title: Treatment Summaries and Follow-Up Care Instructions for Cancer Survivors: Improving Survivor Self-Efficacy and Health Care Utilization.
abstract: Treatment summaries and follow-up care plan information should be provided to cancer survivors. This study examines the association of receiving summaries and care plans with cancer survivor self-efficacy for chronic illness management, and whether self-efficacy was associated with health care utilization.
  
  
  
  Four hundred forty-one cancer survivors (≥2 years from diagnosis and had completed treatment) ≥65 years old from 12 cancer centers across 5 states completed telephone surveys. Survivors responded to three questions about receiving a written treatment summary, written follow-up plan, and an explanation of follow-up care plans. Respondents completed the Stanford Chronic Illness Management Self-Efficacy Scale and reported emergency room visits and hospitalizations in the past year. Three multiple linear regression models estimated the association of written treatment summary, written follow-up care plan, and verbal explanation of follow-up plan with total self-efficacy score. Log-binomial models estimated the association of self-efficacy scores with emergency room visits and hospitalizations (yes/no).
  
  
  
  Among survivors, 40% and 35% received a written treatment summary and follow-up care plan, respectively. Seventy-nine percent received an explanation of follow-up care plans. Receiving a verbal explanation of follow-up care instructions was significantly associated with higher self-efficacy scores (β = 0.72, p = .009). Higher self-efficacy scores were significantly associated with lower prevalence ratios of emergency room visits (prevalence ratio, 0.92; 95% confidence interval, 0.88-0.97) and hospitalizations (prevalence ratio, 0.94; 95% confidence interval, 0.89-0.99).
  
  
  
  Explanation of the follow-up care plan, beyond the written component, enhances survivor self-efficacy for managing cancer as a chronic condition-an important mediator for improving health care utilization outcomes.
  
  
  
  Older cancer survivors (>65 years) are especially vulnerable to poor outcomes in survivorship because of the complexity of follow-up care and other chronic conditions. Delivering written treatment summaries, written follow-up care plans, and verbal explanations of follow-up care plans all independently increased the self-efficacy for chronic illness management among older survivors. In particular, delivering this information in the verbal format was significantly associated with higher self-efficacy and, subsequently, a lower likelihood of emergency room visits. Understanding the mechanism through which summaries and follow-up care plans may positively influence survivor health is critical to increasing the delivery of the information.
authors.affiliation: Institute for Cancer Outcomes Research and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA kkenzik@uab.edu.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Kenzik
authors.affiliation: University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Kvale
authors.affiliation: Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, USA.
authors.forename: Gabrielle B
authors.initials: GB
authors.lastname: Rocque
authors.affiliation: University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Demark-Wahnefried
authors.affiliation: University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, USA Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Michelle Y
authors.initials: MY
authors.lastname: Martin
authors.affiliation: Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Bradford E
authors.initials: BE
authors.lastname: Jackson
authors.affiliation: University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, USA School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Meneses
authors.affiliation: University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, USA.
authors.forename: Edward E
authors.initials: EE
authors.lastname: Partridge
authors.affiliation: University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, USA Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Pisu
mesh_terms: D000359:Aftercare; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D010342:Patient Acceptance of Health Care; D020377:Self Efficacy; D017741:Survivors
keywords: Cancer; Disease management; Self-efficacy; Survivorship