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Family management ability and transition readiness in young adult survivors of pediatric brain tumors: social determinants of health as moderators
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Family management ability and transition readiness in young adult survivors of pediatric brain tumors: social determinants of health as moderators

Ashley Elizabeth Anil
Master of Science (M.S.), Drexel University
Mar 2023
DOI:
https://doi.org/10.17918/00001555
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Abstract

Family services--Management Health--Social aspects Young adults--Transition readiness Pediatric brain tumors--Young adults Survivors Clinical Psychology Oncology Psychology
The transition into adulthood is a particularly vulnerable time for young adult survivors of pediatric brain tumors (YAS) and their caregivers due to challenges related to the late effects of their tumor and treatment. Caregivers may question their condition management ability (CMA) as their caregiving role extends into adulthood at a time when resources available for children are no longer accessible to the YAS. Social determinants of health (SDH) may also influence caregivers' CMA as they assist their YAS transition to adult care (transition readiness) by impacting the quality of caregiver's management and hence their confidence in managing. The aim of this study was to determine the relationship between CMA and transition readiness, and the moderating role of SDH for YAS with condition-focused mothers. We hypothesized that CMA and transition readiness would be positively related, and that as the risk of SDH factors increased the relationship between CMA and transition readiness would strengthen. A sample of 53 self-identified maternal caregivers of YAS reporting condition-focused scores (< 51) on the Family Management Measure CMA subscale, completed the Transition Readiness Assessment Questionnaire for their YAS, a cognitive late effect severity rating for their YAS, and a demographics questionnaire. The Social Vulnerability Index (SVI), calculated using 16 factors across US Census data, was utilized as a cumulative measure of SDH. T-tests, ANOVA, Pearson correlations, and multivariate linear regressions were used. The cumulative measure of SDH (SVI) was not related to CMA. Caregivers who reported protective SDH factors including living with a partner, support in caregiving, an annual household income of $60,000 or greater, and YAS with private insurance reported better transition readiness. When controlling for cognitive late effects rating, CMA was not related to transition readiness, and there were no interaction effects. Exploratory analyses found that cognitive late effects had a significant indirect effect on transition readiness through CMA, but only for families with lower SVI scores. Cognitive late effects demonstrated a significant total effect on transition readiness, but mediation by CMA and moderation by SDH factors were not supported. Caregivers with caregiving support, caregivers living with a partner, and YAS with private insurance reported significantly better transition readiness. Findings support the importance of targeted cognitive remediation. Cancer survivorship care models and healthcare policy that targets increased accessibility to and long-term engagement in existing survivorship care and enhancement of supportive services for YAS and caregivers that minimize financial toxicity are indicated.

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