BUILDING A BIOPSYCHOSOCIAL-SPIRITUAL MODEL FOR PREDICTING ADHERENCE AMONG CANCER SURVIVORS

ECU Author/Contributor (non-ECU co-authors, if there are any, appear on document)

Juliann Stalls (Creator)

Institution

East Carolina University (ECU )

Web Site: http://www.ecu.edu/lib/

Abstract: Advancements in medicine and preventive care have led to the greatest number of cancer survivors (CSs) in history. Although surviving cancer may be more achievable today, the care required for CSs persists beyond active treatment. Survivors are often faced with unique challenges throughout survivorship, such as coping with the late-effects of their cancer treatment. CSs also have a greater likelihood of developing secondary malignancies and other chronic health conditions, as compared to their peers without a cancer history. Given these challenges, the National Comprehensive Cancer Network (NCCN) established guidelines for CSs regarding engaging in a healthy lifestyle and regularly attending surveillance appointments with their oncologist and other providers. It is also consistently emphasized that CSs take their medications as prescribed for ongoing treatment of cancer and comorbid conditions. However, research has shown that CSs struggle with adherence to these recommended behaviors. Furthermore, research is still working to identify and understand the relative contribution of factors that contribute to whether or not survivors engage in medication adherence, healthy lifestyle behaviors, and surveillance care. The purpose of this study was to examine the contribution of biopsychosocial-spiritual factors in explaining adherence to survivorship guidelines among CSs, while also taking into account cultural and contextual contributors. Adult CSs (N = 105) were recruited through a family medicine outpatient center and pediatric oncology late-effects clinic that serves patients up to age 29. Their rates of adherence to medication, healthy lifestyle behaviors (i.e., maintaining a healthy weight, eating a healthy diet, exercising, avoiding cigarettes, limiting alcohol, practicing sun safety), and surveillance visits were assessed. Then, the contribution of cultural/contextual, biological, psychological, social, and spiritual domains in explaining variance in adherence were determined. The proposed variables in the cultural/contextual domain included age, race, gender, sexual orientation, income, education, survivorship care plan status, and survivorship phase. Variables in the biological domain included treatment side effect interference, disease severity/course, and number of comorbidities. The proposed psychological domain included variables such as depressive symptomology, anxiety symptomology, posttraumatic stress symptomology, self-efficacy, perceived barriers to caring for one"s health, perceived benefits to caring for one"s health, and health literacy. Exploratory social and spiritual domains, which have been most understudied in relation to adherence behaviors, included variables such as the patient-provider relationship, instrumental social support, and emotional social support as well as religious coping, religious involvement, and perceiving God as one"s "locus of health control." The results revealed that among a diverse sample of CSs, many were struggling with adherence. The behaviors that this sample reported struggling with most included maintaining a healthy weight, consuming recommended amounts of fruit, vegetables, and whole grains, and practicing sun safety. Across the domains studied, the cultural/contextual domain was a consistent predictor of adherence, with age and education being significant drivers within this domain. The biological domain was not a consistent predictor of adherence behaviors, contrary to hypotheses. The psychological domain was predictive of some adherence behaviors, with anxiety being a significant driver within this domain, partially supporting hypotheses related to the psychological domain predicting adherence. Notably, the psychological domain was often more predictive than the biological domain. The exploratory social and spiritual domains were not predictive of adherence behaviors above and beyond the contribution of other domains. The adherence behaviors/behavioral indicators that were best predicted in this study were medication adherence and body mass index (BMI) while the behaviors that were least predicted were red meat consumption and attendance to PCP visits. The findings of this study highlighted the crucial role of social determinants as reflected in cultural/contextual domain, underscoring the need for consideration of cultural/contextual contributors when developing interventions to address difference in adherence behaviors among CSs. In addition, the study highlighted that in some instances, the psychological domain explained variance in adherence behaviors above and beyond the cultural/contextual domain, supporting the idea that this domain should also be considered during intervention development to address adherence difficulties.

Additional Information

Publication

Dissertation

Language: English

Date: 2020

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