title: Associates of Engagement in Adult-Oriented Follow-Up Care for Childhood Cancer Survivors.
abstract: OBJECTIVE
  Understanding how to predict appropriate uptake of adult-oriented medical care is important for adult patients with pediatric-onset chronic health conditions with continued health vulnerability. We examined associates of engagement in adult survivors of childhood cancer following transfer to adult-oriented care.
  
  
  METHODS
  Adult survivors of childhood cancer (N = 80), within 1-5 years post transfer from pediatric to adult-oriented follow-up care, completed assessments of engagement with recommended adult-oriented follow-up care and psychosocial and transition readiness measures. Measures were validated with adolescent and young adults and/or intended to measure readiness to transition to adult care.
  
  
  RESULTS
  Earlier age at diagnosis, parental involvement in health care decision-making, higher motivation, and increased comfort speaking to providers about health concerns were significantly associated with attendance at adult-oriented follow-up care visits.
  
  
  CONCLUSIONS
  Associates of engagement in adult care are complex, representing social-ecological variables. Current measures of transition readiness or adolescent and young adult health-related measures may not adequately capture the associates of engagement in care or identify targets of intervention to promote successful transfer of care. Identifying patients at risk for loss to follow-up will be useful to design interventions for young adult survivors of childhood cancer and other young adults with pediatric-onset chronic conditions who require ongoing adult-oriented care.
authors.affiliation: Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: szaldad@email.chop.edu.
authors.forename: Dava
authors.initials: D
authors.lastname: Szalda
authors.affiliation: Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Lisa
authors.initials: L
authors.lastname: Piece
authors.affiliation: Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Lauren
authors.initials: L
authors.lastname: Brumley
authors.affiliation: Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Yimei
authors.initials: Y
authors.lastname: Li
authors.affiliation: University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Schapira
authors.affiliation: Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Monika
authors.initials: M
authors.lastname: Wasik
authors.affiliation: Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Wendy L
authors.initials: WL
authors.lastname: Hobbie
authors.affiliation: Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jill P
authors.initials: JP
authors.lastname: Ginsberg
authors.affiliation: Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D000359:Aftercare / Q000379:methods*; D000367:Age Factors; D002648:Child; D002908:Chronic Disease / Q000523:psychology / Q000628:therapy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D010290:Parents; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D060305:Transition to Adult Care / Q000458:organization & administration*; D055815:Young Adult
keywords: Childhood cancer survivors; Transition to adult care; Young adults