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Motivating behavior change in adult survivors of childhood cancer: A randomized controlled trial (RCT) from the Childhood Cancer Survivor Study (CCSS)
METHODS:CCSS participants (age > 25 years) who received cardiotoxic therapy and reported no cardiac screening in >5 years were eligible. Participants (n=472, mean age 40.1, range 25.0-59.0; 53.3% females) were randomized to: standard care (SC) (personalized cancer treatment summary, lifestyle and cardiac health screening recommendations (n=234)) or INT (SC plus two nurse-tailored telephone sessions (n=238)). At 1 year, motivation measures were compared using adjusted linear models; LVFA completion was validated by medical records and compared between the two arms (adjusted relative risks (RR), 95% confidence intervals (CI)).
RESULTS: With 411 participants completing the study, the two groups did not differ by demographic or clinical characteristics. INT survivors scored higher than SC survivors on targeted motivation measures: autonomous regulation (p=0.001), effort (p<0.0001), competence (p=0.04), and screening value/utility (p=0.02). Among the INT survivors, 107/205 (52.2%) completed screening compared to 46/206 (22.3%) SC survivors (p<0.0001). With adjustment for gender, age (<30, 30+) and Children’s Oncology Group recommended screening intervals (annual, 2 years, 5 years), INT survivors were > two times more likely than SC survivors to obtain an LVFA (RR 2.31; 95% CI: 1.74-3.07).
CONCLUSIONS: Consistent with conceptual premises, risk behavior can be modified if the intervention addresses motivation for change and the behavioral outcome simultaneously.
Learning Areas:
Chronic disease management and preventionEpidemiology
Provision of health care to the public
Public health or related nursing
Public health or related research
Learning Objectives:
Identify major treatment-related cardiovascular (CV) risks in adult survivors of childhood cancer.
Identify recommended screening practices to detect overt and sub-clinical adverse cardiovascular outcomes in these at-risk survivors.
Describe how a nursing-based conceptual model can be used to formulate and test an intervention to promote CV screening in cancer survivors.
Evaluate the methodology and results of a randomized clinical trial that tested an intervention to motivate CV screening behavior in at-risk adult survivors of pediatric cancer.
Keyword(s): Cancer Prevention and Screening, Chronic Disease Management and Care
Qualified on the content I am responsible for because: I have been the PI on multiple NIH R01 grants and have conducted 2 randomized controlled trials most recently. I have been actively involved in health behavior change research among childhood cancer survivors for 13 years. I have over 100 publications and am a frequent presenter at major national scientific meetings.
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.