A structural equation modeling approach to understanding pathways linking patient-centered communication to self-rated health among cancer survivors: HINTS analysis

Authors: De La Torre SA, Spruijt-Metz D, Farias AJ

Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2023

Abstract Body:
Purpose: Few studies have investigated the pathways linking patient centered communication (PCC) to more distal survivor-level health outcomes like self-rated health (SRH), therefore, the aim of this study is to investigate the relationship between PCC and SRH mediated by anxiety/depression (A/D) and quality of care (QOC) satisfaction. Methods: Data on cancer survivors was leveraged from the National Cancer Institute's Health Information National Trends Survey (HINTS) 5 Cycles 1-4 (January 2017-April 2020) (n=1,847). Structural equation modeling (SEM) was used to test the hypothesized direct, indirect, and total effects of pathways linking PCC to SRH. First, a measurement model was tested using confirmatory factor analysis (CFA) on the 2 latent factors, PCC and A/D. After evaluating the fit and factor loadings in the measurement model, a structural model was specified based on the Patient-Clinician Communication framework. Results: The mean age of the sample was 66.9 years (SD=12.2). Most participants were from a Non-Hispanic White racial/ethnic background (n=1,351, 73.1%) and female (n=1,056, 57.2%). The most frequently reported cancer types were breast (n=262, 14.2%) and skin (n=474, 25.7%) and the average time since diagnosis was 13.5 years (SD=12.7). PCC had significant total (standardized beta (SB)=0.263, p<0.001) effects on SRH. However, the direct effects were not statistically significant (SB=0.016, p=0.737) and the significant effects came from both of the mediated pathways, the QOC pathway (SB=0.131, p<0.001) and the A/D pathway (SB=0.116, p<0.001). Lastly, QOC satisfaction was directly significantly associated with SRH (SB=0.166, p<0.001). Conclusions: These results provide evidence of potential pathways linking PCC to proximal and distal survivor-level health outcomes, namely SRH. Providers engaging in PCC, which aims to acknowledge the patient as a whole, and educate survivors in taking an active role in their care, can potentially provide an opportunity to address A/D. Furthermore, PCC can also lead to survivors experiencing a higher QOC satisfaction, which can ultimately have a positive impact on how survivors perceive their overall health and the health care they receive.

Keywords: self-rated health, patient-centered communication, quality of care satisfaction, anxiety/depression