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Green SMC, Smith SG, Collins LM, Strayhorn JC. Decision-making in the multiphase optimization strategy: Applying decision analysis for intervention value efficiency to optimize an information leaflet to promote key antecedents of medication adherence. Transl Behav Med 2024:ibae029. [PMID: 38795061 DOI: 10.1093/tbm/ibae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2024] Open
Abstract
Advances in the multiphase optimization strategy (MOST) have suggested a new approach, decision analysis for intervention value efficiency (DAIVE), for selecting an optimized intervention based on the results of a factorial optimization trial. The new approach opens possibilities to select optimized interventions based on multiple valued outcomes. We applied DAIVE to identify an optimized information leaflet intended to support eventual adherence to adjuvant endocrine therapy for women with breast cancer. We used empirical performance data for five candidate leaflet components on three hypothesized antecedents of adherence: beliefs about the medication, objective knowledge about AET, and satisfaction with medication information. Using data from a 25 factorial trial (n = 1603), we applied the following steps: (i) We used Bayesian factorial analysis of variance to estimate main and interaction effects for the five factors on the three outcomes. (ii) We used posterior distributions for main and interaction effects to estimate expected outcomes for each leaflet version (32 total). (iii) We scaled and combined outcomes using a linear value function with predetermined weights indicating the relative importance of outcomes. (iv) We identified the leaflet that maximized the value function as the optimized leaflet, and we systematically varied outcome weights to explore robustness. The optimized leaflet included two candidate components, side-effects, and patient input, set to their higher levels. Selection was generally robust to weight variations consistent with the initial preferences for three outcomes. DAIVE enables selection of optimized interventions with the best-expected performance on multiple outcomes.
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Affiliation(s)
- Sophie M C Green
- Behavioural Oncology Research Group, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Samuel G Smith
- Behavioural Oncology Research Group, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Linda M Collins
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA
| | - Jillian C Strayhorn
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA
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Nicoletti AP, Damin AP. Factors influencing the first and the fifth years adherence to adjuvant endocrine therapy in breast cancer patients in a low income country. Breast Cancer Res Treat 2024; 204:599-606. [PMID: 38225523 DOI: 10.1007/s10549-023-07221-6] [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: 06/28/2023] [Accepted: 12/10/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE Breast cancer is the leading cause of cancer death in Brazil and in many countries around the world. In order to minimize the risk of recurrence and death, adjuvant endocrine therapy (AET) is used in women whose tumors express hormone receptors; however, the therapy is associated with low rates of compliance. Therefore, we sought to evaluate the proportion of patients who are adherent/non-adherent to AET at the beginning of the therapy (1st year) and at its end (5th year). METHODS Cross-sectional study assessing adherence through the Brief Medication Questionnaire. RESULTS It was identified that eventual failures in maintaining the correct adherence to the treatment have risen from 23% of patients in the 1st year of treatment to 35% of patients in the 5th year (p = 0.005). In both groups, use of aromatase inhibitors, polypharmacy of at least 3 mediations and the previous diagnosis of diabetes mellitus (DM) or systemic arterial hypertension (SAH) have contributed to low adherence among patients. CONCLUSION The proportion of patients who are not adherent to AET was high in both cohorts, and the rate of non-adherent patients rises over time. It is essential to incorporate screening methods for lack of compliance to AET, as well as measures to try to reduce non-persistence to the treatment, such as educating the patients on the benefits of the treatment, managing comorbidities through lifestyle changes and, therefore, reducing polypharmacy and, above all, detecting and treating very early the adverse effects of AET that might interfere with its correct use.
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Affiliation(s)
- Antonio Pedro Nicoletti
- Faculty of Medicine, Post Graduation Program in Health Sciences: Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande Do Sul, Brazil.
| | - Andrea P Damin
- Faculty of Medicine, Post Graduation Program in Health Sciences: Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande Do Sul, Brazil
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Post KE, Ahmad Z, Jankauskaite G, Centracchio J, Oswald L, Horick N, Park ER, Temel JS, Greer JA, Jacobs J. Managing Symptom Distress: Key Factors for Patients on Adjuvant Endocrine Therapy for Breast Cancer. J Pain Symptom Manage 2024; 67:88-97. [PMID: 37816436 PMCID: PMC10842924 DOI: 10.1016/j.jpainsymman.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/22/2023] [Accepted: 10/03/2023] [Indexed: 10/12/2023]
Abstract
CONTEXT Patients with breast cancer taking adjuvant endocrine therapy (AET) experience significant symptoms impacting mood, quality of life (QOL), and AET adherence and satisfaction. OBJECTIVES The aim of this study was to examine the extent to which coping ability and self-efficacy for symptom management moderate the relationships between patients' symptom distress and their mood, QOL, and AET adherence and satisfaction. METHODS As part of a randomized controlled trial, participants completed baseline measures including: sociodemographics, symptom distress (breast cancer prevention trial symptom checklist), coping skills (measure of current status), self-efficacy (self-efficacy for managing symptoms), anxiety and depression (hospital anxiety and depression scale), QOL (functional assessment of cancer therapy - general), AET adherence (medication adherence report scale), and AET satisfaction (cancer therapy satisfaction questionnaire). We conducted moderated regression analyses to examine whether coping and self-efficacy moderated the associations of symptom distress with baseline measures. RESULTS Coping skills moderated the associations of symptom distress with depression and QOL. Among those with lower coping, higher symptom distress was associated with worse depression symptoms (p=.04) and worse QOL (p < 0.001). Self-efficacy moderated the associations of symptom distress with depression symptoms and AET adherence and satisfaction. Among those with higher self-efficacy, higher symptom distress was associated with worse depression symptoms (p < 0.001), worse AET adherence (p < 0.001), and less AET satisfaction (p = 0.01). CONCLUSION Coping skills may buffer the effect of AET symptom distress. Findings indicate the relationship between symptom distress and self-efficacy is more nuanced and requires further research to better understand.
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Affiliation(s)
- Kathryn E Post
- Massachusetts General Hospital (P.K.E., A.Z., J.G., C.J., H.N., P.E.R., T.J.S., G.J.A., J.J.), Boston, Massachusetts, USA; Harvard Medical School (P.K.E., A.Z., J.G., H.N., P.E.R., T.J.S., G.J.A., J.J.), Boston, Massachusetts, USA.
| | - Zeba Ahmad
- Massachusetts General Hospital (P.K.E., A.Z., J.G., C.J., H.N., P.E.R., T.J.S., G.J.A., J.J.), Boston, Massachusetts, USA; Harvard Medical School (P.K.E., A.Z., J.G., H.N., P.E.R., T.J.S., G.J.A., J.J.), Boston, Massachusetts, USA
| | - Greta Jankauskaite
- Massachusetts General Hospital (P.K.E., A.Z., J.G., C.J., H.N., P.E.R., T.J.S., G.J.A., J.J.), Boston, Massachusetts, USA; Harvard Medical School (P.K.E., A.Z., J.G., H.N., P.E.R., T.J.S., G.J.A., J.J.), Boston, Massachusetts, USA
| | - Joely Centracchio
- Massachusetts General Hospital (P.K.E., A.Z., J.G., C.J., H.N., P.E.R., T.J.S., G.J.A., J.J.), Boston, Massachusetts, USA
| | - Laura Oswald
- Moffitt Cancer Center (O.L.), Tampa, Florida, USA
| | - Nora Horick
- Massachusetts General Hospital (P.K.E., A.Z., J.G., C.J., H.N., P.E.R., T.J.S., G.J.A., J.J.), Boston, Massachusetts, USA; Harvard Medical School (P.K.E., A.Z., J.G., H.N., P.E.R., T.J.S., G.J.A., J.J.), Boston, Massachusetts, USA
| | - Elyse R Park
- Massachusetts General Hospital (P.K.E., A.Z., J.G., C.J., H.N., P.E.R., T.J.S., G.J.A., J.J.), Boston, Massachusetts, USA; Harvard Medical School (P.K.E., A.Z., J.G., H.N., P.E.R., T.J.S., G.J.A., J.J.), Boston, Massachusetts, USA
| | - Jennifer S Temel
- Massachusetts General Hospital (P.K.E., A.Z., J.G., C.J., H.N., P.E.R., T.J.S., G.J.A., J.J.), Boston, Massachusetts, USA; Harvard Medical School (P.K.E., A.Z., J.G., H.N., P.E.R., T.J.S., G.J.A., J.J.), Boston, Massachusetts, USA
| | - Joseph A Greer
- Massachusetts General Hospital (P.K.E., A.Z., J.G., C.J., H.N., P.E.R., T.J.S., G.J.A., J.J.), Boston, Massachusetts, USA; Harvard Medical School (P.K.E., A.Z., J.G., H.N., P.E.R., T.J.S., G.J.A., J.J.), Boston, Massachusetts, USA
| | - Jamie Jacobs
- Massachusetts General Hospital (P.K.E., A.Z., J.G., C.J., H.N., P.E.R., T.J.S., G.J.A., J.J.), Boston, Massachusetts, USA; Harvard Medical School (P.K.E., A.Z., J.G., H.N., P.E.R., T.J.S., G.J.A., J.J.), Boston, Massachusetts, USA
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Green SMC, Hall LH, French DP, Rousseau N, Parbutt C, Walwyn R, Smith SG. Optimization of an Information Leaflet to Influence Medication Beliefs in Women With Breast Cancer: A Randomized Factorial Experiment. Ann Behav Med 2023; 57:988-1000. [PMID: 37494669 PMCID: PMC10578395 DOI: 10.1093/abm/kaad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Adherence to adjuvant endocrine therapy (AET) is low in women with breast cancer. Negative beliefs about the necessity of AET and high concerns are barriers to adherence. PURPOSE To use the multiphase optimization strategy to optimize the content of an information leaflet intervention, to change AET beliefs. METHODS We conducted an online screening experiment using a 25 factorial design to optimize the leaflet. The leaflet had five components, each with two levels: (i) diagrams about AET mechanisms (on/off); (ii) infographics displaying AET benefits (enhanced/basic); (iii) AET side effects (enhanced/basic); (iv) answers to AET concerns (on/off); (v) breast cancer survivor (patient) input: quotes and photographs (on/off). Healthy adult women (n = 1,604), recruited via a market research company, were randomized to 1 of 32 experimental conditions, which determined the levels of components received. Participants completed the Beliefs about Medicines Questionnaire before and after viewing the leaflet. RESULTS There was a significant main effect of patient input on beliefs about medication (β = 0.063, p < .001). There was one significant synergistic two-way interaction between diagrams and benefits (β = 0.047, p = .006), and one antagonistic two-way interaction between diagrams and side effects (β = -0.029, p = .093). There was a synergistic three-way interaction between diagrams, concerns, and patient input (β = 0.029, p = .085), and an antagonistic four-way interaction between diagrams, benefits, side effects, and concerns (β = -0.038, p = .024). In a stepped approach, we screened in four components and screened out the side effects component. CONCLUSIONS The optimized leaflet did not contain enhanced AET side effect information. Factorial experiments are efficient and effective for refining the content of information leaflet interventions.
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Affiliation(s)
- Sophie M C Green
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Louise H Hall
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David P French
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Catherine Parbutt
- Medicines Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust Leeds, Leeds, UK
| | - Rebecca Walwyn
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Samuel G Smith
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Green SM, Hall LH, Rousseau N, French DP, Graham CD, Collinson M, Mason E, Wilkes H, Howdon D, Foy R, Walwyn R, Clark J, Parbutt C, Raine E, Ellison R, Buxton J, Moore SJL, Velikova G, Farrin A, Smith SG. Acceptability, fidelity and trial experience of four intervention components to support medication adherence in women with breast cancer: A process evaluation protocol for a pilot fractional factorial trial. NIHR OPEN RESEARCH 2023; 3:3. [PMID: 37881449 PMCID: PMC10593334 DOI: 10.3310/nihropenres.13337.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 10/27/2023]
Abstract
Background The Refining and Optimising a behavioural intervention to Support Endocrine Therapy Adherence (ROSETA) programme has developed four intervention components aiming to improve medication adherence in women with early-stage breast cancer. These are (a) text messages, (b) information leaflet, (c) Acceptance and Commitment Therapy-based guided self-help (ACT), (d) side-effect management website. Guided by the Multiphase Optimisation Strategy, our pilot trial will use a fractional factorial design to evaluate the feasibility of undertaking a larger optimisation trial. The pilot will include a process evaluation to maximise learning regarding the fidelity and acceptability of the intervention components before proceeding with a larger trial. The trial process evaluation has three aims: to assess the (1) fidelity and (2) acceptability of the intervention components; and (3) to understand participant's trial experience, and barriers and facilitators to recruitment and retention. Methods The process evaluation will use multiple methods. Fidelity of the intervention components will be assessed using self-reported questionnaire data, trial data on intervention component adherence, and observations of the ACT sessions. Acceptability of the intervention components and trial experience will be explored using an acceptability questionnaire and interviews with patients and trial therapists. Trial experience will be assessed using a questionnaire and interviews with participants, while barriers and facilitators to recruitment and retention will be assessed using a questionnaire completed by research nurses and participant interviews. The pilot trial opened for recruitment on 20th May 2022 and was open at the time of submission. Conclusions This process evaluation will provide information regarding whether the intervention components can be delivered with fidelity within a national healthcare setting and are acceptable to participants. We will also better understand participant experience in a pilot trial with a fractional factorial design, and any barriers and facilitators to recruitment and retention. Registration ISRCTN registry ( ISRCTN10487576, 16/12/2021).
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Affiliation(s)
- Sophie M.C. Green
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS29NL, UK
| | - Louise H. Hall
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS29NL, UK
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS29NL, UK
| | - David P. French
- Manchester Centre for Health Psychology, University of Manchester, Manchester, M13 9PL, UK
| | | | - Michelle Collinson
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS29NL, UK
| | - Ellen Mason
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS29NL, UK
| | - Hollie Wilkes
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS29NL, UK
| | - Daniel Howdon
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS29NL, UK
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS29NL, UK
| | - Rebecca Walwyn
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS29NL, UK
| | - Jane Clark
- Department of Clinical and Health Psychology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - Catherine Parbutt
- Medicines Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - Erin Raine
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS29NL, UK
| | - Rachel Ellison
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS29NL, UK
| | | | | | - Galina Velikova
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, LS9 7TF, UK
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, LS9 7TF, UK
| | - Amanda Farrin
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS29NL, UK
| | - Samuel G. Smith
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS29NL, UK
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Anderson B, Vicini F, Wazer D, Arthur D. Breast brachytherapy: Building a bright future on the foundation of a rich history of advancement in technology, technique, and patient-centered care. Brachytherapy 2023; 22:368-380. [PMID: 36740541 DOI: 10.1016/j.brachy.2022.12.009] [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: 09/20/2022] [Revised: 12/02/2022] [Accepted: 12/23/2022] [Indexed: 02/05/2023]
Abstract
For over 20 years, the concept of accelerated partial breast irradiation (APBI) has received considerable attention. Initially concentrating on the appropriateness of APBI as an alternative treatment to whole breast radiotherapy, investigation and innovation evolved towards dose delivery and technique appropriateness. The purpose of this article is to review the pertinent literature that supports the role brachytherapy serves in delivering APBI and the recognized brachytherapy techniques for dose delivery. Publications establishing techniques utilizing multicatheter brachytherapy, single-entry brachytherapy applicators, permanent breast seed implantation brachytherapy, noninvasive breast brachytherapy and electronic brachytherapy are described. The use of brachytherapy for repeat breast conservation therapy is additionally reviewed. A historical perspective and potential direction of future investigation and innovation are presented.
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Affiliation(s)
- Bethany Anderson
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - David Wazer
- Department of Radiation Oncology, Tufts Medical Center, Boston, MA
| | - Douglas Arthur
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA.
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van den Biggelaar YJPG, Kuiper JG, van der Sangen MJC, Luiten EJT, Siesling S, van Herk-Sukel M, Voogd AC, Mesters I. 5-year adherence to adjuvant endocrine treatment in Dutch women with early stage breast cancer: A population-based database study (2006-2016). Breast Dis 2023; 42:331-339. [PMID: 37927248 DOI: 10.3233/bd-230024] [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] [Indexed: 11/07/2023]
Abstract
BACKGROUND Hormonal receptor (HR) positive breast tumors are common. Adjuvant hormonal therapy (AHT) with tamoxifen or Aromatase Inhibitors (AIs) is beneficial depending on the stage of the tumor. Despite the fact that AHT has been shown to improve survival and recurrence, Dutch adherence rates, which were mostly dependent on Tamoxifen prescriptions until 2006, plummeted from 80% after one year to 50% after five years. Nonadherence with AHT reduces its effectiveness. This research presents more recent adherence statistics (from 2006 to 2016), on a larger sample (7,996 vs 1,451), as well as factors that influence AHT adherence. In addition to tamoxifen data, AIs are now included. OBJECTIVE As low use of adjuvant endocrine therapy is a potentially important and modifiable risk factor for poor outcome, it is important to monitor the rate as an indicator of women's burden of disease and the direction of adherence trends. METHODS The Netherlands Cancer Registry (NCR) was used to find women with early-stage breast cancer who started AHT within a year of surgery and were linked to the PHARMO Database Network (n = 8,679). The Kaplan-Meier approach was used to measure AHT adherence five years after treatment was started, with a 60-day gap between refills as our primary outcome. Furthermore, the Medication Possession Rate (MPR) was determined using a cutoff of ≥80%. Analysis was performed on influential factors of adherence. RESULTS The proportion of persistent women declined over time to reach 46.6% at the end of the fifth year and 53.3% of the women had a MPR ≥80% during the fifth year. Older and being diagnosed in 2006-2010 were associated with AHT adherence. CONCLUSION Dutch 5-year AHT adherence appears to remain poor. Improving AHT adherence in HR+ breast cancer survivors is a critical medical need.
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Affiliation(s)
| | | | | | - Ernest J T Luiten
- Department of Surgery, Breast Care Center Tawam Hospital, Abu Dhabi, United Arab Emirates
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Myrthe van Herk-Sukel
- Department of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Ilse Mesters
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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