Short communicationDoes patient activation level affect the cancer patient journey?
Introduction
Patient activation is defined as the individual's knowledge, skill, and confidence for managing their own health [1], [2]. There is growing evidence about the importance of patient activation in supporting positive outcomes among chronic disease patients [3], [4]. More activated patients are more likely to adhere to treatment regimens, to monitor conditions, to obtain recommended care, and to have better clinical outcomes [5], [6], [7], [8], [9]. While this evidence comes from a variety of settings and within patient populations, there are only a few studies that focus on patient activation in cancer patients. The studies that do tend to examine only one type of cancer [10], [11], [12], [13]. Studies that take a broader view show that patient activation is linked with attitudes toward cancer, satisfaction with care, and the likelihood of getting a cancer screening [14], [15], [16].
As more patients survive cancer, they need to self-manage on a long term basis. Cancer as a chronic illness places new demands on patients to manage their own care, often with minimal clinical advice or supervision. Chronic cancer care is often delivered in brief ambulatory clinical encounters, and patients and their families increasingly take on responsibility for day-to-day management of their illness [17]. This includes management of symptoms, adhering to complex treatment regimens, as well as adopting new behaviors to reduce the risk of recurrence of their disease.
Using survey data from cancer patients, we assess how patient activation level is associated with the adoption of behaviors, symptom management, communication with providers, and satisfaction related to cancer care across a broad range of cancers.
Section snippets
Design
The study utilizes survey data collected by CancerCare®, who fielded six different on-line surveys among cancer patients [18]. Each survey contained no more than 41 questions including the patient activation measure (PAM) and demographics. To minimize respondent burden, respondents were randomly assigned to receive one of the surveys. Each survey focused on experiences and patient behaviors relating to different phases of the cancer experience.
Study sample
For each survey, cancer patients were recruited
Results
Table 1 shows the characteristics of the study population. Over half the study sample is female (57%), and sixty-eight percent are 55 years or older. Thirty-two percent of the study participants have incomes lower than $50,000. Fifty-two percent have less than a college education, and 68% are white. The study population is evenly distributed across the regions of the country, and 39% had their cancer diagnosed within the two years before the survey.
The multivariate analysis results (Table 2),
Discussion
All long the continuum of care, more activated patients are likely to be better informed and more proactive about managing their condition. They are more likely to understand their diagnosis, feel sufficiently informed about their treatment plan and believe that these plans reflect their values. Higher activated patients are more likely to report being able to effectively manage symptoms/side effects.
The findings are similar to what has been found in assessing patient activation within other
Funding
None.
Conflicts of interest
Judith Hibbard and Eldon Mahoney are consultants to and equity stakeholders in Insignia Health. Ellen Soney has no potential conflicts of interest to report.
References (18)
- et al.
The association between patient activation and medication adherence, hospitalization, and emergency room utilization in patients with chronic illnesses: a systematic review
Patient Educ. Couns.
(2015) - et al.
Development and testing of a short form of the patient activation measure
Health Serv. Res.
(2005) - et al.
Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers
Health Serv. Res.
(2004) - et al.
When patient activation levels change, health outcomes and costs change too
Health Aff.
(2015) - et al.
Effect of patient activation on self-management in patients with heart failure
J. Cardiovasc. Nurs.
(2013) - et al.
Patient factors and glycaemic control--associations and explanatory power
Diabet. Med.
(2012) - et al.
Is patient activation associated with future health outcomes and healthcare utilization among patients with diabetes?
J. Ambul. Care Manage.
(2009) - et al.
Is patient activation associated with outcomes of care for adults with chronic conditions?
J. Ambul. Care Manage.
(2007) - et al.
What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs
Health Aff. (Millwood)
(2013)
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