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- Title
Factors supporting cardiomyopathy screening among at-risk adult survivors of pediatric malignancies.
- Authors
Cox, Cheryl; Zhu, Liang; Ojha, Rohit; Steen, Brenda; Ogg, Susan; Robison, Leslie; Hudson, Melissa; Cox, Cheryl L; Ojha, Rohit P; Steen, Brenda D; Robison, Leslie L; Hudson, Melissa M
- Abstract
<bold>Purpose: </bold>Anthracyclines and chest irradiation place adult survivors of childhood cancer at risk of cardiomyopathy; many survivors do not obtain the recommended screening. Based on our recent clinical trial, the addition of telephone counseling to a printed survivorship care plan more than doubled survivors' risk-based screening. Here, we sought to measure the impact of specific factors targeted in the intervention for their impact on survivors' screening participation.<bold>Methods: </bold>Study population-survivors participating in a randomized longitudinal intervention trial. Survivor questionnaires and medical records at baseline and 1-year follow-up provided the data. Within- and between-group differences in factors were assessed at baseline and follow-up; structural equation modeling (SEM) identified direct and indirect effects on screening participation.<bold>Results: </bold>Of the 411 survivors, 55.3% were female, 89.3% white, 38.9% college graduates, and age 26-59 years (mean = 41 years, SD = 7.68 years). At follow-up, the counseling group demonstrated higher scores for intent to undergo screening (p < 0.001), adherence determination (p < 0.001), autonomous regulation (p < 0.001), competency (p = 0.03), perceived effort warranted for screening (p < 0.001), and perceived value of screening (p = 0.02). SEM identified four factors that directly influenced screening participation (n = 411, RMSEA = 0.02 [90% CI = 0.000-0.05]; CFI = 0.99; TLI = 0.99; WRMR = 0.63): the counseling intervention (p < 0.0001), intrinsic motivation (p < 0.0001), competency (p < 0.0001), and decisional control (p = 0.001); intrinsic motivation was also a mediator (p = 0.002) of screening participation.<bold>Conclusions: </bold>Direct interpersonal interaction that focused on multiple modifiable, autonomy-supportive factors powerfully enhances the efficacy of a print survivorship care plan in increasing survivors' screening participation. This finding challenges providers to reach beyond the disease treatment focus and embrace these strategies in their behavior change efforts.
- Subjects
CARDIOMYOPATHIES; TREATMENT of cardiomyopathies; ECHOCARDIOGRAPHY; ANTHRACYCLINES; AT-risk people; CHILDHOOD cancer; CARDIOVASCULAR diseases risk factors; THERAPEUTICS; TUMOR treatment; RESEARCH funding; STATISTICAL sampling; SURVIVAL; TUMORS; RANDOMIZED controlled trials; DISEASE complications
- Publication
Supportive Care in Cancer, 2017, Vol 25, Issue 4, p1307
- ISSN
0941-4355
- Publication type
journal article
- DOI
10.1007/s00520-016-3530-6