Introduction/Background*The growing number of cancer survivors has led to increased focus on follow-up care. Resent follow-up strategies tend to shift towards personalised care with focus on patient education and self-management. There are limited data on gynaecological cancer survivors’ self-management abilities. This study aimed to assess the relationship between self-management skills and adherence to current follow-up guidelines among gynaecological cancer survivors in the Netherlands, Norway, and Denmark. We also assessed the relationship between adherence to follow-up and use of additional healthcare services.
Methodology We conducted an international, multi-centre, cross-sectional study. Gynaecological cancer survivors were recruited 1–5 years after completion of treatment. We obtained information on clinical characteristics, demographics, self-management (Health Education Impact Questionnaire), follow-up visits, and use of healthcare services by validated questionnaires. Based on national guidelines, we categorised participants as adherent if they attended the recommended number of follow-up visits, non-adherent if they had fewer visits than recommended, or over-users if they had more visits than recommended.
Result(s)*Of 4455 invited survivors, 2428(55%) returned the questionnaires. After excluding 992 randomly selected Danish survivors to even the distribution between countries and survivors with more than 5 years follow-up, 911 survivors were included in the study. Survivors with high self-management skills (e.g. ability to manage medical and psychosocial aspects of one’s illness) most frequently attended the recommended number of follow-up visits. There were lower self-management skills in the health-directed activity domain, indicating less health-promoting physical activity (OR 1.54, 95% CI 1.03-2.32) among non-adherent survivors compared to adherent survivors. No other associations between self-management and follow-up adherence were revealed. Non-adherent survivors were likely to be older, treated by surgery only, Danish residents and have endometrial cancer. Over-users not only reported more follow-up visits but also used additional healthcare services, such as oncologic rehabilitation and/or oncological nurses, more frequently than adherent survivors.
Conclusion*Possession of low self-management skills appears to reduce the likelihood of adhering to national guidelines for gynaecological cancer follow-up. As personalisation of care is gradually implemented, a special attention on patient education for survivors at risk of low self-management may help to ensure their adherence to recommended follow-up.
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