Discussion
The concept of self-advocacy, as derived from this systematic synthesis of the literature, is a
process of internalizing and activating resources into actions to overcome cancer- and
treatment-related obstacles. When fully realized, this process extends beyond the skillsbased
and situation-focused concepts of self-management and self-efficacy to a personbased
advocacy. Self-advocacy becomes a personal journey where survivors assess and
tackle the challenges of cancer on their own terms, thus producing a patient-driven model of
individualized care (Peppercorn et al. 2011).
The proposed conceptual model represents an integrated understanding of the previous uses
of self-advocacy in the literature. Survivors may self-advocate in a wide range of issues,
including both physical and emotional needs or even in larger social and political arenas.
This model is not limited to a single phase of survivorship and should accommodate a wide
range of experiences and challenges (Miller et al. 2008, Muraca et al. 2011). The elements in
this model are similar to key elements of a model of self-advocacy in the disabilities
literature that successfully guided intervention research to improve patient outcomes (Test et
al. 2005). This suggests that self-advocacy could also be a productive target for intervention
among cancer survivors.