1
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Agnew S, Crawford M, MacPherson I, Shiramizu V, Fleming L. The impact of symptom clusters on endocrine therapy adherence in patients with breast cancer. Breast 2024; 75:103731. [PMID: 38599048 PMCID: PMC11017041 DOI: 10.1016/j.breast.2024.103731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND When taken as prescribed, endocrine therapy is effective in reducing risk of recurrence and mortality in the treatment of patients with breast cancer. However, treatment side effects can act as a barrier to medication adherence. Existing research has not identified any specific side effects as consistent predictors of nonadherence. Our aim was to explore the influence of symptom clusters on self-reported adherence in patients with breast cancer. METHODS A cross-sectional online survey was conducted, including patients with breast cancer currently or previously prescribed endocrine therapy (N = 1051). This included measures of self-reported endocrine therapy adherence and common symptoms among this population (insomnia, depression, anxiety, fatigue, musculoskeletal, and vasomotor symptoms). RESULTS Unintentional nonadherence was higher than intentional nonadherence (50.8 % vs 31.01 %). The most troublesome symptom was insomnia (73.83 % displayed probable insomnia disorder). K-means cluster analysis identified 2 symptom clusters: overall High symptoms, and overall Low symptoms. Participants in the Low symptoms cluster were significantly more likely to be classed as adherent based on unintentional and intentional items. CONCLUSIONS Nonadherence was high in the current sample, and significantly more likely in participants reporting overall severe symptoms. Clinicians should be aware of the scale of common side effects and facilitate open conversation about potential barriers to adherence. Follow-up care should include assessment of common symptoms and signpost patients to appropriate support or treatment when required. Future research should explore potential for a central symptom to act as a target for intervention, to relieve overall side effect burden and facilitate better medication adherence.
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Affiliation(s)
- Sommer Agnew
- University of Strathclyde, 16 Richmond St, Glasgow, G1 1XQ, Scotland, UK.
| | - Megan Crawford
- University of Strathclyde, 16 Richmond St, Glasgow, G1 1XQ, Scotland, UK.
| | | | - Victor Shiramizu
- University of Strathclyde, 16 Richmond St, Glasgow, G1 1XQ, Scotland, UK.
| | - Leanne Fleming
- University of Strathclyde, 16 Richmond St, Glasgow, G1 1XQ, Scotland, UK.
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2
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Kumar T, Dutta RR, Thakre S, Singh A, Velagala VR, Shinde RK. Resistance to Resilience: Understanding Post-surgical Hormone Therapy in Breast Cancer Care. Cureus 2023; 15:e47869. [PMID: 38021507 PMCID: PMC10681032 DOI: 10.7759/cureus.47869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Breast cancer is one of the most common types of cancer affecting women worldwide. Over the years, breast cancer has become a major public health concern, and its incidence is rising globally. The treatment of breast cancer does not stop with surgical intervention, but adjuvant therapies are administered to improve patient outcomes post-surgery based on the type of breast cancer diagnosed. This review focuses on the value of hormone therapy (HT) in improving the prognosis of breast cancer patients and why adhering to adjuvant treatment post-surgery is difficult for patients. HT aims to reduce the chances of breast cancer recurrence after surgical treatment. Even though HT is life-saving, patients tend to not adhere to the therapy due to various factors such as side effects, age-related issues, and socioeconomic status. Most patients stop adhering to the therapy as the duration can be as long as 5-10 years, and the quality of life is greatly impacted due to the side effects of the treatment. This review examines the possible factors leading to non-adherence to HT and tries to propose possible interventions that might improve patient compliance with the treatment. This article not only focuses on the impact of side effects of HT on patients' quality of life but also tries to understand the problems faced by breast cancer patients in adhering to HT.
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Affiliation(s)
- Tanishq Kumar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rajoshee R Dutta
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swedaj Thakre
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Arihant Singh
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vivek R Velagala
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raju K Shinde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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3
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Yang S, Park SW, Bae SJ, Ahn SG, Jeong J, Park K. Investigation of Factors Affecting Adherence to Adjuvant Hormone Therapy in Early-Stage Breast Cancer Patients: A Comprehensive Systematic Review. J Breast Cancer 2023; 26:309-333. [PMID: 37272247 PMCID: PMC10475712 DOI: 10.4048/jbc.2023.26.e22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/05/2023] [Accepted: 04/16/2023] [Indexed: 06/06/2023] Open
Abstract
PURPOSE Adherence and persistence to adjuvant hormone therapy (AHT) are seldom maintained among early-stage hormone receptor-positive breast cancer (BC) survivors, despite the significant clinical benefits of long-term AHT. As the factors influencing adherence to AHT remain unclear, this study aimed to comprehensively identify such factors and classify them into specific dimensions. METHODS PubMed, Cochrane Library, Embase, PsycINFO, and CINAHL were searched for qualified articles. The search mainly focused on three components: early-stage (0-III) BC, oral AHT administration, and adherence to AHT, with keywords derived from MeSH and entry terms. The factors identified were then classified into six categories based on a modified WHO multidimensional model. RESULTS Overall, 146 studies were included; the median sample size was 651 (range, 31-40,009), and the mean age of the population was 61.5 years (standard deviation, 8.3 years). Patient- and therapy-related factors were the most frequently investigated factors. Necessity/concern beliefs and self-efficacy among patient-related factors were consistently related to better adherence than depression. Although drug side effects and medication use cannot be modified easily, a refined prescription strategy for the initiation and switching of AHT is likely to increase adherence levels. CONCLUSION An effective psychological program that encourages positive views and beliefs about medication and management strategies for each therapy may be necessary to improve adherence to AHT. Social support and a sense of belonging can be enhanced through community participation and social media for better adherence to AHT. Patient-centered communication and appropriate recommendations by physicians may be attributable to better adherence outcomes. Findings from systematically organized factors that influence adherence to AHT may contribute to the establishment of intervention strategies to benefit patients with early-stage BC to achieve optimal health.
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Affiliation(s)
- Seongwoo Yang
- HERINGS, The Institute of Advanced Clinical & Biomedical Research, Seoul, Korea
| | - Seong Won Park
- HERINGS, The Institute of Advanced Clinical & Biomedical Research, Seoul, Korea
| | - Soong June Bae
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine/Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine/Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine/Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyounghoon Park
- HERINGS, The Institute of Advanced Clinical & Biomedical Research, Seoul, Korea.
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4
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Mooiweer Y, Seeber GH, Brütt AL, Eleveld R, Ulitzka R, Lazovic D, Ansmann L, Stevens M. Influence of health system and patient characteristics on expectations and outcome in total hip arthroplasty patients in the Dutch-German border region: protocol for a mixed-methods prospective observational comparative study (hip across). BMJ Open 2023; 13:e067499. [PMID: 37105704 PMCID: PMC10151850 DOI: 10.1136/bmjopen-2022-067499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Total hip arthroplasty (THA) is the treatment of choice for end-stage osteoarthritis of the hip. Management of THA differs between countries, and it is hypothesised that this can influence patients' expectations and self-efficacy. Using Chen's intervening mechanism evaluation approach, this study aims to explore how structure of care influences expectations and self-efficacy of patients undergoing THA, and how expectations and self-efficacy in turn influence outcome in terms of perceived physical function and satisfaction. METHODS AND ANALYSIS A mixed-methods study will be conducted in two German and two Dutch hospitals near the Dutch-German border. In the quantitative part, patients will complete questionnaires at three timepoints: preoperatively and at 3 and 6 months postoperatively. Data analysis will include multiple regression analysis and structural equation modelling. In the qualitative part, interviews will be held with patients (preoperatively and 3 months postoperatively) and healthcare providers. Analysis will be performed using structured qualitative content analysis. ETHICS AND DISSEMINATION The study is approved by the Institutional Review Boards of both Carl von Ossietzky University Oldenburg (2021-167) and University Medical Center Groningen (METc 2021/562 and METc 2021/601). The results will be disseminated in the international scientific community via publications and conference presentations. TRIAL REGISTRATION NUMBER The study is registered in the German Clinical Trials Registry (DRKS: DRKS00026744).
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Affiliation(s)
- Yvet Mooiweer
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
- Department of Orthopedics, University Medical Center Groningen, Groningen, The Netherlands
| | - Gesine H Seeber
- Department of Orthopedics, University Medical Center Groningen, Groningen, The Netherlands
- University Hospital of Orthopedics and Trauma Surgery Pius-Hospital, Medical Campus University Oldenburg, Oldenburg, Germany
| | - Anna Levke Brütt
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Rienk Eleveld
- Department of Orthopedics, Ommelander Ziekenhuis Groningen, Scheemda, The Netherlands
| | - Raimund Ulitzka
- Department of Orthopedics and Trauma Surgery, Klinikum Leer gGmbH, Leer, Germany
| | - Djordje Lazovic
- University Hospital of Orthopedics and Trauma Surgery Pius-Hospital, Medical Campus University Oldenburg, Oldenburg, Germany
| | - Lena Ansmann
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Martin Stevens
- Department of Orthopedics, University Medical Center Groningen, Groningen, The Netherlands
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5
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Smith SG, Green SMC, Ellison R, Foy R, Graham CD, Mason E, French DP, Hall LH, Wilkes H, McNaught E, Raine E, Walwyn R, Howdon D, Clark J, Rousseau N, Buxton J, Moore SJL, Parbutt C, Velikova G, Farrin A, Collinson M. Refining and optimising a behavioural intervention to support endocrine therapy adherence (ROSETA) in UK women with breast cancer: protocol for a pilot fractional factorial trial. BMJ Open 2023; 13:e069971. [PMID: 36737093 PMCID: PMC9900066 DOI: 10.1136/bmjopen-2022-069971] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Women with breast cancer who do not adhere to adjuvant endocrine therapy (AET) have increased risks of mortality and recurrence. There are multiple barriers to AET adherence, including medication side-effects, beliefs about medication, memory and psychological distress. We developed four intervention components, each targeting a different barrier. This pilot trial is part of the preparation phase of the Multiphase Optimisation Strategy, and aims to establish key trial parameters, establish intervention component adherence, establish availability and feasibility of outcome and process data, estimate variability in planned outcome measures and estimate cost of developing and delivering each intervention component. METHODS AND ANALYSIS The four intervention components are as follows: short message service text reminders (target: memory); a written information leaflet (target: medication beliefs); a guided self-help Acceptance and Commitment Therapy programme (target: psychological flexibility to reduce distress) and a self-management website (target: side-effect management). To evaluate the feasibility of recruitment, acceptability of the intervention components and the availability of outcome data, we will conduct a multisite, exploratory pilot trial using a 24-1 fractional factorial design, with a nested process evaluation. We will randomise 80 women with early-stage breast cancer who have been prescribed AET to one of eight experimental conditions. This will determine the combination of intervention components they receive, ranging from zero to four, with all conditions receiving usual care. Key outcomes of interest include medication adherence and quality of life. Progression to the optimisation phase will be based on predefined criteria for consent rates, patient adherence to intervention components and availability of medication adherence data. ETHICS AND DISSEMINATION The study was reviewed by the Wales Research Authority Research Ethics Committee 3 (21/WA/0322). Written informed consent will be obtained from all patients before randomisation. The results of this trial will be disseminated in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ISRTCN10487576.
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Affiliation(s)
- Samuel G Smith
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sophie M C Green
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Rachel Ellison
- Complex Interventions Division, Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Robbie Foy
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Ellen Mason
- Complex Interventions Division, Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - David P French
- School of Psychological Sciences, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Louise H Hall
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Hollie Wilkes
- Complex Interventions Division, Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Emma McNaught
- Complex Interventions Division, Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Erin Raine
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Rebecca Walwyn
- Complex Interventions Division, Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Daniel Howdon
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Jane Clark
- Department of Clinical and Health Psychology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nikki Rousseau
- Surgical, Diagnostic and Devices Division, Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jacqueline Buxton
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sally J L Moore
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Catherine Parbutt
- Medicines Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Galina Velikova
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Amanda Farrin
- Complex Interventions Division, Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Michelle Collinson
- Complex Interventions Division, Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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6
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Janssen AM, Dam J, Prins J, Buffart LM, de Bruin M. Systematic adaptation of the adherence improving self-management strategy to support breast cancer survivors' adherence to adjuvant endocrine therapy: An intervention mapping approach. Eur J Cancer Care (Engl) 2022; 31:e13721. [PMID: 36263723 PMCID: PMC9787620 DOI: 10.1111/ecc.13721] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 08/17/2022] [Accepted: 09/14/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Non-adherence 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 cost-effective adherence improving self-management 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 Non-adherence 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 non-adherence are largely similar to HIV treatment (e.g. motivation, self-regulation and patient-provider relationship); therefore, most strategies in AIMS-HIV also seem suitable for AIMS-AET. 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 self-management across conditions and treatments. Intervention mapping offered a transparent, systematic approach to adapting AIMS-HIV to AET.
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Affiliation(s)
- Anna M. Janssen
- Department of IQ Health, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Joëlle Dam
- Department of IQ Health, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Judith Prins
- Department of Medical Psychology, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Laurien M. Buffart
- Department of Physiology, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Marijn de Bruin
- Department of IQ Health, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
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7
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Green SMC, French DP, Graham CD, Hall LH, Rousseau N, Foy R, Clark J, Parbutt C, Raine E, Gardner B, Velikova G, Moore SJL, Buxton J, Smith SG. 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. BMC Health Serv Res 2022; 22:1081. [PMID: 36002831 PMCID: PMC9404670 DOI: 10.1186/s12913-022-08243-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/21/2022] [Indexed: 01/05/2023] Open
Abstract
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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Affiliation(s)
- Sophie M. C. Green
- grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL UK
| | - David P. French
- grid.5379.80000000121662407Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Christopher D. Graham
- grid.4777.30000 0004 0374 7521Department of Psychology, Queen’s University Belfast, Belfast, UK
| | - Louise H. Hall
- grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL UK
| | - Nikki Rousseau
- grid.9909.90000 0004 1936 8403Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Robbie Foy
- grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL UK
| | - Jane Clark
- grid.443984.60000 0000 8813 7132St. James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Catherine Parbutt
- grid.443984.60000 0000 8813 7132St. James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Erin Raine
- grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL UK
| | - Benjamin Gardner
- grid.13097.3c0000 0001 2322 6764Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Galina Velikova
- grid.443984.60000 0000 8813 7132Leeds Institute of Medical Research at St James’s, University of Leeds, St James’s University Hospital, Leeds, UK ,grid.443984.60000 0000 8813 7132Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
| | - Sally J. L. Moore
- grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL UK
| | - Jacqueline Buxton
- grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL UK
| | | | - Samuel G. Smith
- grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL UK
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Fleming L, Agnew S, Peddie N, Crawford M, Dixon D, MacPherson I. The impact of medication side effects on adherence and persistence to hormone therapy in breast cancer survivors: A quantitative systematic review. Breast 2022; 64:63-84. [PMID: 35609380 PMCID: PMC9130570 DOI: 10.1016/j.breast.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hormone Therapy (HT) is recommended for most women with HR-positive primary breast cancer. When taken as intended, HT reduces breast cancer recurrence by 40% and mortality by one-third. The recommended duration of treatment ranges from 5 to 10 years depending on risk of recurrence and the specific HT regimen. However, recent data indicates that rates of HT non-adherence are high and research suggests this may be due to the impact of HT side effects. The contribution of side effects to non-adherence and non-persistence behaviours has rarely been systematically explored, thereby hindering the implementation of targeted intervention strategies. Our aim is to identify, evaluate and summarise the relationship between HT side effects and patterns of adherence and persistence. METHODS Electronic searches were conducted from inception and were completed by September 2021, utilising Cochrane CENTRAL, Medline, Embase, Web of Science and PsycINFO databases. Searches included a combination of terms related to breast cancer, adherence, hormone therapy and side effects. RESULTS Sixty-two eligible papers were identified and study quality varied by study type. Most observational and cross-sectional studies were rated good quality, whereas most controlled intervention studies were rated fair quality. Three studies were rated poor quality. The most frequently measured side effects were pain, low mood, hot flashes, insomnia, anxiety, fatigue, weight gain, concentration/memory problems. CONCLUSIONS This review identified a lack of consistency in the measurement of adherence and the definition of persistence across studies. The instruments used to measure side effects also varied significantly. This variation and lack of consistency makes it difficult to evaluate and summarise the role of HT side effects in HT adherence and persistence behaviour.
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Affiliation(s)
| | - Sommer Agnew
- University of Strathclyde, George Street, Glasgow, UK
| | - Nicola Peddie
- University of Strathclyde, George Street, Glasgow, UK
| | | | - Diane Dixon
- University of Aberdeen, Kings College, Aberdeen, UK
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9
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Löwe B, Nestoriuc Y, Andresen V, Vettorazzi E, Zapf A, Hübener S, Maehder K, Peters L, Lohse AW. Persistence of gastrointestinal symptoms in irritable bowel syndrome and ulcerative colitis: study protocol for a three-arm randomised controlled trial (SOMA.GUT-RCT). BMJ Open 2022; 12:e059529. [PMID: 35701050 PMCID: PMC9198710 DOI: 10.1136/bmjopen-2021-059529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Ulcerative colitis (UC) and irritable bowel syndrome (IBS) are distressing chronic diseases associated with abdominal pain and altered bowel habits of unknown aetiology. Results from previous studies indicate that, across both diseases, increased levels of illness-related anxiety and dysfunctional symptom expectations contribute to symptom persistence. Thus, comparing both disorders with regard to common and disease-specific factors in the persistence and modification of gastrointestinal symptoms seems justified. Our primary hypothesis is that persistent gastrointestinal symptoms in UC and IBS can be improved by modifying dysfunctional symptom expectations and illness-related anxiety using expectation management strategies. METHODS AND ANALYSIS To assess the extent to which persistent somatic symptoms are modifiable in adult patients with UC and IBS, we will conduct an observer-blinded, three-arm randomised controlled trial. A total of 117 patients with UC and 117 patients with IBS will be randomised into three groups of equal size: targeted expectation management aiming to reduce illness-related anxiety and dysfunctional symptom expectations in addition to standard care (SC, intervention 1), non-specific supportive treatment in addition to SC (intervention 2) or SC only (control). Both active intervention groups will comprise three individual online consultation sessions and a booster session after 3 months. The primary outcome is baseline to postinterventional change in gastrointestinal symptom severity. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of the Hamburg Medical Association (2020-10198-BO-ff). The study will shed light onto the efficacy and mechanisms of action of a targeted expectation management intervention for persistent gastrointestinal symptoms in patients with UC and IBS. Furthermore, the detailed analysis of the complex biopsychosocial mechanisms will allow the further advancement of aetiological models and according evidence-based intervention strategies. TRIAL REGISTRATION NUMBER ISRCTN30800023.
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Affiliation(s)
- Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yvonne Nestoriuc
- Department of Psychology, Helmut Schmidt University, University of the Federal Armed Forces, Hamburg, Germany
| | | | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antonia Zapf
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sina Hübener
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kerstin Maehder
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Luisa Peters
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W Lohse
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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10
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Botto R, De Leonardis B, Salussolia A, Di Nardo C, Ala A, Torta R, Stanizzo MR. Assessment of anxiety, depression, and distress in breast cancer patients: A comparison among different phases of illness. Health Care Women Int 2022; 45:390-402. [PMID: 35695501 DOI: 10.1080/07399332.2022.2078325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
We aimed to assess the levels of anxious and depressive symptoms and distress in a sample of breast cancer patients in the different phases of the illness. We performed a cross-sectional study. We divided 301 female breast cancer patients into three groups, based on the phase of illness they were in being in post-surgery (N = 100), receiving adjuvant therapies (N = 86), and receiving follow-up care (N = 115). We included the follow-up within the phases of illness. We further divided each group into first diagnosed or with recurrence and we administered Hospital Anxiety and Depression Scale and Distress Thermometer. First-diagnosed patients with clinically relevant anxiety increased from being post-surgery (35.8%), to receiving adjuvant therapies (53.7%), and to being in follow-up (61.5%). In patients with recurrence, distress was stable among the illness phases, but many patients had clinically relevant anxiety (55.65%) and depression (43.48%). First-diagnosed patients' emotional distress could be more linked to follow-up-related difficulties. During recurrence, high distress could be due to the failure of previous treatments. Distress screening can better orient psycho-social interventions and healthcare resources.
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Affiliation(s)
- Rossana Botto
- Department of Neuroscience "Rita Levi Montalcini," University of Turin, Turin, Italy
- Clinical Psychology Unit, Department of Neuroscience, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - Brigitta De Leonardis
- Clinical Psychology Unit, Department of Neuroscience, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - Annarita Salussolia
- Clinical Psychology Unit, Department of Neuroscience, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - Cristina Di Nardo
- Clinical Psychology Unit, Department of Neuroscience, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - Ada Ala
- Department of Surgery, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - Riccardo Torta
- Department of Neuroscience "Rita Levi Montalcini," University of Turin, Turin, Italy
| | - Maria Rosa Stanizzo
- Clinical Psychology Unit, Department of Neuroscience, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
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The Associations among Gender, Age, eHealth Literacy, Beliefs about Medicines and Medication Adherence among Elementary and Secondary School Teachers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116926. [PMID: 35682509 PMCID: PMC9180475 DOI: 10.3390/ijerph19116926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/21/2022] [Accepted: 06/03/2022] [Indexed: 02/04/2023]
Abstract
Background: A lack of health literacy may negatively impact patient adherence behavior in health care delivery, leading to a major threat to individual health and wellbeing and an increasing financial burden on national healthcare systems. Therefore, how to cultivate citizens’ health literacy, especially electronic health (eHealth) literacy that is closely related to the Internet, may be seen as a way to reduce the financial burden of the national healthcare systems, which is the responsibility of every citizen. However, previous studies on medication adherence have mostly been conducted with chronic disease patient samples rather than normal samples. Teachers are not only the main body of school health efforts, but also role models for students’ healthy behavior. Therefore, understanding differences in eHealth literacy beliefs among schoolteachers would be helpful for improving the existing health promoting programs and merit specific research. Aims: The present study identified the relationships among gender, age, electronic health (eHealth) literacy, beliefs about medicines, and medication adherence among elementary and secondary school teachers. Methods: A total of 485 teachers aged 22−51 years completed a pen-and-paper questionnaire. The instruments included an eHealth literacy scale, a belief about medicines scale and a medication adherence scale. Results: The results showed a significant difference between genders in necessity beliefs about medication (t = 2.00, p < 0.05), and a significant difference between ages in functional eHealth literacy (F = 3.18, p < 0.05) and in necessity beliefs about medication (Welch = 7.63, p < 0.01). Moreover, age (β = 0.09), functional eHealth literacy (β = 0.12), and necessity beliefs about medication (β = 0.11) positively predicted medication adherence, while concerns about medication (β = −0.23) negatively predicted medication adherence. Conclusions: The results showed that male teachers had stronger concerns about medication than female teachers. Teachers aged 42−51 years had lower functional eHealth literacy and stronger necessity beliefs about medication than teachers aged 22−31 years. In addition, teachers who were older, had higher functional eHealth literacy, had stronger necessity beliefs about medication, and had fewer concerns about medication tended to take their medications as prescribed. These findings revealed that helping teachers develop high eHealth literacy and positive beliefs about medicines is an effective strategy for improving medication adherence.
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12
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von Blanckenburg P, Riera Knorrenschild J, Hofmann M, Fries H, Nestoriuc Y, Seifart U, Rief W, Seifart C. Expectations, end-of-life fears and end-of-life communication among palliative patients with cancer and caregivers: a cross-sectional study. BMJ Open 2022; 12:e058531. [PMID: 35545378 PMCID: PMC9096546 DOI: 10.1136/bmjopen-2021-058531] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES During serious illness, open communication with caregivers can ensure high-quality care. Without end-of-life communication, caregivers may become surrogates and decision-makers without knowing the patient's preferences. However, expectations and fears may influence the initiation of communication. The present study investigates differences between palliative patients with cancer and caregivers regarding expectations of end-of-life communication, end-of-life fears and experiences with end-of-life communication. DESIGN A cross-sectional study using a semi-structured interview and a paper-based questionnaire SETTING: University Hospital in Germany. PARTICIPANTS 151 participants: 85 palliative cancer patients (mean age: 62.8 years, 65.9% male) and 66 caregivers (mean age: 56.3 years, 28.8% male). PRIMARY AND SECONDARY OUTCOME MEASURES Expectations, end-of-life fears and experiences of end-of-life discussions. RESULTS Patients and caregivers wish for the patient to be self-determined. In general, participants reported more positive than negative expectations of end-of-life discussions. Importantly, concerns about emotionally burdening other person was rated much higher in an informal context than a professional context (F(1,149)=316 958, p<0.001, ηp²=0.680), even though the emotional relief was expected to be higher (F(1,149)=46.115, p<0.001, ηp²=0.236). Caregivers reported more fears about the last period of life and more fears about end-of-life discussions than palliative patients, whereas palliative patients tended to avoid the topics of death and dying to a greater extent. CONCLUSIONS There seems to exist a 'self-other' asymmetry: palliative patients and their caregivers expect substantial personal relief when openly talking about end-of-life issues, but also expect the other person to be burdened by such communication. Professionals repeatedly need to initiate end-of-life communication.
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Affiliation(s)
- Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Jorge Riera Knorrenschild
- Department of Internal Medicine, Division of Haematology and Oncology, Philipps-Universität Marburg Fachbereich Medizin, Marburg, Germany
| | - Mareike Hofmann
- Department of Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Hansjakob Fries
- Department of Internal Medicine III - Oncology, Hematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Yvonne Nestoriuc
- Department of Clinical Psychology, Helmut-Schmidt-Universität, Hamburg, Germany
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulf Seifart
- Rehabilitation Clinic Sonnenblick, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Carola Seifart
- Department of Medicine, Research Group Medical Ethics, Philipps-Universität Marburg, Marburg, Germany
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Extending Adjuvant Endocrine Therapy for 10 Years: A Mixed-Methods Analysis of Women's Decision Making in an Online Breast Cancer Forum. Healthcare (Basel) 2021; 9:healthcare9060688. [PMID: 34200326 PMCID: PMC8227818 DOI: 10.3390/healthcare9060688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/21/2022] Open
Abstract
An additional 5 years of treatment with adjuvant hormonal therapy, to complete 10 years of medication, is recommended to reduce the risk of breast cancer recurrence. Yet professionals and patients should balance this benefit against side effects and toxicities. Little is known about women’s decision making regarding persistence with extended endocrine therapy. In this study, we collected data from a UK online breast cancer forum to analyse patterns of persistence and its associated factors. A mixed-methods exploratory sequential design was used, with a qualitative analysis of text (n = 61 individuals) informing the development of a quantitative instrument to statistically analyse the prevalence of the findings (n = 130). Our findings identified three different groups of women who had to make decisions regarding persistence with treatment: those about to complete 5 years of therapy, those who decided to extend treatment, and those who were initially prescribed 10 years. Factors affecting persistence were, lack of self-efficacy in managing side effects, lack of reassurance about individual risk of recurrence, and impact on quality of life. Interventions such as training of healthcare professionals including risk communication, medication reviews by clinical pharmacists, and re-planning of services in follow-up care, should better support women’s needs in extended hormonal therapy.
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van Middendorp H, Berende A, Vos FJ, Ter Hofstede HHM, Kullberg BJ, Evers AWM. Expectancies as predictors of symptom improvement after antimicrobial therapy for persistent symptoms attributed to Lyme disease. Clin Rheumatol 2021; 40:4295-4308. [PMID: 34031759 PMCID: PMC8463383 DOI: 10.1007/s10067-021-05760-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/29/2021] [Accepted: 05/02/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION/OBJECTIVE Expectancies about symptom improvement or deterioration are reliable predictors of symptom progression and treatment outcomes (symptom resolution or symptomatic improvement) in many (non-)pharmacological studies and treatments. This study examined predictors of symptom improvement after antimicrobial therapy for persistent symptoms attributed to Lyme disease, hypothesizing particularly pre-treatment expectancies regarding symptom improvement to be predictive. METHODS A predictive study was performed on pre-treatment and post-treatment individual characteristics, including expectancies, and physical and mental health-related quality of life (HRQoL) from the PLEASE-trial comparing randomized 12-weeks of doxycycline, clarithromycin-hydroxychloroquine, or placebo following 2 weeks of intravenous ceftriaxone. At end-of-treatment (14 weeks after trial start) and follow-up (52 weeks), complete data of 231 and 170 (of initial 280) patients with persistent symptoms temporally related to a history of erythema migrans or otherwise confirmed symptomatic Lyme disease, or accompanied by B. burgdorferi IgG or IgM antibodies, were examined through hierarchical regression analyses. RESULTS In addition to pre-treatment HRQoL, pre-treatment expectancies regarding symptom improvement were consistently associated with stronger physical and mental HRQoL improvements at both end-of-treatment and follow-up (95% CI range: .09;.54, p < .01 to .27;.92, p < .001). Post-treatment expectancies regarding having received antibiotics vs. placebo was associated with more HRQoL improvement at end-of-treatment, but not at follow-up (95% CI-range 1.00;4.75, p = .003 to -7.34; -2.22, p < .001). CONCLUSIONS The present study shows that, next to pre-treatment functioning, patients' pre-treatment and post-treatment expectancies regarding improvement of persistent symptoms attributed to Lyme disease relate to a more beneficial symptom course. Expectancies of patients may be relevant to explain and potentially improve patient outcomes (e.g., by optimized communication about treatment success). TRIAL REGISTRATION ClinicalTrials.gov, NCT01207739 (Registration date: 23-09-2010) Key Points • As there is currently no sufficient symptom resolution or symptomatic improvement for many patients with persistent symptoms attributed to Lyme disease, it is relevant to know which factors determine symptom progression and predict heterogeneity in treatment response. • Next to pre-treatment functioning, expectancies regarding symptom improvement and having received antimicrobial study medication are associated with a more beneficial symptom course after both shorter-term and longer-term antimicrobial treatment. • Expectancies are relevant to consider in treatment studies and may be useful in clinical settings to improve symptom course and treatment outcome (e.g., by optimized communication about treatment success).
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Affiliation(s)
- Henriët van Middendorp
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Institute of Psychology, Leiden University, PO Box 9555, 2300 RB, Leiden, The Netherlands.
| | - Anneleen Berende
- Department of Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.,Gelre Ziekenhuizen, Apeldoorn, The Netherlands
| | - Fidel J Vos
- Department of Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.,Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Hadewych H M Ter Hofstede
- Department of Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bart Jan Kullberg
- Department of Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Institute of Psychology, Leiden University, PO Box 9555, 2300 RB, Leiden, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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15
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Tan EH, Wong ALA, Tan CC, Wong P, Tan SH, Ang LEY, Lim SE, Chong WQ, Ho J, Lee SC, Tai BC. Facilitators and barriers to medication adherence with adjuvant endocrine therapy in women with breast cancer: a structural equation modelling approach. Breast Cancer Res Treat 2021; 188:779-788. [PMID: 33948777 DOI: 10.1007/s10549-021-06204-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To identify a structure to explain the relationship between socio-clinico factors, necessity-concerns beliefs, and perceived barriers to adherence with adjuvant endocrine therapy (AET) amongst women with breast cancer. METHODS Participants were 244 patients with early-stage breast cancer recruited from two tertiary hospitals from May 2015 to December 2018 who completed questionnaires on medication adherence (Simplified Medication Adherence Questionnaire), necessity-concerns beliefs (Beliefs about Medicine Questionnaire), and barriers to adherence (Adherence Starts with Knowledge Questionnaire). Socio-clinico variables were collected via interview and medical records review. Structural equation modelling was applied to examine the relationships between these variables and possible mediating effects of necessity-concerns beliefs on adherence to AET. RESULTS The median age of the study participants was 61 (range 32-80) years and the median duration on AET was 1.6 (IQR 1.2-2.6) years. Adherence was positively associated with age (β = 0.145, 95% CI: 0.011 to 0.279, p = 0.034) and negatively associated with barriers (β = - 0.381, 95% CI: - 0.511 to - 0.251, p < 0.001). There was no effect of Necessity (β = 0.006, 95% CI: - 0.145 to 0.158, p = 0.933) or Concerns (β = 0.041, 95% CI: - 0.117 to 0.199, p = 0.614) on adherence. Necessity-concerns beliefs were also not significant mediators in the relationship between socio-clinico factors and medication adherence. CONCLUSIONS Older age and lower barriers to adherence were associated with higher adherence scores. Necessity-concerns beliefs did not have a significant effect on adherence as majority of the patients identified forgetfulness as a reason for non-adherence.
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Affiliation(s)
- Eng Hooi Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-03F, Singapore, 117549, Singapore
| | - Andrea Li Ann Wong
- Department of Haematology-Oncology, National University Cancer Institute, NUHS, Tower Block Level 7, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Chuan Chien Tan
- Department of General Surgery, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606, Singapore
| | - Patrick Wong
- Division of Oncology Pharmacy, National University Cancer Institute, NUHS, Tower Block Level 7, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Sing Huang Tan
- OncoCare Cancer Centre, 6 Napier Road, #02-17/18/19, Gleneagles Medical Centre, Singapore, 258499, Singapore
| | - Li En Yvonne Ang
- Department of Haematology-Oncology, National University Cancer Institute, NUHS, Tower Block Level 7, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Siew Eng Lim
- Department of Haematology-Oncology, National University Cancer Institute, NUHS, Tower Block Level 7, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Wan Qin Chong
- Department of Haematology-Oncology, National University Cancer Institute, NUHS, Tower Block Level 7, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Jingshan Ho
- Department of Haematology-Oncology, National University Cancer Institute, NUHS, Tower Block Level 7, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Soo Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute, NUHS, Tower Block Level 7, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-03F, Singapore, 117549, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
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Montagna E, Zagami P, Masiero M, Mazzocco K, Pravettoni G, Munzone E. Assessing Predictors of Tamoxifen Nonadherence in Patients with Early Breast Cancer. Patient Prefer Adherence 2021; 15:2051-2061. [PMID: 34552323 PMCID: PMC8450184 DOI: 10.2147/ppa.s285768] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/31/2021] [Indexed: 12/11/2022] Open
Abstract
Adjuvant endocrine therapy (AET) is generally proposed to all patients with hormone receptor-positive breast cancer to reduce the risk of recurrence and death. Adherence to therapy is crucial. However, non-adherence to AET is common, with estimates of up to 50% of patients not successfully completing a five-year course of treatment, and it is significantly associated with lower survival rates and a higher risk of recurrence. Currently, no gold standard is available to assess adherence. Several studies, most of them retrospective in nature, have used both direct and indirect methods to monitor the adherence to therapy in breast cancer. The indirect method is more widely used, and it is based on pharmacy prescription refills and patient administered questionnaires. On the other hand, direct methods such as a measurement of the level of the drug or its metabolites in blood or urine are much more precise, but more expensive and not routinely implemented. In this review, we analyzed the results of the major studies focused on the adherence to tamoxifen in breast cancer patients. We identified several factors associated with poor adherence, such as the side effects of therapy, the lack of shared decision-making between the physician and patient, the context in which the discussion takes place, and whether the patients are enrolled in a clinical trial. Moreover, we discussed possible methods to improve adherence to adjuvant therapy in breast cancer.
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Affiliation(s)
- Emilia Montagna
- Division of Medical Senology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Correspondence: Emilia Montagna Division of Medical Senology, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, 20141, ItalyTel +39 02 57489439Fax +39 02 574829212 Email
| | - Paola Zagami
- Division of Medical Senology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Division of Early Drug Development for Innovative Therapies, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Marianna Masiero
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Ketti Mazzocco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Elisabetta Munzone
- Division of Medical Senology, IEO European Institute of Oncology IRCCS, Milan, Italy
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Kaptein AA, Schoones JW, van der Meer PB, Matsuda A, Murray M, Heimans L, Kroep JR. Psychosocial determinants of adherence with oral anticancer treatment: 'we don't need no education'. Acta Oncol 2021; 60:87-95. [PMID: 33151764 DOI: 10.1080/0284186x.2020.1843190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Given the potentially fatal consequences of inadequate adherence with oral anticancer treatment in persons with cancer, understanding the determinants of adherence is vital. This paper aims at identifying psychosocial determinants of adherence to oral anticancer treatment. METHODS We reviewed the literature on psychosocial determinants of adherence with oral anticancer treatment, based on published literature in English, from 2015 to present. Literature searches were performed in PubMed, Embase, Web of Science, Cochrane library, Emcare, and PsychINFO, with 'cancer', 'medication adherence', 'psychology', and 'oral anticancer treatment' as search terms. The obtained 608 papers were screened by two independent reviewers. RESULTS In the 25 studies identified, illness perceptions, medication beliefs, health beliefs, and depression were found to be the major psychosocial determinants of adherence to oral anticancer treatment; sociodemographic and clinical characteristics were found to be of no major importance. The quality of the identified studies as assessed by two independent reviewers was found to be acceptable overall. The majority of papers were from North America and focused on patients with breast cancer; sample size varied from 13 to 1371; adherence was assessed with questionnaires derived from various theoretical models, pill counts and electronic pharmacy records; illness perceptions reflecting adaptive coping, and medication beliefs reflecting high necessity and low concerns were found to be associated with adherence. CONCLUSION Psychosocial concepts are major determinants of adherence with oral anticancer treatment. 'Beliefs about medicines' and 'illness perceptions' in particular determine adherence with this treatment. Studies aiming at impacting adherence would benefit from interventions with a solid basis in behavioral theory in order to help health care providers explore and address illness perceptions and medication beliefs. Pre-consultation screening of adherence behavior may be a helpful supportive approach to improve adherence. Blaming the victim ('patients should be educated about the importance of adherence') is better replaced by encouraging health professionals to identify and address maladaptive psychosocial determinants of adherence.
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Affiliation(s)
- Adrian A. Kaptein
- Department of Medical Psychology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan W. Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, The Netherlands
| | - Pim B. van der Meer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ayako Matsuda
- Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan
| | - Michael Murray
- School of Psychology, Keele University, Newcastle-under-Lyme, UK
| | - Lotte Heimans
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith R. Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
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Potentially Modifiable Factors Associated with Adherence to Adjuvant Endocrine Therapy among Breast Cancer Survivors: A Systematic Review. Cancers (Basel) 2020; 13:cancers13010107. [PMID: 33561076 PMCID: PMC7794693 DOI: 10.3390/cancers13010107] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 01/01/2023] Open
Abstract
Adjuvant endocrine therapy (AET) reduces risk of breast cancer recurrence. However, suboptimal adherence and persistence to AET remain important clinical issues. Understanding factors associated with adherence may help inform efforts to improve use of AET as prescribed. The present systematic review examined potentially modifiable factors associated with adherence to AET in accordance with PRISMA guidelines (PROSPERO registration ID: CRD42019124200). All studies were included, whether factors were significantly associated with adherence or results were null. This review also accounted for the frequency with which a potentially modifiable factor was examined and whether univariate or multivariate models were used. This review also examined whether methodological or sample characteristics were associated with the likelihood of a factor being associated with AET adherence. A total of 68 articles were included. Potentially modifiable factors were grouped into six categories: side effects, attitudes toward AET, psychological factors, healthcare provider-related factors, sociocultural factors, and general/quality of life factors. Side effects were less likely to be associated with adherence in studies with retrospective or cross-sectional than prospective designs. Self-efficacy (psychological factor) and positive decisional balance (attitude toward AET) were the only potentially modifiable factors examined ≥10 times and associated with adherence or persistence ≥75% of the time in both univariate and multivariate models. Self-efficacy and decisional balance (i.e., weight of pros vs. cons) were the potentially modifiable factors most consistently associated with adherence, and hence may be worth focusing on as targets for interventions to improve AET adherence among breast cancer survivors.
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Racial differences in genomic testing and receipt of endocrine therapy in early-stage breast cancer. Breast Cancer Res Treat 2020; 184:849-859. [PMID: 32888137 DOI: 10.1007/s10549-020-05888-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/17/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Genomic testing in early-stage hormone-positive breast cancer is the standard of care. However, decisions based on genomic testing results are predicated on the assumption that patients receive endocrine treatment. We sought to investigate racial differences in genomic testing and adjuvant treatment in breast cancer. METHODS A retrospective, population-based hospital registry study using the National Cancer Database. Participants included women with stages I-II, ER + breast cancer between 2010 and 2014. Sociodemographic factors were analyzed. Primary outcomes were the utilization of genomic testing and receipt of endocrine therapy. Logistic regression modeling was used to compute crude and adjusted odds of genomic testing and receipt of endocrine therapy. RESULTS Among a total sample size of 387,008 patients, 147,863 (38.2%) underwent genomic testing. Older age (≥ 70 years) was associated with a lower adjusted odd of genomic testing (OR 0.33; 95% CI 0.32-0.34, p = < 0.0001). Black patients had lower odds of receiving genomic testing on multivariate analysis compared to Whites (OR 0.82; 95% CI 0.80-0.85, p = < 0.0001). In patients who underwent a genomic test, compared to Whites, Blacks had a lower odds of receiving endocrine therapy (OR 0.86; 95% CI 0.80-0.93, p = < 0.0001) even if they did not receive adjuvant chemotherapy (OR 0.90; 95% CI 0.82-0.98, p = 0.014). CONCLUSIONS In a national sample of breast cancer patients, Black women are less likely to get genomic testing and receive hormonal therapy, even when adjuvant chemotherapy is omitted. A priority in addressing breast cancer disparities is to ensure adherence to hormonal therapy among all women, including those who do not receive adjuvant chemotherapy.
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Smith LE, Webster RK, Rubin GJ. A systematic review of factors associated with side-effect expectations from medical interventions. Health Expect 2020; 23:731-758. [PMID: 32282119 PMCID: PMC7495066 DOI: 10.1111/hex.13059] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Fear of side-effects can result in non-adherence to medical interventions, such as medication and chemotherapy. Side-effect expectations have been identified as strong predictors of later perception of side-effects. However, research investigating predictors of side-effect expectations is disparate. OBJECTIVE To identify factors associated with side-effect expectations. SEARCH STRATEGY We systematically searched Embase, Ovid MEDLINE, Global Health, PsycARTICLES, PsycINFO, Web of Science and Scopus. INCLUSION CRITERIA Studies were included if they investigated associations between any predictive factor and expectations of side-effects from any medical intervention. DATA EXTRACTION AND SYNTHESIS We extracted information about participant characteristics, medication, rates of side-effects expected and predictors of side-effect expectations. Data were narratively synthesized. MAIN RESULTS We identified sixty-four citations, reporting on seventy-two studies. Predictors fell into five categories: personal characteristics, clinical characteristics, psychological traits and state, presentation format of information, and information sources used. Using verbal risk descriptors (eg 'common') compared to numerical descriptors (eg percentages), having lower quality of life or well-being, and currently experiencing symptoms were associated with increased side-effect expectations. DISCUSSION AND CONCLUSIONS Decreasing unrealistic side-effect expectations may lead to decreased experience of side-effects and increased adherence to medical interventions. Widespread communications about medical interventions should describe the incidence of side-effects numerically. Evidence suggests that clinicians should take particular care with patients with lower quality of life, who are currently experiencing symptoms and who have previously experienced symptoms from treatment. Further research should investigate different clinical populations and aim to quantify the impact of the media and social media on side-effect expectations.
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Affiliation(s)
- Louise E Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - G James Rubin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Optimizing expectations about endocrine treatment for breast cancer: Results of the randomized controlled psy-breast trial. CLINICAL PSYCHOLOGY IN EUROPE 2020; 2:e2695. [DOI: 10.32872/cpe.v2i1.2695] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/05/2019] [Indexed: 11/25/2022] Open
Abstract
Background
Medication side effects are strongly determined by non-pharmacological, nocebo mechanisms, particularly patients’ expectations. Optimizing expectations could minimize side effect burden. This study evaluated whether brief psychological expectation management training (EXPECT) optimizes medication-related expectations in women starting adjuvant endocrine therapy (AET) for breast cancer.
Method
In a multisite randomized controlled design, 197 women were randomized to EXPECT, supportive therapy (SUPPORT), or treatment as usual (TAU). The three-session cognitive-behavioral EXPECT employs psychoeducation, guided imagery, and side effect management training. Outcomes were necessity-concern beliefs about AET, expected side effects, expected coping ability, treatment control expectations, and adherence intention.
Results
Both interventions were well accepted and feasible. Patients’ necessity-concern beliefs were optimized in EXPECT compared to both TAU and SUPPORT, d = .41, p < .001; d = .40, p < .001. Expected coping ability and treatment control expectations were optimized compared to TAU, d = .35, p = .02; d = .42, p < 001, but not to SUPPORT. Adherence intention was optimized compared to SUPPORT, d = .29, p = .02, but not to TAU. Expected side effects did not change significantly.
Conclusion
Expectation management effectively and partly specifically (compared to SUPPORT) modified medication-related expectations in women starting AET. Given the influence of expectations on long-term treatment outcome, psychological interventions like EXPECT might provide potential pathways to reduce side effect burden and improve quality of life during medication intake.
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Eraso Y. Oncologists' perspectives on adherence/non-adherence to adjuvant endocrine therapy and management strategies in women with breast cancer. Patient Prefer Adherence 2019; 13:1311-1323. [PMID: 31534318 PMCID: PMC6681570 DOI: 10.2147/ppa.s211939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/21/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Adherence to adjuvant endocrine therapy (AET) is suboptimal, and a range of variables have been explored for understanding patients' experiences and motivations for medication-taking. However, oncologists' views on adherence are poorly understood. The aim of this study was to explore oncologists' perspectives on adherence/non-adherence and their strategies to ensure patients continue with treatments to inform the development of potential modifiable interventions. METHODS A qualitative study using in-depth, semi-structured interviews with 16 oncologists was conducted in Argentina. A stratified purposive sampling was used to recruit female and male participants from 3 health subsystems (private, social security, and public). Data were analyzed using the Framework approach. RESULTS Oncologists believed patients' adherence was overall high and associated it with good tolerance of AET in comparison to chemotherapy, information provided, and patients feeling reassured (fear of recurrence). Non-adherence was not perceived as a major source of concern, and it was related to rare cases of severe side effects, young age, refusing treatment, losing the insurance plan, lack of education, and social circumstances. Patients' complaints of bothersome side effects were not identified as a main reason to discontinuation. Public and private sector patients, however, were perceived as having different attitudes toward side effects. Management strategies included medicine change, referral to support services, and a supportive relationship with the oncologist. CONCLUSION Oncologists' perspectives on adherence/non-adherence to AET show similarities and significant differences with those in the literature based on patient-reported factors. Overall adherence was considered high, but the likelihood of unintentional non-adherence seems important in public sector patients. Information to patients should provide clear explanations on both severe and unpleasant side effects. Interventions to improve communication skills in oncologists and specialists responsible for survivorship care should be considered to strengthen patients' self-efficacy and effective medication-taking. Reliable data on adherence are needed.
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Affiliation(s)
- Yolanda Eraso
- School of Social Professions, London Metropolitan University, London, UK
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Birand N, Boşnak AS, Diker Ö, Abdikarim A, Başgut B. The role of the pharmacist in improving medication beliefs and adherence in cancer patients. J Oncol Pharm Pract 2019; 25:1916-1926. [PMID: 30786821 DOI: 10.1177/1078155219831377] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiple factors have been reported to affect adherence to medication, including beliefs about medicines, while specifically tailored pharmaceutical care services for patients may improve adherence. The aim was to assess the impact of counselling by an oncology pharmacist on patients' medication adherence and beliefs. METHODS An interventional prospective study was performed in the oncology department at a tertiary hospital in Northern Cyprus from November 2017 to April 2018. The Beliefs about Medicines Questionnaire was used to evaluate the balance between beliefs about necessity and concerns and medication beliefs before and after an educational intervention. The Morisky Green Levine Test 2018 was used to evaluate adherence. RESULTS In total, 81 patients (65.4% females; mean age: 59.1 ± 11.34 years; 34.6% hypertensive; 19.8% with diabetes) were analysed before and after receiving counselling from an oncology pharmacist. Pharmacist education significantly enhanced the mean patient necessity-concern balance scores by two-fold (MT0(baseline) = -3.1 ± 8.6; MT1(posteducation) =3.0 ± 7.3; p < 0.0001), with patients who received counselling for the first time experiencing the greatest benefit. Multivariate analysis showed that patients who had a negative balance between their beliefs about the necessity of the medication and their concerns were less likely to adhere to the medication (0.138 (0.025-0.772)). CONCLUSION Counselling by an oncology pharmacist was effective in decreasing patient concerns and increasing their understanding of the necessity of the medication, thus enhancing their adherence and consequently improving the care they received.
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Affiliation(s)
- Nevzat Birand
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, North Cyprus, Turkey
| | | | - Ömer Diker
- Department of Medical Oncology, Near East Hospital, North Cyprus, Turkey
| | - Abdi Abdikarim
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, North Cyprus, Turkey
| | - Bilgen Başgut
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, North Cyprus, Turkey
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Xu L, Wang A. Health belief about adjuvant endocrine therapy in premenopausal breast cancer survivors: a qualitative study. Patient Prefer Adherence 2019; 13:1519-1525. [PMID: 31564839 PMCID: PMC6743632 DOI: 10.2147/ppa.s217562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/28/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The aim of this study is to describe the connotations of health beliefs about adjuvant endocrine therapy (AET) in premenopausal breast cancer survivors in Northeast China and to explore the reasons underlying bad behaviours and influential factors of AET adherence and persistence. METHODS Semi-structured interviews were conducted using a qualitative description research method with 30 premenopausal breast cancer survivors who had undergone surgery and AET for more than half a year. The researcher collected and coded the interview transcripts and extracted the concepts and themes. RESULTS Two main categories of themes regarding the health beliefs of survivors who were undergoing AET were formed in the conceptual framework: connotations and modifiable factors. Subcategories of the first category included perceptions of the survivors regarding the risks and effects of recurrence or metastasis of breast cancer; the methods, benefits and barriers of AET; behavioural clues; and self-efficacy. Subcategories of the second category included religious belief, disposition, matrimony and other demographic factors as well as traditional Chinese female characteristics, gender role and other socio-cultural factors. CONCLUSION Demographic, socio-cultural and other factors play an important role in the health beliefs of breast cancer survivors. Health beliefs such as related knowledge of AET, related cognition of recurrence or metastasis of breast cancer directly affect adherence to and persistence with AET. Therefore, implementing interventions with respect to health beliefs may enhance adherence to AET.
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Affiliation(s)
- Lei Xu
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Aiping Wang
- Department of Nursing, The First Affiliated Hospital of China Medical University, Shenyang, People’s Republic of China
- Correspondence: Aiping Wang Department of Nursing, The First Affiliated Hospital of China Medical University, No. 155, Nanjing St. Heping District, Shenyang110001, People’s Republic of ChinaTel +86 248 328 2827Fax +86 248 328 2830Email
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