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Adjuvant endocrine therapy (AET) after breast cancer: A qualitative study of factors associated with adherenceBrett, Jo; Boulton, Mary; Fenlon, Deborah F.; Hulbert-Williams, Nicholas J.; Walter, Fiona M.; Donnelly, Peter; Lavery, Bernadette; Morgan, Adrienne; Morris, Carolyn; Watson, Eila; et al. (Dove Medical Press, 2018-02-16)Introduction : Despite evidence of the efficacy of Adjuvant Endocrine Therapy (AET) in reducing the risk of recurrence and mortality after treatment for primary breast cancer, adherence to AET is suboptimal. This study aimed to explore factors that influence adherence and non-adherence to adjuvant endocrine therapy (AET) following breast cancer to inform the development of supportive interventions. Methods: Interviews were conducted with 32 women who had been prescribed AET, 2-4 years following their diagnosis of breast cancer,. Both adherers (n=19) and non-adherers (n=13) were recruited. The analysis was conducted using the Framework approach. Results: Factors associated with adherence were: Managing side effects including information and advice on side effects, and taking control of side effects, Supportive relationships, and Personal influences. Factors associated with non-adherence were: Burden of side effects, Feeling unsupported, Concerns about long term AET use, Re-gaining normality, including valuing quality of life over length of life, and Risk perception Conclusions: Provision of timely information to prepare women for the potential side effects of AET and education on medication management strategies are needed, including provision of timely and accurate information on the efficacy of AET in reducing breast cancer recurrence, and on potential side effects and ways to manage these should they arise. . Trust in the doctor-patient relationship and clear patient pathways for bothersome side effects and concerns with AET are important. Training and education around AET for GPs should be considered alongside novel care pathways such as primary care nurse cancer care review, and community pharmacist follow-up.
Factors Associated with Intentional and Unintentional Non-adherence to Adjuvant Endocrine Therapy Following Breast CancerBrett, Jo; Fenlon, Deborah F.; Boulton, Mary; Hulbert-Williams, Nicholas J.; Walter, Fiona M.; Donnelly, Peter; Lavery, Bernadette; Morgan, Adrienne; Morris, Carolyn; Watson, Eila; et al. (Wiley, 2016-11-30)Adherence to adjuvant endocrine therapy (AET) following breast cancer is known to be sub-optimal despite its known efficacy in reducing recurrence and mortality. This study aims to investigate factors associated with non-adherence and inform the development of interventions to support women and promote adherence. A questionnaire survey to measure level of adherence, side effects experienced, beliefs about medicine, support received and socio-demographic details was sent to 292 women 2-4 years post breast cancer diagnosis. Differences between non-adherers and adherers to AET were explored, and factors associated with intentional and unintentional non-adherence are reported. Approximately one quarter of respondents, 46 (22%), were non-adherers, comprising 29 (14%) intentional non-adherers and 17 (8%) unintentional non-adherers. Factors significantly associated with intentional non-adherence were: the presence of side effects (p<0.03), greater concerns about AET (p<0.001), and a lower perceived necessity to take AET (p<0.001). Half of the sample (105/211) reported that side effects had a moderate or high impact on their quality of life. Factors associated with unintentional non-adherence were: younger age (<65), (p<0.001), post-secondary education (p=0.046), and paid employment (p=0.031). There are distinct differences between intentional non-adherence and unintentional non-adherence. Differentiation between the two types of non-adherence may help tailor support and advice interventions
Psychometric properties of the Beliefs about Medicine Questionnaire (BMQ)-AET for Women taking Adjuvant Endocrine Therapies (AET) following early-stage breast cancerBrett, Jo; Hulbert-Williams, Nicholas J.; Fenlon, Deborah F.; Boulton, Mary; Walter, Fiona M.; Donnelly, Peter; Lavery, Bernadette; Morgan, Adrienne; Morris, Carolyn; Horne, Rob; et al. (SAGE, 2017-11-17)Objectives: To evaluate the Beliefs about Medicine Questionnaire to explore adherence to adjuvant endocrine therapy after treatment for breast cancer (BMQ-AET). Method: Factor structure of the BMQ-AET was explored alongside internal consistency, convergent validity and acceptability. Results: The BMQ-AET Specific Scale fitted the original 10 item model. Internal consistency of the BMQ-AET was much improved compared to the original BMQ and convergent validity showed predicted direction of correlation, although correlation with BMQ-AET concerns scale was low. Acceptability was good. Conclusions: The evaluation of the BMQ-AET is encouraging, and could facilitate future research around adherence to AET.