Development of a self-management intervention to improve tamoxifen adherence in breast cancer survivors using an Intervention Mapping framework

Abstract

Objective Up to 50% of women prescribed tamoxifen do not take it as prescribed for the full duration, which increases risk of recurrence and mortality. The current paper describes the development of a self-management intervention aiming to improve adherence in breast cancer survivors taking tamoxifen. Methods The intervention was developed following an Intervention Mapping approach. The content of the intervention was determined by theories of health behaviour and empirical evidence. Development was an iterative process involving input from expert researchers, clinicians and patient representatives. Results The intervention was designed to improve both intentional and unintentional non-adherence. Key features included modifying unhelpful illness and treatment beliefs, improving confidence for coping with side effects and developing strategies for remembering to take tamoxifen. Conclusion Intervention Mapping proved a useful tool for developing an intervention which is grounded in theory and empirical evidence. The intervention has the potential to improve adherence in breast cancer survivors but needs to be trialled before the effectiveness of the intervention can be determined.

Supporting adjuvant endocrine therapy adherence in women with breast cancer: the development of a complex behavioural intervention using Intervention Mapping guided by the Multiphase Optimisation Strategy

“… Text messaging AI RCT; text messages vs no text messages No significant difference between text messages (55.55%) and no text messages (55.4%) at 36 months. None mentioned Moon et al (2019) [ 33 , 83 ] Self-directed paper booklet designed in line with CBT and behaviour change theory. Included sections to modify beliefs about recurrence and the medication, to help manage side effects and to increase perceived behavioural control.…”

“…An extended version of the commonsense model of illness representations (CSM) highlights that cognitive and emotional illness representations, in addition to medication beliefs, influence adherence [ 110 ]. The CSM has previously been applied to the development of an intervention to support AET adherence [ 33 ]. Illness representations have been correlated with necessity and concern beliefs in women with AET [ 59 ], suggesting they could be targeted together.…”

“…It consists of six stages that cover designing, implementing and evaluating an intervention, and it promotes relevant stakeholder engagement throughout development [28]. IM has previously been used to develop interventions targeting adherence [29][30][31] and women with breast cancer [32,33].…”

A Multi-Domain Group-Based Intervention to Promote Physical Activity, Healthy Nutrition, and Psychological Wellbeing in Frail Older People: AMICOPE Development Study

“…Scientific literature is scarce for published intervention development studies. To date, the few examples found using the GUIDED checklist includes two PubMed peer-reviewed articles reporting interventions aimed to improve mental health help-seeking behaviours for male students [57], and tamoxifen adherence in breast cancer [58]; two preprints reporting interventions aimed to improve early diagnosis of cancer in primary care [59] and targeting antipsychotic prescribing to nursing home residents with dementia [60]; and one doctoral thesis reporting an arts-based intervention for patients with kidney disease [61].…”

Person-centred support programme (RESPECT intervention) for women with breast cancer treated with endocrine therapy: a feasibility study

“… 12 A combination of information with cognitive–behavioural therapy to manage the side effects of tamoxifen showed successful results for the development of management skills among patients who were unable to stay in treatment. 11 Furthermore, training intervention with a physiotherapist or personal trainer followed by adapted training at home could be effective. However, a problem with this intervention was programme adherence, as patients reported difficulty meeting the training goal in frequency and intensity due to other demands in life 14 Additionally, training has not been found to have an effect on musculoskeletal symptoms in patients treated with Aromatase inhibitors (AIs).…”