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

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. PRACTICE IMPLICATIONS: 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.