Accepted for/Published in: JMIR Research Protocols
Date Submitted: Feb 17, 2020
Date Accepted: Jun 15, 2020
Improving adherence to adjuvant hormonal therapy among socioeconomically disadvantaged women diagnosed with breast cancer in South Carolina: A multi-method study
ABSTRACT
Background:
Background:
Current clinical guidelines recommend that hormone-receptor positive breast cancer survivors take adjuvant hormonal therapy (AHT) for 5 to 10 years following the end of definitive treatment. However, fewer than half of patients are adherent to guidelines and suboptimal adherence to AHT is associated with increased risk of breast cancer mortality. Research has extensively documented socio-demographic and disease-specific factors associated with adherence to AHT, but very little evidence exists on behavioral factors that can be modified (e.g., knowledge, patient-provider communication) and targeted by interventions.
Objective:
Objective:
The goal of this study is to develop and test a theory-based, multi-level intervention to improve adherence to AHT among breast cancer survivors from racial and socioeconomically-disadvantaged backgrounds (e.g., Medicaid-insured). The specific aims are to: 1) explore multi-level (e.g., patient, health care system) factors that influence adherence to AHT; 2) develop a theory-based, multi-level intervention to improve adherence to AHT; and 3) pilot test and evaluate a theory-based, multi-level intervention.
Methods:
Methods:
For Aim 1, we will recruit breast cancer survivors and health care professionals to participate in semi-structured interviews to gain their perspectives about barriers and facilitators to AHT use. We will conduct a directed content analysis of the Aim 1 qualitative interview data. For Aim 2, we will integrate Aim 1 findings and current literature into the design of a multilevel intervention using an Intervention Mapping approach. For Aim 3, we will recruit Medicaid-insured breast cancer survivors to assess the feasibility of the pilot intervention.
Results:
Results:
From May 2016 to July 2018, we completed interviews with 20 breast cancer survivors and 23 health care professionals in South Carolina. We will conduct a directed content analysis of the qualitative interview data. Results from this analysis will be used, in combination with the current literature, to design (Aim 2) and pilot test a theory-based multilevel intervention (Aim 3) in Fall 2020.
Conclusions:
Conclusions:
This study will provide a deeper understanding of how to improve adherence to AHT using a novel, multilevel approach among socioeconomically disadvantaged breast cancer survivors who often experience disproportionate breast cancer mortality.
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.