Date of Award

Spring 12-2019

Degree Name

Doctor of Philosophy (Medical Science)

Advisor(s)

MARLYN A. ALLICOCK, PHD, MPH

Second Advisor

BIJAL A. BALASUBRAMANIAN, PHD, MBBS

Third Advisor

FOLEFAC ATEM, MS, PHD

Abstract

PURPOSE: Cancer survivors have complex journeys following the completion of active treatment. The Institute of Medicine and other high-profile organizations have recommended and mandated the use of a survivorship care plan (SCP) despite mixed evidence supporting the impact of SCPs on key survivor-level outcomes. The purpose of this dissertation was to understand the complex relationship linking the delivery of SCPs and to relevant survivor level outcomes. STUDY GROUP: This dissertation focuses on breast and colorectal cancer survivors because they comprise nearly 30% of the entire cancer survivor population in the US and are the two most prevalent cancers in men and women. METHODS: The first paper was a cross-sectional study using structural equation modeling to assess hypothesized pathways linking SCPs to survivor-level outcomes among a nationally representative sample of colorectal and breast cancer survivors from the Health Information National Trends Survey (HINTS). The second paper involved semi-structured interviews with safety-net breast and colorectal cancer survivors to elucidate the experiences with and relevant outcomes of survivorship care planning. The third paper used an adapted-mixed methods approach to provide a high-level synthesis of relevant survivor-level outcomes. RESULTS: The first paper found no total or direct effects linking the receipt of a SCP to survivor-level outcomes. Paper two found that the participants reported positive experiences with the survivorship care planning process and stated that their oncology care team prepared them for life post-treatment. The third paper modified a conceptual framework for survivorship care planning research by emphasizing the role of communication and distinguishing outcomes specific to the care planning process versus outcomes that likely require a survivor-level intervention. CONCLUSION: These findings emphasize the central role of patient-centered communication in the survivorship care planning process and identified survivor-level characteristics and determinants that are likely to impact outcomes across the survivorship continuum.

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