Exploration of Predictors of Self-Efficacy Among Adolescent and Young Adult Cancer Survivors

Background/Purpose: This study seeks to build upon previous research about psychosocial indicators of functioning among adolescent and young adult (AYA) cancer survivors by examining predictors of self-efficacy among AYA oncology survivors.  This study explores both individual (e.g. distress, preparedness) and systems (e.g. patient navigation services, patient involvement in healthcare decision making) predictors of self-efficacy among AYA oncology survivors. 

Methods: Secondary data analysis was conducted using the LiveSTRONG 2012 “Coping with Cancer” survey data. The study sample was drawn from the population of AYA oncology survivors who were diagnosed with cancer between the ages of 15-39 who had accessed LIVESTRONG Cancer Navigation (LCN) services and who consented to participate in the 2012 LiveSTRONG navigation research study (N=334).  Patients who answered all survey questionnaire items related to the indicator variables in the regression model are included in final analyses (N=103).

Independent variables were utilized from survey questions around distress, involvement in decision-making, preparedness, and receipt of patient navigation services. A composite measure using the mean scores of all three self-efficacy questions was computed and used as the outcome variable in this study.  All three self-efficacy questions were asked on a likert scale (1: Not at all confident to 5: Very confident), with an additional option, “Prefer not to respond”.  These items were stated as “Get emotional support from friends, family or community resources”, “Discuss openly with your doctor any personal problems that may be related to your cancer diagnosis” and “Do something to make yourself feel better when you feel sad or down”.  Hierarchical linear regression was computed to examine predictors of self-efficacy among AYA oncology survivors who accessed LiveSTRONG cancer navigation services, when controlling for demographic characteristics (age, sex, race, and marital status). 

Limitations: Of the AYA cancer survivors who consented to be in the 2012 LiveSTRONG navigation research study (N=334), many did not answer all survey questionnaire items; only those participants who answered all survey questionnaire items related to the indicator variables used in the regression model are included in final analyses (N=103). The majority of this study sample is female (61.2%) and Caucasian (76.7%), limiting generalizability beyond this population.

Results:  The final regression model had a statistically significant and strong relationship with self-efficacy (F(12,90)=6.13, p<.001, R²=.45, R² _Adjusted=.38). A one unit increase in involvement in decision making would on average increase self-efficacy by .38 (β=.38, t(90)=4.07, p<.001). A one unit increase in distress would on average decrease self-efficacy by .28 (β=-.28, t(90)=-3.24, p<.01).  Having visited a cancer care navigator in a medical center would on average increase self-efficacy by .19 (β=.19, t(90)=2.08, p<.05). 

Conclusions and Implications: Findings suggest that involvement in healthcare decision-making and working with a cancer care navigator can help foster self-efficacy among AYA cancer survivors and that distress should be monitored throughout the continuum of care. Increased understanding of how to help foster self-efficacy among AYA cancer survivors has great potential to contribute to the advancement and innovation of survivorship care.