Women’s experiences of hormonal therapy for breast cancer: exploring influences on medication-taking behaviour
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Five to 10 years of adjuvant hormonal therapy is recommended to prevent breast cancer recurrence. This study investigated modifiable influences on adjuvant hormonal therapy medication-taking behaviour (MTB) in women with stage I–III breast cancer.
Semi-structured face-to-face interviews among women with stage I–III breast cancer prescribed adjuvant hormonal therapy purposively sampled by their MTB at two cancer centres. Thematic analysis was conducted based on the Framework approach, with the Theoretical Domains Framework (TDF) informing the analysis framework; the TDF is an integrative framework consisting of 14 domains of behavioural change to inform intervention design.
Thirty-one women participated in interviews (14 adherent/persistent; 7 non-adherent/persistent; 10 non-persistent). Three domains identified both barriers and enablers to hormonal therapy MTB across the three MTB strata: beliefs about consequences, intentions and goals and behaviour regulation, but their influence was different across the strata. Other domains influenced individual MTB strata. Key enablers for adherent/persistent women were identified within the domain beliefs about consequences (breast cancer recurrence), intentions and goals (high-priority), beliefs about capabilities (side effects) and behaviour regulation (managing medication). Barriers were identified within the domain behaviour regulation (no routine), memory, attention and decision processes (forgetting) and environmental context and resources (stressors) for non-adherent/persistent women and intentions and goals (quality of life), behaviour regulation (temporal self-regulation), reinforcement, beliefs about consequences (non-necessity) and social influences (clinical support) for non-persistent women.
This study identified modifiable influences on hormonal therapy MTB. Targeting these influences in clinical practice may improve MTB and hence survival in this population.
KeywordsHormonal therapy Medication-taking behaviour Adherence Breast cancer
We wish to thank all of the women at the two cancer centres who kindly gave their time to participate in this study. We wish to acknowledge Aileen Timmons who helped develop the coding index for this study.
CC is Health Research Board, Ireland (HRB) ICE fellow (ICE/2011/9) and this grant funded data collection.
Conflict of interests
All authors have nothing to declare.
CC, KB, MJK, CMK and LS planned and designed the study. CC and AT developed the coding index. CC and SD analysed and interpreted the study data. CC drafted the manuscript. CC, SD, CMK, MJK, KB and LS critically reviewed and approved the final manuscript. CC is guarantor.
Ethical approval was obtained from the individual hospital Research Ethics Boards and all participants provided informed consent.
Independence of researchers
All authors and their affiliated institutions are independent of the Health Research Board.
Access to the data
All authors had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.
- 1.Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;365(9472):1687-717Google Scholar
- 12.Cane J, O’Connor D, Michie S (2012) Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci 7(37):1–17Google Scholar
- 15.Ritchie J, Lewis J (2012) Qualitative research practice. SAGE Publications Ltd, LondonGoogle Scholar
- 16.Francis JJ, Stockton C, Eccles MP, Johnston M, Cuthbertson BH, Grimshaw JM et al (2009) Evidence-based selection of theories for designing behaviour change interventions: using methods based on theoretical construct domains to understand clinicians' blood transfusion behaviour. Br J Health Psychol 14(4):625–646CrossRefPubMedGoogle Scholar
- 34.Gollwitzer PM, Sheeran P. (2006) Implementation intentions and goal achievement: A Meta‐analysis of effects and processes. In: Mark PZ, editor. Advances in Experimental Social Psychology: Academic Press; p. 69-119Google Scholar
- 39.Nielsen-Bohlman LN, Panzar AM, Kindig DA (2004) Health literacy: a prescription to end confusion. National Academic Press, Washington DCGoogle Scholar
- 41.Fowler FJ Jr, Gerstein BS, Barry MJ (2013) How patient centered are medical decisions? results of a national survey. JAMA 173(13):1215–1221Google Scholar