Abstract:Purpose
Adjuvant endocrine therapy (AET) utilization is linked to improved clinical outcomes among breast cancer survivors (BCS); yet, AET adherence rates remain suboptimal. Little is known about provider perspectives regarding barriers and facilitators to AET-related symptom management (SM). In this study, we examined provider perspectives on the barriers and facilitators to AET-related SM among BCS and opportunities for improvement.
Methods
We conducted three focus groups (FGs) with a multidisciplinary gro… Show more
“…Findings revealing inadequacy of patient-clinician communication on treatment-related symptoms and symptom management options are consistent with findings from other recent work,[34] and highlight the potential need for additional clinician training. Such training could focus on identifying and addressing physical (e.g., pain, nausea, rashes) and non-physical (e.g., emotional issues, social isolation, financial toxicity) symptoms, and the possibility of unexpected, less common symptoms.…”
This study elucidates opportunities for future research aimed at improving equity for cancer treatment-related symptom management. For Black women, warnings about anticipated symptoms and treatment for ongoing symptoms were particular areas of concern. Routine symptom assessment for all women, as well as clinicians' management of symptoms for racially diverse cancer patients, need to be more thoroughly studied and addressed.
“…Findings revealing inadequacy of patient-clinician communication on treatment-related symptoms and symptom management options are consistent with findings from other recent work,[34] and highlight the potential need for additional clinician training. Such training could focus on identifying and addressing physical (e.g., pain, nausea, rashes) and non-physical (e.g., emotional issues, social isolation, financial toxicity) symptoms, and the possibility of unexpected, less common symptoms.…”
This study elucidates opportunities for future research aimed at improving equity for cancer treatment-related symptom management. For Black women, warnings about anticipated symptoms and treatment for ongoing symptoms were particular areas of concern. Routine symptom assessment for all women, as well as clinicians' management of symptoms for racially diverse cancer patients, need to be more thoroughly studied and addressed.
“…Yet, the lack of symptom management guidelines and the number of patients referred back to oncologists indicate that HCPs may not have access to the professional support required to manage AET-related symptoms in primary care settings. This is consistent with research that found primary care providers expressed uncertainty about their ability to delivery AET-related symptom management and questioned if doing so was beyond their scope of practice [ 20 ]. Despite the complexity of symptom management, HCPs need to be aware of the importance of asking about AET symptoms in follow-up consults to ensure womenâs side effects are not neglected or minimized.…”
Section: Discussionsupporting
confidence: 82%
“…This study provides a comprehensive portrayal of the unique challenges HCPs face in caring for women on AET. Previous qualitative research with HCPs has mainly focused on investigating a single aspect of AET-related care, such as symptom management [ 19 , 20 ] and physician prescribing patterns [ 21 ].…”
Adherence to adjuvant endocrine therapy (AET) for breast cancer is suboptimal. The purpose of this study was to: (1) explore the experiences and perspectives of healthcare providers (HCPs) in providing care to breast cancer survivors prescribed AET, (2) identify how social and structural factors influence the provision of AET-related care, and (3) ascertain HCP recommendations for optimizing AET adherence and related care. Individual, in-depth interviews were conducted with 14 HCPs using an interpretive descriptive approach to inquiry and the theoretical lens of relational autonomy. Data was analyzed using thematic and constant comparative techniques. Healthcare providers focused on four main components of AET-related care: (1) the importance of having careful conversations about AET, (2) difficulties in navigating transitions in care, (3) symptom management as a big part of their role, and (4) dealing with AET discontinuation. Recommendations to improve AET adherence focused on developing sustainable and efficient models of delivering high-quality care to women on AET. Healthcare providers play a pivotal role educating women about AET and supporting their adherence to therapy. Sustainable healthcare system innovations and new models of care that address current system gaps are needed to enhance survivorship care, AET adherence, and ultimately, reduce cancer recurrence and mortality.
Objective
Nonâadherence to adjuvant endocrine therapy (AET) for breast cancer leads to increased recurrence and mortality risk and healthcare costs. Evidence on feasible, effective AET adherence interventions is scarce. This paper describes the systematic adaptation of the costâeffective adherence improving selfâmanagement strategy (AIMS) for patients with HIV to AET for women after breast cancer treatment.
Methods
We followed the intervention mapping protocol for adapting interventions by conducting a needs assessment, reviewing target behaviours and determinants, reassessing behaviour change methods and adapting programme content. Therefore, we performed a literature review, consulted behavioural theory and organised nine advisory board meetings with patients and healthcare professionals.
Results
Nonâadherence occurs frequently among AET users. Compared to HIV treatment, AET is less effective, and AET side effects are more burdensome. This drives AET treatment discontinuation. However, the key determinants of nonâadherence are largely similar to HIV treatment (e.g. motivation, selfâregulation and patientâprovider relationship); therefore, most strategies in AIMSâHIV also seem suitable for AIMSâAET. Modifications were required, however, regarding supporting patients with coping with side effects and sustaining treatment motivation.
Conclusion
AIMS seems to be a suitable framework for adherence selfâmanagement across conditions and treatments. Intervention mapping offered a transparent, systematic approach to adapting AIMSâHIV to AET.
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