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）。辅助激素治疗是一种既定的治疗方法，可以减少乳腺癌女性的复发（EBCTCG, 2005），但高达75%的女性不坚持这些治疗（Murphy等人，2012），增加了她们的死亡风险（Hershman等人，2011）。鼓励依从性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-Mendoza等人，2016）。随着数字平台的发展，个性化护理的电子保健解决方案越来越有吸引力。例如，在其他情况下，及时发送短信可有效提高对长期治疗的依从性（Thakkar et al., 2016）。近年来，准时制自适应干预（JITAIs）得到了发展。jitai是具有内置决策规则的数字应用程序，根据特定时间或他们的情况向用户发送通知。jitai已成功用于增加身体活动（Hardeman et al., 2016），但尚未应用于药物依从性。还需要进一步的证据来证明jitai如何、何时以及对谁有效地改变行为（Thomas & Bond, 2015）。一种尖端的实验设计，微随机试验（MRT），已经被提出来解决这些问题（Murphy等人，2015）。该博士学位将：1)综合先前报道的JITAIs的证据，并确定如何将其应用于药物依从性；2)开发有效的短信在JITAI中使用；3)检查和评估JITAI在MRT中使用辅助激素治疗的可行性，以定量优化干预；4)调查最有效的信息组合，并分析根据环境、时间或不同患者群体的影响可能有何不同。

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.