Pathways to Resilience of Social Networks of Older Adults with Advanced Cancer

Our study will address the goals of RFA-AG-24-025 by elucidating how the pathways by which key aspects of social connectedness in social networks (SNs)—structural characteristics, functional aspects, and quality of relationships—interact and are associated with clinically significant health behaviors of older adults with advanced cancer. We focus on older adults with advanced cancer with an estimated survival of less than 12 months because our research shows that a) they rely heavily on social networks (SNs) for instrumental and emotional support, b) their health behaviors are complicated by poor disease understanding, c) aging-related conditions and treatment-related toxicities adversely affect their quality of life (QoL) and survival, d) their interpersonal emotional processes and social determinants influence discretionary utilization (e.g., chemotherapy) at the end of life (i.e., DIALs), and e) serious illness conversations and advance care planning with SN members promote appropriate use of palliative care. In this proposal, we focus on three behaviors known to improve outcomes at the end of life (EoL): initiating and participating in serious illness conversations about preferences for EoL care, completing advance care planning, and engaging with palliative care. We will examine how structural characteristics of patients’ SNs (e.g., density; size and composition of inner circle), their functional aspects for provision of social support, and the quality of relationships (perceptions of belonging, interpersonal emotional processes) influence these health behaviors. We will also examine SN resilience: how SNs evolve to continue to provide support for patient behaviors in the face of cancer progression and network disruptions. We will assess interactions among structure, function, and quality of relationships of SNs using Mixed Methods Social Network Analysis (MMSNA) to integrate structural analysis with qualitative assessment of network characteristics, and evaluate associations with health behaviors at the EoL. At study entry, we will survey 300 patients with advanced cancer (age >65 years, with a life expectancy <12 months) to assess their SN structures. Then, we will use criterion-based emergent sampling to purposively select up to 70 patients and one key influential member of their SNs for in-depth semi-structured interviews to characterize how SN members influence health behaviors of older patients with advanced cancer at the EoL. Our aims are (1) To assess the interrelationships between SN structure, function, and quality of relationships; (2) To analyze how SN structure, function, and quality of relationships relate to key health behaviors, including engagement in serious illness conversations about EoL preferences, advance care planning, and palliative care; and (3) To describe thematic pathways of network resilience (i.e, how the structure, function, quality of relationships evolve) in response to cancer progression and SN stressors over 6 months. Our findings will help develop SN interventions, informed by and adapted to network structures and interpersonal processes of behavior change, to improve EoL care in older patients with advanced cancer.