Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management

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 group of health care providers (n=13) experienced in caring for BCS undergoing AET. We utilized semi-structured discussion guides to elicit provider perspectives on AET-related SM. FGs were audiotaped, transcribed, and analyzed using qualitative software to identify key themes. Results Providers described patient-, provider-, and system- level barriers and facilitators to AET-related SM. At the patient-level, barriers included competing demands, limited time/resources, and possible misattribution of some symptoms to AET, while family/social relationships and insurance emerged as important facilitators. Discomfort with SM, limited time, and challenges distinguishing AET-related symptoms from other conditions were key provider-level barriers. Provider-level facilitators included routine symptom documentation and strong provider relationships. Care fragmentation and complexity of the cancer care delivery system were described as system-level barriers; however, survivor clinics were endorsed by providers. Conclusions Provider perspectives on AET-related SM can shed light on SM barriers and facilitators spanning multiple levels of the cancer care delivery system. Strategies for improving AET-related SM in BCS include increasing patients' knowledge and engagement in SM, equipping providers with efficient SM strategies, and improving coordination of symptom-related services through survivorship programs.

Racial differences in symptom management experiences during breast cancer treatment

“…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.…”

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

“…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 women’s side effects are not neglected or minimized.…”

“…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 ].…”

Systematic adaptation of the adherence improving self‐management strategy to support breast cancer survivors' adherence to adjuvant endocrine therapy: An intervention mapping approach

“…Identified as eligible: (Accordino & Hershman, 2013 ; Banning, 2012 ; Cahir, Guinan, et al, 2015 ; Chlebowski et al, 2014 ; Gotay & Dunn, 2011 ; Lambert, Balneaves, Howard, & Gotay, 2018 ; Mausbach et al, 2015 ; McCowan & Thompson, 2012 ; Miaskowski et al, 2008 ; Milata et al, 2018 ; Moon, Moss‐Morris, Hunter, Carlisle, et al, 2017; Murphy et al, 2012 ; Paranjpe et al, 2019 ; Puts et al, 2014 ; Sawesi et al, 2014 ; Van Liew et al, 2014 ; Wassermann & Rosenberg, 2017 )

APPENDIX B2 Flow chart qualitative articles. Identified as eligible: (Bluethmann et al, 2017 ; Brett et al, 2018 ; Cahir, Dombrowski, et al, 2015 ; Farias, 2016 ; Farias et al, 2017 ; Hackett et al, 2018 ; Harrow et al, 2014 ; Humphries et al, 2018 ; Hurtado‐de‐Mendoza, Cabling, et al, 2019 ; Iacorossi et al, 2018 ; Lambert, Balneaves, Howard, Chia, et al, 2018; Moon, Moss‐Morris, Hunter, & Hughes, 2017 ; Pellegrini et al, 2010 ; Pieters et al, 2019 ; Samuel et al, 2017 ; Toledo et al, 2019 ; van Londen et al, 2014 ; Wheeler et al, 2015 ; Wouters et al, 2013 ; Yamamoto et al, 2015 )

APPENDIX B3 Flow chart quantitative articles. Identified as eligible: (Brett et al, 2018b ; Cabling et al, 2018 ; Hagen et al,

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“… Flow chart qualitative articles. Identified as eligible: (Bluethmann et al, 2017 ; Brett et al, 2018 ; Cahir, Dombrowski, et al, 2015 ; Farias, 2016 ; Farias et al, 2017 ; Hackett et al, 2018 ; Harrow et al, 2014 ; Humphries et al, 2018 ; Hurtado‐de‐Mendoza, Cabling, et al, 2019 ; Iacorossi et al, 2018 ; Lambert, Balneaves, Howard, Chia, et al, 2018; Moon, Moss‐Morris, Hunter, & Hughes, 2017 ; Pellegrini et al, 2010 ; Pieters et al, 2019 ; Samuel et al, 2017 ; Toledo et al, 2019 ; van Londen et al, 2014 ; Wheeler et al, 2015 ; Wouters et al, 2013 ; Yamamoto et al, 2015 ) …”