Perspectives of Postmenopausal Breast Cancer Survivors on Adjuvant Endocrine Therapy-Related Symptoms

Londen, G J. Van; Donovan, Heidi S.; Beckjord, Ellen Burke; Cardy, Alexandra L.; Bovbjerg, Dana H.; Davidson, Nancy E.; Morse, Jennifer Q.; Switzer, Galen E.; Leeuw, Irma M. Verdonck‐de; Dew, Mary Amanda

doi:10.1188/14.onf.660-668

Cited by 32 publications

(74 citation statements)

References 54 publications

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“…Prior studies have largely focused on patient perspectives, highlighting issues such as patient uncertainty in determining symptom origins, dissatisfaction with symptom management information received from providers, communication challenges, and unmet preferences for non-pharmacological symptom management approaches [21-23,45]. Our findings are consistent with and complement results from patient-focused studies.…”

Section: Discussionsupporting

confidence: 84%

“…Moreover, although BC survivors often receive care from multidisciplinary healthcare providers (e.g., oncologists, nurses, psychologists), little is known about provider perspectives on barriers and facilitators to AET-related symptom management, as most previous studies have been limited to patient perspectives [21-23]. Given the shared role of patients and providers in the symptom management process, it is equally important to understand provider perspectives on factors influencing AET-related symptom management.…”

Section: Introductionmentioning

confidence: 99%

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

Samuel

Turner

Donovan

et al. 2017

Support Care Cancer

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Purpose Adjuvant endocrine therapy (AET) utilization is linked to improved clinical outcomes among breast cancer survivors (BCS); yet, AET adherence rates remain suboptimal. Little is known about provider perspectives regarding barriers and facilitators to AET-related symptom management (SM). In this study, we examined provider perspectives on the barriers and facilitators to AET-related SM among BCS and opportunities for improvement. Methods We conducted three focus groups (FGs) with a multidisciplinary group of health care providers (n=13) experienced in caring for BCS undergoing AET. We utilized semi-structured discussion guides to elicit provider perspectives on AET-related SM. FGs were audiotaped, transcribed, and analyzed using qualitative software to identify key themes. Results Providers described patient-, provider-, and system- level barriers and facilitators to AET-related SM. At the patient-level, barriers included competing demands, limited time/resources, and possible misattribution of some symptoms to AET, while family/social relationships and insurance emerged as important facilitators. Discomfort with SM, limited time, and challenges distinguishing AET-related symptoms from other conditions were key provider-level barriers. Provider-level facilitators included routine symptom documentation and strong provider relationships. Care fragmentation and complexity of the cancer care delivery system were described as system-level barriers; however, survivor clinics were endorsed by providers. Conclusions Provider perspectives on AET-related SM can shed light on SM barriers and facilitators spanning multiple levels of the cancer care delivery system. Strategies for improving AET-related SM in BCS include increasing patients' knowledge and engagement in SM, equipping providers with efficient SM strategies, and improving coordination of symptom-related services through survivorship programs.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

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

Samuel

Turner

Donovan

et al. 2017

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“…Furthermore, studies suggest that survivors may be dissatisfied with patient-provider communication regarding AET symptom management. In a recent study examining AET symptom management experiences, survivors reported that providers were often dismissive of symptom concerns and failed to provide adequate information regarding symptom management [17]. …”

Section: Introductionmentioning

confidence: 99%

“…To date, most prior studies have obtained survivors’ perspectives on patient-provider communication regarding AET symptoms; yet, no studies, to our knowledge, have assessed provider perspectives on this care process [17, 29]. Providers’ communication skills play a key role in eliciting survivors’ report of symptoms and ensuring survivors’ adherence to long-term treatments such as AET [30].…”

Section: Introductionmentioning

confidence: 99%

Provider perspectives on patient-provider communication for adjuvant endocrine therapy symptom management

Turner

Samuel

Donovan

et al. 2016

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Purpose Providers’ communication skills play a key role in encouraging breast cancer survivors to report symptoms and adhere to long-term treatments such as adjuvant endocrine therapy (AET). The purpose of this study was to examine provider perspectives on patient-provider communication regarding AET symptom management and to explore whether provider perspectives vary across the multi-disciplinary team of providers involved in survivorship care. Methods We conducted three one-hour focus groups with a multi-disciplinary group of health care providers including oncology specialists, primary care physicians, and non-physician providers experienced in caring for breast cancer survivors undergoing AET (n = 13). Themes were organized using Epstein and Street’s (2007) Framework for Patient-Centered Communication in Cancer Care. Results The findings of this study suggest providers’ communication behaviors including managing survivors’ uncertainty, responding to survivors’ emotions, exchanging information, and enabling self-management influences the quality of patient-provider communication about AET symptoms. Additionally, lack of systematic symptom assessment tools for AET requires providers to use discretion in determining which symptoms to discuss with survivors resulting in approaches that vary based on providers’ discipline. Conclusion There may be AET-specific provider communication skills and behaviors that promote effective patient-provider communication but additional research is needed to identify practices and policies that encourage these skills and behaviors among the many providers involved in survivorship care. Efforts are also needed to coordinate AET symptom assessment across providers, clarify providers’ roles in symptom assessment, and determine best practices for AET symptom communication.

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“…These side-effects can have a significant impact on quality of life [37,38], and are often identified as drivers of non-adherence [7,39]. Studies suggest that women often feel unprepared for the side-effects and that they are given little support in dealing with them [40,41].Whilst the relationship between side-effects and adherence is not always consistent, qualitative research has shown that many women stop taking tamoxifen because of their side-effects [30,42].…”

Section: Stage 1: Needs Assessmentmentioning

confidence: 99%

Development of a self-management intervention to improve tamoxifen adherence in breast cancer survivors using an Intervention Mapping framework

Moon¹,

Moss‐Morris²,

Hunter³

et al. 2019

Preprint

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Objective: Up to 50% of women prescribed tamoxifen do not take it as prescribed for the full duration, which increases risk of recurrence and mortality. The current paper describes the development of a self-management intervention aiming to improve adherence in breast cancer survivors taking tamoxifen. Methods: The intervention was developed following an Intervention Mapping approach. The content of the intervention was determined by theories of health behaviour and empirical evidence. Development was an iterative process involving input from expert researchers, clinicians and patient representatives. Results: The intervention was designed to improve both intentional and unintentional non-adherence. Key features included modifying unhelpful illness and treatment beliefs, improving confidence for coping with side effects and developing strategies for remembering to take tamoxifen. Conclusion: Intervention Mapping proved a useful tool for developing an intervention which is grounded in theory and empirical evidence. The intervention has the potential to improve adherence in breast cancer survivors but needs to be trialled before the effectiveness of the intervention can be determined. Practice implications: If shown to be effective, the intervention could be rolled out at a low cost to improve adherence and support breast cancer survivors prescribed tamoxifen.

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Perspectives of Postmenopausal Breast Cancer Survivors on Adjuvant Endocrine Therapy-Related Symptoms

Cited by 32 publications

References 54 publications

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

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

Provider perspectives on patient-provider communication for adjuvant endocrine therapy symptom management

Development of a self-management intervention to improve tamoxifen adherence in breast cancer survivors using an Intervention Mapping framework

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