Associations of self-advocacy and perceptions of care coordination among rural patients with early-stage cancer.

Abstract

329 Background: Effective care coordination (CC) is an essential component of high-quality, patient-centered cancer care; however, many rural cancer patients experience significant CC-related challenges. For rural patients, one’s ability to self-advocate for their cancer care-related needs may play an important role in CC. To date, little is known about self-advocacy and care coordination in rural cancer patients. In this study, we examined associations between patient-reports of self-advocacy and CC among rural patients with early-stage cancer. Methods: 31 patients with early-stage (I-III) cancer completed the self-advocacy and care coordination questionnaires in 2021-2022. Participants were receiving active treatment and residing in rural areas of Hawaii at time of survey completion. Levels of self-advocacy were measured using the adapted Female Self-Advocacy in Cancer Survivorship Scale (FSACS; Hagan et al., 2018). The FSACS assesses overall self-advocacy and includes three subscales, Informed Decision Making, Effecting Communication, and Connected Strength. The validated Care Coordination Instrument (CCI) was used to assess patients’ perceptions of CC. The CCI assesses overall (total) and three CC domains, Communication, Navigation, and Operational. Pearson’s correlation analyses were conducted to examine associations between self-advocacy and CC. Results: Mean age of participants was 58.6, and 64.5% were female. The most common cancer types were breast (41.9%) and GI (32.3%). Overall, the total self-advocacy scores were positively associated with the total CCI and Operational domain scores ( r = .39 and .41, p < .05). Informed Decision Making and Effective Communication subscale scores were also positively correlated with the total CCI and CC domain scores ( r = .682-.945, p < .001). Connected Strength subscale scores were not associated with CCI scores. The presence of a patient navigator was associated with higher self-advocacy scores ( p = .011). Conclusions: Our findings indicate that higher levels of self-advocacy are associated with better perceptions of care coordination among rural patients with early-stage cancer. Conversely, patients with lower levels of self-advocacy report poorer CC and are less likely to present with a patient navigator. These findings suggest that interventions to enhance self-advocacy skills may be a potential strategy to improve rural patients’ CC experiences.