e-health literacy levels promotes patient activation and enhances their self-health management ability.
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Affiliation(s)
| | - Zhang Yan
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
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Carrion IV, Neelamegam M, Estapé T, Doering T, Snyder O, Tollinchi E, Estapé J. Cancer Prevention and Diagnosis Knowledge among Spanish-speaking Older Latino/as Residing in Tampa, Florida. Ethn Dis 2022; 32:185-192. [PMID: 35909640 PMCID: PMC9311304 DOI: 10.18865/ed.32.3.185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objective Cancer remains the leading cause of death among Latino/as in the United States, and advancing age is a major risk factor for developing most cancer types. Given the growing population of Latino/as immigrants aged ≥60 years and the current lack of relevant data, this study aims to understand the cancer prevention and perception of cancer diagnosis among older Latinos to ensure that they receive effective prevention, intervention, and psychosocial care. Method A survey exploring attitudes about cancer was developed and administered in Spanish. Using convenience sampling, 168 individuals identifying as Latino/as were surveyed in Tampa, Florida. Descriptive analysis was conducted to understand study population characteristics. Frequencies were assessed to understand the participants' responses to cancer-related attitude questions. The effects of age, country of origin, length of stay in the United States, and marital status on the participants' cancer-related attitudes were assessed using logistic regression. Results The mean age of the study participants was 67.9 years, 34.5% were male, and the mean length of stay in the United States was 25.8 years. In total, 29% and 24.4% of the participants knew that breast cancer and prostate cancer, respectively, can be diagnosed early. Individuals with an elementary education were less likely to have sufficient knowledge of cancer prevention and diagnosis. Additionally, 93.5% of the population was aware that tobacco use can lead to cancer, and 84.5% knew that exposure to tobacco smoke can affect both the smoker and their family. Conclusion Older Latino/as possess knowledge about cancer causes yet lack knowledge regarding cancer prevention and diagnosis, potentially creating barriers and causing them to avoid treatment. Focusing on cancer-related health education among older Latino/as is a step toward appropriate and equitable cancer care.
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Affiliation(s)
- Iraida V. Carrion
- University of South Florida, School of Social Work, Tampa, FL, Address correspondence to Iraida V. Carrion, PhD, University of South Florida, School of Social Work, 13301 Bruce B. Downs Blvd., Tampa, FL 33612-3807.
| | - Malinee Neelamegam
- University of North Texas Health Science Center, School of Public Health, Fort Worth, TX
| | - Tania Estapé
- FEFOC, Fundación Contra El Cáncer, Barcelona, Spain
| | - Tracy Doering
- University of South Florida, School of Social Work, Tampa, FL
| | - Olivia Snyder
- University of South Florida, School of Social Work, Tampa, FL
| | - Ebony Tollinchi
- University of South Florida, School of Social Work, Tampa, FL
| | - Jorge Estapé
- FEFOC, Fundación Contra El Cáncer, Barcelona, Spain
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Zivanov CN, Apple A, Brown AJ, Robinson MA, Prescott LS. Stopping the revolving door: An exploratory analysis of health care super-utilization in gynecologic oncology. Gynecol Oncol Rep 2021; 37:100789. [PMID: 34095425 PMCID: PMC8166766 DOI: 10.1016/j.gore.2021.100789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/10/2021] [Accepted: 05/13/2021] [Indexed: 11/29/2022] Open
Abstract
The objective of this study was to determine the prevalence of and risk factors for health care super-utilization among gynecologic oncology patients at a single academic hospital. A retrospective cohort study of gynecologic oncology patients with an index unplanned encounter between January and December 2018 was performed. Super-utilizers were defined as patients with 3 or more unplanned hospital encounters during a 12-month period starting at the time of the index unplanned encounter. We identified 553 patients with gynecologic cancer. Of those, 37(7%) met inclusion criteria for super-utilizers accounting for 193/310(62%) of unplanned visits. The median number of unplanned visits was 4 (range 3-24). The most common cancers were uterine (N = 15 (41%)) and ovarian (N = 11 (30%)). Nineteen (51%) super-utilizers had advanced stage disease. Phases of oncologic care at index unplanned encounter included primary diagnosis (N = 24 (65%)), recurrence (N = 10 (27%)), and surveillance (N = 2 (5%)). Twelve super-utilizers (32%) had new diagnoses of cancer without prior therapy, 19(51%) had prior chemotherapy, 17(46%) had prior surgery, and 10(27%) had prior radiation therapy at the time of initial encounter. Fifteen super-utilizers (41%) were in the last year of life. The most common reasons for unplanned encounters were pain (66%) and gastrointestinal symptoms (61%). Multivariable analysis adjusting for key variables demonstrated that Medicaid insurance, ASA classification, and disease status are risk factors for health care super-utilization. The majority of health care utilization occurred during the first year of diagnosis. This exploratory analysis suggests an opportunity to decrease health care utilization, particularly during upfront treatment.
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Affiliation(s)
| | - Annie Apple
- Vanderbilt University School of Medicine, Nashville, TN 37240, USA
| | - Alaina J. Brown
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Marc A. Robinson
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Lauren S. Prescott
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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David D, Barnes DE, McMahan RD, Shi Y, Katen MT, Sudore RL. Patient Activation: A Key Component of Successful Advance Care Planning. J Palliat Med 2018; 21:1778-1782. [PMID: 30129808 DOI: 10.1089/jpm.2018.0096] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Patient activation-or knowledge, confidence, and skill managing overall health-is associated with improved health behaviors such as exercise; it is unknown whether it is associated with advance care planning (ACP). Objective: To determine whether patient activation is associated with ACP. Design: This is a cross-sectional study. Setting/Subjects: A total of 414 veterans (≥60 years) with serious and chronic illness enrolled in an ACP trial. Measures: Patient characteristics and self-report surveys included the validated 13-item patient activation measure (PAM, five-point Likert) (e.g., "Taking an active role in your own healthcare is the most important factor…") categorized into four levels (e.g., Level 1: "disengaged and overwhelmed" to Level 4: "maintaining behaviors"). ACP was measured with the ACP Engagement Survey including 57-item process scores (i.e., knowledge, contemplation, self-efficacy, readiness, 5-point Likert scale) and 25-item action scores (i.e., surrogate designation, yes/no items). Associations were determined with linear regression. Results: Participants were 71.1 ± 7.8 years of age, 43% were non-white, 9% were women, and 20% had limited health literacy. Higher PAM levels were associated with higher finances, having adult children, lower comorbidity, and more social support (p < 0.05). After adjusting for these characteristics, higher PAM (Level 4 vs. Level 1) was associated with higher ACP engagement (ACP process scores, 2.8 ± 0.7 vs. 3.8 ± 0.7 and action scores 9.7 ± 4.4 vs. 15.1 ± 6.0, p < 0.001). Conclusions: Higher patient activation to manage one's overall healthcare is associated with higher engagement in ACP. Interventions designed to foster general patient activation and self-efficacy to engage in health behaviors and disease management may also improve engagement in the ACP process.
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Affiliation(s)
- Daniel David
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California
- Department of Medicine, Division of Geriatrics and Palliative Care, University of California, San Francisco, San Francisco, California
- Veterans Affairs Medical Center, San Francisco, California
| | - Deborah E Barnes
- Veterans Affairs Medical Center, San Francisco, California
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | | | - Ying Shi
- Department of Medicine, Division of Geriatrics and Palliative Care, University of California, San Francisco, San Francisco, California
- Veterans Affairs Medical Center, San Francisco, California
| | - Mary T Katen
- Department of Medicine, Division of Geriatrics and Palliative Care, University of California, San Francisco, San Francisco, California
- Veterans Affairs Medical Center, San Francisco, California
| | - Rebecca L Sudore
- Department of Medicine, Division of Geriatrics and Palliative Care, University of California, San Francisco, San Francisco, California
- Veterans Affairs Medical Center, San Francisco, California
- UCSF School of Medicine, San Francisco, California
- Innovation and Implementation Center in Aging and Palliative Care, University of California, San Francisco, San Francisco, California
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Hibbard JH, Mahoney E, Sonet E. Does patient activation level affect the cancer patient journey? PATIENT EDUCATION AND COUNSELING 2017; 100:1276-1279. [PMID: 28330715 DOI: 10.1016/j.pec.2017.03.019] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/13/2017] [Accepted: 03/11/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES We assess how patient activation is associated with behaviors and experiences of people with cancer, including: understanding risks; making treatment decisions; communicating with providers; coping with symptoms; and adhering to regimens. METHODS The study utilizes survey data from six surveys each including 500 cancer survivors. Multivariate analyses are presented. RESULTS Higher activated patients are more than 9 times more likely to feel their treatment plans reflect their values, 4.5 times more likely to cope with side effects, and almost 3.3 times more likely to initiate a healthier diet after their diagnosis, than are less activated patients. Less activated patients are less likely understand their diagnosis, to follow treatment regimens, and to be satisfied with their care. CONCLUSIONS The findings show that all along the care continuum, patient activation is associated with differences in experiences. PRACTICE IMPLICATIONS The findings point to the value of assessing patients' activation levels at the beginning of their cancer experience.
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Affiliation(s)
- Judith H Hibbard
- University of Oregon, Health Policy Research Group, Eugene, OR 97403-1209, USA.
| | - Eldon Mahoney
- Institute for Critical Junctures, Bellingham, WA, USA.
| | - Ellen Sonet
- CancerCare, 275 Seventh Ave, New York, NY 10001, USA.
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Baser RE, Li Y, Brennessel D, Kemeny MM, Hay JL. Measurement invariance of intuitive cancer risk perceptions across diverse populations: The Cognitive Causation and Negative Affect in Risk scales. J Health Psychol 2017; 24:1221-1232. [PMID: 28810422 DOI: 10.1177/1359105317693910] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Intuitive cancer risk perceptions may inform strategies to motivate cancer prevention behaviors. This study evaluated factor structure and measurement invariance of two new measures of intuitive cancer risk, the Cognitive Causation and Negative Affect in Risk scales. Single- and multiple-group confirmatory factor analysis models were fit to responses from three diverse samples. The confirmatory factor analysis models fit the data well, with all comparative fit indices (CFI) ≥ 0.94. Items flagged by chi-square difference tests as potentially non-invariant were largely invariant between samples according to practical fit indices (e.g. ΔCFI). These novel scales may be particularly relevant in diverse, underserved populations.
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Affiliation(s)
| | - Yuelin Li
- 1 Memorial Sloan Kettering Cancer Center, USA
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Hay JL, Ramos M, Li Y, Holland S, Brennessel D, Kemeny MM. Deliberative and intuitive risk perceptions as predictors of colorectal cancer screening over time. J Behav Med 2016; 39:65-74. [PMID: 26280754 PMCID: PMC4724274 DOI: 10.1007/s10865-015-9667-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/31/2015] [Indexed: 02/05/2023]
Abstract
Cancer risk perceptions may involve intuitions-including both affect as well as gut-level thoughts about risk-and deliberative risk magnitudes. Yet, little research has examined the potentially diverse relations between risk perceptions and behavior across time. A highly diverse primary care sample (N = 544, aged ≥50) was utilized to compare how deliberative and intuitive perceptions of risk relate to chart-confirmed colorectal cancer screening at cross-sectional and prospective time points. At baseline, deliberative and intuitive risk perceptions were negatively associated with chart-confirmed colorectal cancer screening adherence in bivariable but not multivariable analyses. Among those who were non-adherent with colorectal cancer screening at baseline, deliberative and intuitive risk perceptions were positively associated with prospective uptake of chart-confirmed colorectal cancer screening adherence at 12-months in bivariable analyses; only deliberative risk perceptions remained significant in the multivariable model. This study indicates that diverse risk perceptions are differentially important for screening at different time points.
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Affiliation(s)
- Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, Seventh Floor, New York, NY, 10022, USA.
| | - Marcel Ramos
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, Seventh Floor, New York, NY, 10022, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, Seventh Floor, New York, NY, 10022, USA
| | - Susan Holland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, Seventh Floor, New York, NY, 10022, USA
| | - Debra Brennessel
- Mount Sinai Medical Center, Queens Hospital Center, New York, NY, 11432, USA
| | - M Margaret Kemeny
- Mount Sinai Medical Center, Queens Hospital Center, New York, NY, 11432, USA
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