Gender Differences in Self-Advocacy Among Cancer Survivors: How Women and Men Vary in How They Learn to Engage in Decision-Making and Social Support.

Abstract

Understanding gender variations in self-advocacy can help oncology clinicians support the educational needs of cancer survivors. This study aims to examine the role of gender along with additional other sociodemographic variables in how cancer survivors self-advocate including their engagement in decision-making, communication with healthcare providers, and use of social support. Data from two cross-sectional descriptive studies were combined for analyses. Each study used convenience sampling methods to recruit adults (≥ 18 years old) with a history of invasive cancer who had English literacy from cancer clinics and community advocacy groups. The first study recruited women (n = 317), and the second study recruited men (n = 179). In both studies, participants completed two assessments of self-advocacy: Self-Advocacy in Cancer Survivorship (SACS) Scale and the Patient Self-Advocacy Scale. We built a linear regression model to test the association between gender and self-advocacy total and subscale scores controlling for covariates. N = 496 participants completed study procedures between 2014 and 2022. On both self-advocacy scales, women reported higher self-advocacy scores compared to men, with women's higher scores on the SACS subscales of connected strength and informed decision-making driving the gender difference in cancer-specific self-advocacy. Self-advocacy behaviors are associated with gender, most notably by way of individuals' ability to derive strength through social connection. Women tend to have greater engagement in care with larger and more meaningful social networks, while men report less engagement. Educational materials for cancer survivors should leverage gender-associated self-advocacy skills and bolster skills that require support.