Adolescent cancer patients' perceived quality of cancer care: The roles of patient engagement and supporting independence.

Objectives: A lack of focus on variation in engagement among cancer populations of differing developmental stages led us to examine the associations between patient engagement, the patient-provider relationship, cognitive development, readiness to transition to adulthood (transitional readiness) and perceived quality of care.

Methods: A sample of 101 adolescent cancer patients (diagnosed 10-20 years) completed survey items concerning patient engagement, dimensions of the patient-provider relationship, cognitive development, transitional readiness, and demographic characteristics using an iPad/tablet during a routine clinic visit.

Results: Patient engagement was not significantly associated with perceived quality of care (b = .02, 95% CI: -0.06, 0.11). Instead, adolescents with providers that supported their independence (b = .34, 95% CI: 0.17, 0.52) were significantly more likely to perceive higher quality care.

Conclusion: Supportive patient-provider relationships are an integral part of adolescents' perceptions of quality of care. Adolescents are still gaining important skills for navigating the medical system, and the patient-provider relationship may provide an important scaffolding relationship to help adolescents build independence in their treatment experience.

Practice Implications: Identifying potential mechanisms through which adolescents can provide their opinion, ask questions, and participate in their treatment plan will help in supporting adolescent independence and improve quality of care.