Patient-centered communication and emotional well-being among cancer survivors: The role of online peer interaction and the COVID-19 context.

Abstract

Patient-centered communication (PCC) predicts better emotional well-being among cancer survivors, but whether this benefit holds across changing care contexts is unclear. The COVID-19 pandemic, which disrupted in-person care and shifted survivors toward digital support, offers a natural test of whether PCC's value depends on context. We examined how the PCC-well-being association varies across pandemic periods and online participation, and whether self-efficacy consistently mediates it. Data came from cancer survivors (N = 2765) across four Health Information National Trends Survey (HINTS) cycles spanning pre- (2019), during- (2020, 2022), and post-pandemic (2024). PCC (seven items) and emotional well-being (four items) were latent factors; online participation and self-efficacy were single-item indicators. Analyses used confirmatory factor analysis, regression with three-way interactions, bootstrapped mediation, and multi-group structural equation modeling. Descriptive statistics were survey-weighted; models were unweighted. PCC was positively associated with emotional well-being (total effect B = 0.23 [0.19, 0.27]), partly mediated by health self-efficacy (indirect effect = 0.08 [0.07, 0.10]). This direct association was moderated by pandemic period and online participation (three-way interaction p = .015 during and p = .031 after). Before the pandemic, the association was, if anything, weaker among participants than non-participants (p = .09); during the pandemic, it was significantly stronger (p = .04), and positive but non-significant afterward (p = .14), consistent with online peer support complementing provider communication as informational demands rose. The self-efficacy-well-being path was weaker during the pandemic, indicating context-dependent mediation. The PCC-well-being association is not fixed but contingent on the communication environment, including survivors' online peer interaction. PCC is not uniform; findings identify boundary conditions under which it matters. Survivorship communication strategies should account for shifting care contexts and patients' digital peer interaction, distinguishing among types of digital communication rather than treating them as one.