The transition to adult-focused care settings is a critical juncture at which many young adult (YA) cancer survivors fall out of care. Unsuccessful transition of care may lead to poorer outcomes including delayed diagnosis and treatment of cancer’s long-term effects. Transition readiness is a vital precursor that may predict successful transition and continued engagement in lifelong survivorship care. However, a full understanding of factors that contribute to transition readiness remains unclear. Guided by the Common Sense Model for Illness Self-Regulation (CSM), this mixed-methods study sought to elucidate cognitive and emotional illness representations and their associations with readiness for transition to adult-focused care in a sample of YA cancer survivors. The potential moderating influence of approach and avoidant coping orientation was also explored.
YA survivors (ages 18-26 years) were recruited from a local children’s hospital and the California Cancer Registry. Participants completed online questionnaires that included the Revised Illness Perception Questionnaire (IPQ-R), COPE Inventory (COPE), and Transition Readiness Inventory (TRI). A subset of participants completed semi-structured web-based interviews to gather qualitative data regarding transition readiness. Hierarchical linear regressions were utilized to examine how CSM constructs (perceptions of cancer as a chronic illness, perceived personal control over cancer, and emotional distress attributed to cancer) were associated with readiness for transition to adult care. Interview transcripts were coded utilizing reflexive thematic analysis as defined by Braun and Clark.
A total of 108 YA cancer survivors participated in the study. On average, participants were 21.4 ± 2.3 years old and 16.0 ± 3.7 years since diagnosis. Regression analyses showed that cancer-related emotional distress was negatively associated with readiness for transition to care ( = -.27, p = .008), but that cancer chronicity and personal control were not associated with transition readiness when controlling for age, gender, depression, anxiety, and time since diagnosis. Qualitative data analysis revealed three cross-cutting themes that characterize the transition to adult care and influences on readiness. First, transition readiness hinges on the ability of YA survivors, their families, and providers to strike a balance: in timing of transition discussions, in navigating mixed emotions associated with transition, and in handling controllable and uncontrollable factors associated with the transition. Second, the transition to adult care is one of many transitions occurring simultaneously during this developmental period. Third, understanding contradictions between YA survivor perceptions versus objective survivorship needs is necessary in promoting readiness for transition.
While cognitive factors associated with the transition of care remain central to developing readiness, the findings of this mixed methods study suggest a need to address YA survivors’ emotions to better facilitate transition preparation. Emotional distress associated with cancer and mixed emotions regarding the transition to adult care are potential targets for intervention.
