Healthcare Provider Perspectives on Adherence to Adjuvant Endocrine Therapy after Breast Cancer

Lambert, Leah; Balneaves, Lynda G.; Howard, A. Fuchsia; Chia, Stephen L K; Gotay, Carolyn

doi:10.3390/curroncol28020139

Cited by 5 publications

(7 citation statements)

References 34 publications

(42 reference statements)

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“…A recent study about qualitative health care provider perspectives related to AET acceptance highlighted the pivotal role of a trustful patient-provider relationship. 36 Current results align with published literature, showing that trust in the treating physician is highly relevant for acceptance of AET, outweighing other commonly adopted factors such as age and a less favorable prognosis. 29 In cancer patients with potential life-threatening disease, a trustful patientphysician relationship can be essential for the success of the treatment.…”

Section: Trustsupporting

confidence: 83%

“…However, the difference between both groups is not as pronounced as we had expected, and it is outweighed by beliefs about medicine (especially the concerns regarding AET) and by trust in the treating physician (Table 2). On the assumption that the treating physician supports the AET, especially in patients with higher tumor stage, the physicians' belief might be an important factor in influencing the patients' acceptance 36 …”

Section: Discussionmentioning

confidence: 99%

“…On the assumption that the treating physician supports the belief might be an important factor in influencing the patients' acceptance. 36…”

Section: Acceptance and Non-modifiable Factorsmentioning

confidence: 99%

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The role of trust in the acceptance of adjuvant endocrine therapy in breast cancer patients

Elfgen

Güth

et al. 2022

Psycho-Oncology

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Objective: Despite adjuvant endocrine therapy (AET) considerably reducing mortality and recurrence in hormonal receptor-positive (HR+) breast cancer (BC) patients, acceptance of AET remains an issue. The reasoning behind the lack of acceptance is complex and multifactorial, and some associated risk factors have been previously analyzed. Our study aims to assess women's beliefs and concerns toward AET and women's trust in the treating physician, focusing on determining the importance of these factors in the acceptance of AET. Methods: Out of n = 539, n = 269 women with HR + BC participated in a crosssectional online survey. The main study variables were AET necessity beliefs and concerns (Beliefs about Medicines Questionnaire) and the trust in treating physicians. A binary hierarchical logistic regression was applied to predict AET acceptance. Results:We did not observe a meaningful mean difference in the necessity beliefs between women who accepted versus refused AET by the time of study conduct.Women with ongoing AET intake indicated significantly higher trust in their treating physician (d = 0.57) and have lower concerns (d = −1.65) regarding AET than women who had declined or discontinued AET prematurely. Results of the logistic regression demonstrated that after adjusting for clinical factors (e.g., prognosis, age), higher trust and lower concerns significantly increased the likelihood of accepting AET treatment. Conclusions:Our results demonstrate the importance of discussing potential concerns regarding AET and establishing a trustful patient-physician relationship, which outweighs non-modifiable factors such as cancer prognosis.

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Section: Trustsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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The role of trust in the acceptance of adjuvant endocrine therapy in breast cancer patients

Elfgen

Güth

et al. 2022

Psycho-Oncology

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“…Symptoms and concerns can cause different levels of distress (Mazor et al, 2018;Palmer et al, 2017;Vance et al, 2019) and can impact the quality of life negatively (Lambert et al, 2021). A significant number of patients after primary cancer treatment feel unprepared about how to manage life (Fitch et al, 2020).…”

Section: Backg Rou N Dmentioning

confidence: 99%

Symptoms and need for individualised support during the first year after primary treatment for breast cancer—A qualitative study

Rooth,

Sundberg,

Gustavell

et al. 2024

Journal of Clinical Nursing

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BackgroundThe survival rate among patients with breast cancer is high. It is well described that after primary treatment patients may experience symptoms and concerns but the needs and resources during the first year to manage everyday life are not well described.AimTo describe experiences of symptom distress, needs and support during the first year after primary treatment for breast cancer from the perspectives of patients and healthcare professionals.DesignQualitative descriptive.MethodsData collection through individual interviews with patients (n = 17) and a focus group interview with healthcare professionals (n = 7). Data was analysed using thematic analysis and resulted in three themes.ResultsThe first theme, ‘Struggling with symptoms and changes in everyday life’ shows how symptoms and concerns interfered with the everyday life of patients and in some situations even impeded them. Patients try to adapt to their new situation by creating new routines and managing symptoms through self‐care. The second theme, ‘Adaption in a period of uncertainty’ describes thoughts about cancer recurrence and doubts about continuing with the endocrine therapy if symptoms prolong. In the third theme, ‘Support and need for individualized follow‐up care’ healthcare professionals described that they provide support by being available and by giving both verbal and written information. Patients expressed that the information could be too general and voiced a need for more individually tailored support.ConclusionDuring the first year after primary treatment, patients with breast cancer describe how they try to manage by themselves, but express both unmet needs and a wish for extended and more individually tailored support. The healthcare professionals recognised that patients lack a structured plan for the first year and the need for continued support. This stresses a need for development of care models with special consideration towards individualised support after breast cancer treatment.No Patient or Public ContributionThere was no patient or public involvement in the design or conduct of the study. The interview study was not considered to benefit from involving patients or healthcare professionals when designing the interview guides as they were developed through literature and previous research of patients treated for breast cancer.

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“…In previous co-development work, patient representatives and healthcare professionals suggested that a website would allow patients to access side-effect management resources when required [71]. Demand for an online resource detailing evidence-based solutions to manage side-effects has also been reported elsewhere [129]. Therefore, a practical strategy to inform women about side-effects and their management was required.…”

Section: Living With Side-effectsmentioning

confidence: 99%

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

Green

French²,

Graham³

et al. 2022

BMC Health Serv Res

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Background Adjuvant endocrine therapy (AET) reduces the risk of breast cancer recurrence and mortality. However, up to three-quarters of women with breast cancer do not take AET as prescribed. Existing interventions to support adherence to AET have largely been unsuccessful, and have not focused on the most salient barriers to adherence. This paper describes the process of developing four theory-based intervention components to support adherence to AET. Our aim is to provide an exemplar of intervention development using Intervention Mapping (IM) with guidance from the Multiphase Optimisation Strategy (MOST). Methods Iterative development followed the six-stage IM framework with stakeholder involvement. Stage 1 involved a literature review of barriers to adherence and existing interventions, which informed the intervention objectives outlined in Stage 2. Stage 3 identified relevant theoretical considerations and practical strategies for supporting adherence. Stage 4 used information from Stages 1-3 to develop the intervention components. Stages 1-4 informed a conceptual model for the intervention package. Stages 5 and 6 detailed implementation considerations and evaluation plans for the intervention package, respectively. Results The final intervention package comprised four individual intervention components: Short Message Service to encourage habitual behaviours surrounding medication taking; an information leaflet to target unhelpful beliefs about AET; remotely delivered Acceptance and Commitment Therapy-based guided self-help to reduce psychological distress; and a website to support self-management of AET side-effects. Considerations for implementation within the NHS, including cost, timing and mode of delivery were outlined, with explanation as to how using MOST can aid this. We detail our plans for the final stage of IM which involve feasibility testing. This involved planning an external exploratory pilot trial using a 24-1 fractional factorial design, and a process evaluation to assess acceptability and fidelity of intervention components. Conclusions We have described a systematic and logical approach for developing a theoretically informed intervention package to support medication adherence in women with breast cancer using AET. Further research to optimise the intervention package, guided by MOST, has the potential to lead to more effective, efficient and scalable interventions.

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Healthcare Provider Perspectives on Adherence to Adjuvant Endocrine Therapy after Breast Cancer

Cited by 5 publications

References 34 publications

The role of trust in the acceptance of adjuvant endocrine therapy in breast cancer patients

The role of trust in the acceptance of adjuvant endocrine therapy in breast cancer patients

Symptoms and need for individualised support during the first year after primary treatment for breast cancer—A qualitative study

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

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