Deconstructing Decisions to Initiate, Maintain, or Discontinue Adjuvant Endocrine Therapy in Breast Cancer Survivors: A Mixed-Methods Study
Deconstructing Decisions to Initiate, Maintain, or Discontinue Adjuvant Endocrine Therapy in Breast Cancer Survivors: A Mixed-Methods Study
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DOI：
10.1188/17.onf.e101-e110
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发表时间：
2017-05-01
影响因子：
1.9
通讯作者：
Bartholomew, Leona Kay
中科院分区：
文献类型：
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作者：
Bluethmann, Shirley M.;Murphy, Caitlin C.;Bartholomew, Leona Kay
目的/目标：辅助内分泌治疗（AET）已被证明可以提高激素受体阳性乳腺癌幸存者的生存率，但多达一半的人没有完成推荐的治疗。药物相关副作用的管理和与提供者的接触是两个潜在的可改变因素，但它们与依从性的关系尚不清楚。目的是建立在调查结果的定性探索幸存者的经验与规定的AET（a）描述评估和管理的AET副作用和（B）解构决定开始，停止，或维持AET.Research Approach：作者使用了混合方法的解释序列研究设计与定性的重点。幸存者是从德克萨斯大学西南医学中心的临床癌症登记处招募的，其中包括哈罗德C。Simmons综合癌症中心（国家癌症研究所指定），在达拉斯。参与者：452幸存者完成了一项调查，30人参加了电话interviews.Methodologic方法：定性的方法，其中作者记录和转录的访谈进行分析，并使用开放编码，以减少数据到themes.Findings：在坚持幸存者，耐受副作用和毅力的主题是强大的。非依从性生存者表示更难以管理副作用，并认为较少的好处时，副作用是麻烦的。所有幸存者提到的最常见的副作用是更年期症状和关节疼痛;不太常见的副作用是认知能力下降和心脏窘迫。有些人向他们的肿瘤团队寻求建议。不遵守幸存者出现最初的动机，以维持AET，但确定了一个耐受限度的副作用后，供应商的建议是影响较小，在他们的决定，以维持或中止AET.Interpretation：本研究阐明坚持作为一个复杂的连续的行为，评价，和决策点。这些见解可能是特别有用的咨询幸存者服用AET和促进及时提供临床干预措施，以提高adherence.Implications护理：护士应参与规划和实施的临床干预措施，以管理副作用和其他障碍AET坚持。
Purpose/Objectives: Adjuvant endocrine therapy (AET) has been shown to improve survival in hormone receptor-positive breast cancer survivors, but as many as half do not complete recommended treatment. Management of medication-related side effects and engagement with providers are two potentially modifiable factors, but their associations with adherence are not well understood. The aims were to build on survey results to qualitatively explore survivors' experiences with prescribed AET to (a) describe appraisal and management of AET side effects and (b) deconstruct decisions to initiate, discontinue, or maintain AET.Research Approach: The authors used a mixed-methods explanatory sequence research design with a qualitative emphasis.Setting: Survivors were recruited from a clinical cancer registry maintained at the University of Texas Southwestern Medical Center, which includes the Harold C. Simmons Comprehensive Cancer Center (National Cancer Institute-designated), in Dallas.Participants: 452 survivors completed a survey, and 30 took part in telephone interviews.Methodologic Approach: Qualitative methods were used in which the authors recorded and transcribed interviews for analysis and used open coding to reduce data into themes.Findings: Among adherent survivors, the themes of tolerance of side effects and perseverance were strong. Nonadherent survivors expressed more difficulty managing side effects and perceived fewer benefits when side effects were bothersome. The most common side effects mentioned by all survivors were menopausal symptoms and joint pain; less common side effects were cognitive decline and cardiac distress. Some sought advice from their oncology team. Nonadherent survivors appeared initially motivated to maintain AET but identified a tolerance limit for side effects after which a provider's recommendation was less influential in their decision to maintain or discontinue AET.Interpretation: This study elucidated adherence as a complex continuum of behaviors, appraisals, and decision points. These insights may be particularly useful in counseling survivors taking AET and promoting timely delivery of clinical interventions to enhance adherence.Implications for Nursing: Nurses should be involved in the planning and implementation of clinical interventions to manage side effects and other barriers to AET adherence.