Developing and quantitatively optimising a Just-In-Time-Adaptive-Intervention (JITAI) to improve adherence to medication in women with breast cancer.

乳腺癌是英国最常见的癌症，也是癌症死亡的第二大常见原因（ONS，2019）。辅助激素疗法是一种既定的治疗方法，其减少患有乳腺癌的女性的复发（EBCTCG，2005），但高达75%的女性不坚持这些疗法（Murphy等人，2012），增加了他们的死亡风险（Hershman等人，2011年）。鼓励坚持的干预措施在很大程度上未能支持乳腺癌幸存者的健康和福祉（Hurtado-de-门多萨等人，2016）。随着数字平台的发展，用于个性化护理的电子健康解决方案越来越有吸引力。例如，及时的SMS消息的递送在增加对其他病症中的长期治疗的依从性方面是有效的（Thakkar等人，2016年）。最近，已经开发了即时自适应干预（JITAIs）。JITAI是具有内置决策规则的数字应用程序，根据特定时间或情况向用户发送通知。JITAI已经成功地用于增加身体活动（Hardeman等人，2016年），但尚未应用于药物治疗。还需要进一步的证据来证明JITAI如何、何时以及对谁有效改变行为（托马斯和邦德，2015）。已经提出了一种尖端的实验设计，即微随机试验（MRT），以解决这些问题（Murphy等人，2015).这个博士将：1）综合先前报告的JITAI的证据，并确定如何将其应用于药物依从性; 2）开发有效的SMS消息用于JITAI; 3）检查在MRT中使用辅助激素治疗的女性的JITAI的可行性并对其进行评估，以定量优化干预;以及4）调查最有效的信息组合，并分析效果如何根据背景、时间或针对不同患者群体而不同。

Breast cancer is the most common cancer in the UK and second most common cause of cancer death (ONS, 2019). Adjuvant hormonal therapy is an established treatment which reduces recurrence in women with breast cancer (EBCTCG, 2005) but up to 75% of women do not adhere to these therapies (Murphy et al., 2012), increasing their mortality risk (Hershman et al., 2011). Interventions to encourage adherence have largely failed to support the health and wellbeing of breast cancer survivors (Hurtado-de-Mendoza et al., 2016). As digital platforms evolve, e-Health solutions for personalised care are increasingly attractive. For example, the delivery of timely SMS messages are effective in increasing adherence to long-term therapies in other conditions (Thakkar et al., 2016). Recently, Just-In-Time-Adaptive-Intervention's (JITAIs) have been developed. JITAIs are digital applications with inbuilt decision rules, delivering notifications to users based on the specific time or their situation. JITAIs have been used successfully to increase physical activity (Hardeman et al., 2016) but have not been applied to medication adherence. Further evidence is also needed on how, when, and for whom JITAIs can be effective for behaviour change (Thomas & Bond, 2015). A cutting-edge experimental design, the Micro-Randomised Trial (MRT), has been proposed to address these questions (Murphy et al., 2015).This PhD will: 1) synthesise the evidence on previously reported JITAIs and establish how they can be applied to medication adherence; 2) develop effective SMS messages to use in a JITAI; 3) examine the feasibility of and evaluate a JITAI with women using adjuvant hormonal therapy within an MRT to quantitatively optimise the intervention; and 4) investigate the most effective combination of messages and analyse how effects might differ according to context, timing or for different patient groups.