The overall purpose (of the project) is to identify effective strategies that will improve patient compliance with the radiation therapy treatment schedule, the prescribed health maintenance plan while on radiation therapy, and the follow-up evaluation schedule post therapy. Compliance is essential to the present and future health of the patient with cancer. Compliance will be evaluated against the patient's reported quality of life, emotional state, and satisfaction with the health care received. Data will be collected on a sample of 225 cancer patients receiving radiation therapy to the pelvic region for primary treatment of disease, or as an adjuvant to surgery, or as therapy for recurrent disease. A 2 x 2 factorial + 1 control condition blocks experiment is planned. It will test: (1) the effects of two types of patient education strategies (self-directed program or a nurse-directed program) and two types of commitment strategies (contract or letter reminder about expected behaviors and goals) on compliance with radiation therapy, health maintenance plan, and the follow-up schedule; and (2) the interaction between the treatment factors (types of education and commitment strategies) and the blocking factor personal preference for control or no control over health matters. Analyses of variance will be computed to test the main effects of the education and commitment strategies and the interaction effects of these variables with the blocking factor preference for control or no control over health matters, on compliance, quality of life, emotional states, and satisfaction with care. Regression analyses will be used to describe the influence of a number of variables on compliance. Path analyses will be used to describe patterns of variables that predict compliance. Results are expected to show: (1) that the contracting strategy for commitment is powerful enough to elicit greater compliance regardless of educational approach or personal preference for control-no control; (2) that patients preferring control respond with greater compliance to the internally oriented strategies of self-directed learning and contracting; while patients preferring no control respond with greater compliance to the externally oriented strategies of nurse-directed teaching and letter reminders; and (3) that self-directed learning is practical and cost effective since results are similar to the more expensive nurse-directed teaching approach.
