254842 Health-related needs hierarchies of adult survivors of pediatric malignancies: Forecasting priorities to inform intervention strategies

Monday, October 29, 2012 : 4:30 PM - 4:50 PM

Cheryl Cox, PhD , Epidemiology, Cancer Prevention and Control, St. Jude Children's Research Hospital, Memphis
Deborah Sherrill-Mittleman, PhD , Epidemiology, Cancer Prevention and Control, St. Jude Children's Research Hospital, Memphis, TN
Barth B. Riley, PhD , Chestnut Health Systems, Oak Park, IL
Melissa M. Hudson, MD , Oncology, St. Jude Children's Research Hospital, Memphis, TN
Lauren J. Williams, BA, CRA , Epidemiology, Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
Margie G. Zacher, CRA, CCRP , Epidemiology, Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
Leslie L. Robison, PhD , Epidemiology, Cancer Prevention and Control, St. Jude Children's Research Hospital, Memphis, TN
Background: Great progress has been made in documenting morbidity, mortality, and treatment effects in the rapidly growing population of adult survivors of childhood cancer; however, we know little about survivors' health-related needs and how these needs affect their adult lives. Previous studies have relied on underdeveloped instrumentation and non-representative samples. Methods: The Childhood Cancer Survivor Study Needs Assessment Questionnaire (CCSS-NAQ) was administered to 1,178 randomly selected Childhood Cancer Survivor Study participants (mean age = 39.66, SD = 7.71; mean years since diagnosis = 31.61, SD = 4.71). Minorities and rural residents were oversampled at a 2:1 rate. Rasch modeling was used to assess the instrument's ability to hierarchically order both individuals (based on need level) and items (based on frequency of endorsement). Results: Data fit the Rasch model well: item reliability was 0.97 - 0.99, person reliability was 0.80 0.90, and separation index scores were 2.00 - 3.01. Item hierarchy was clinically significant across subscales (Psycho-Emotional, Health System Information, Cancer-related Information, General Health, Care & Support, Surveillance, Coping, Fiscal Concerns, Relationships). Common needs were help to deal with fears/worry; health maintenance; and information about late effects and screening. Less common, but endorsed at higher intensity, were needs related to provider interaction/communication. Demographics, diagnosis, and treatment exposures were strong predictors of need levels across subscales. Conclusion: The CCSS-NAQ successfully captures all levels of health-related needs with equal precision and provides meaningful need hierarchies. Accurate needs assessment is essential to inform health promotion and risk-reduction interventions for this vulnerable population.

Learning Areas:
Chronic disease management and prevention
Epidemiology
Public health or related research
Social and behavioral sciences

Learning Objectives:
At the conclusion of this presentation, participants will be able to: 1) Describe the multi-dimensional structure and psychometric/ item-response performance of the newly developed Childhood Cancer Survivor Study Needs Assessment Questionnaire (CCSS-NAQ). 2) Identify specific demographics, diagnosis, and treatment exposures that are associated with higher health-related need levels in adult survivors of pediatric malignancies. 3) Identify specific health-related need hierarchies that profile survivors at highest risk. 4) Formulate priorities for interventions targeting health promotion and risk reduction in adult survivors of childhood cancer.

Keywords: Screening Instruments, Evidence Based Practice

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be an abstract Author on the content I am responsible for because I am principal investigator on multiple federally-funded grants focusing on health promotion and risk reduction in adult survivors of pediatric malignancies.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.