Attendance to Follow-Up Care in Survivors of Adolescent and Young Adult Cancer: Application of the Theory of Planned Behavior.

ABSTRACT

PURPOSE: The aim was to study follow-up care attendance in adolescent and young adult (AYA) cancer survivors to investigate (1) correlates of the intention to attend follow-up care and (2) whether the intention is associated with the actual attendance, applying the theory of planned behavior (TPB). METHODS: We conducted a questionnaire survey in AYA cancer survivors diagnosed 1990-2005 at age 16-25 years, registered in the Cancer Registry Zurich and Zug, Switzerland, who had survived at least 5 years. Structural equation modeling was applied to investigate TPB-related correlates (attitudes, subjective norms, and perceived behavioral control) of intention to attend follow-up care. Logistic regression analysis was used to study the association between intention and actual attendance. RESULTS: We included 160 AYA cancer survivors in the study (mean age at study 34.0 years, mean age at diagnosis 21.6 years, 98 [61.3%] male). Positive attitudes toward follow-up care (coefficient = 0.32, 95% confidence interval [CI] 0.05 to 0.60) and supportive subjective norms (coefficient = 0.59, 95% CI 0.41 to 0.78) were associated with higher intention to attend follow-up care. Perceived behavioral control was not associated with intention to attend (coefficient = -0.13, 95% CI -0.36 to 0.10), but with actual attendance (odds ratio [OR] = 4.55, 95% CI 1.83 to 11.31). Higher intention was associated with actual follow-up care attendance (OR = 14.29, 95% CI 5.80 to 35.21). CONCLUSION: Positive attitudes and supportive social norms were associated with higher intention to attend follow-up care, and higher intention was associated with actual follow-up care attendance. Increasing awareness of the importance and benefits of follow-up care not only among survivors but also family, friends and healthcare professionals may help increase follow-up care attendance among AYA cancer survivors.