The relationship between medication adherence and illness perception in breast cancer patients with adjuvant endocrine therapy: beliefs about medicines as mediators

Exploring the real-world experience of abemaciclib treatment for HR +, HER2 - metastatic breast cancer-a qualitative analysis of the IMPACTOR study

PURPOSE

The IMPACTOR study (IMPact of AbemaCiclib on patienTs' rOles and Responsibilities-ISRCTN17281696) was developed to capture experiences of women with MBC being treated with abemaciclib in a real-world setting. The primary aim was to explore changes to quality of life over time and our secondary aim was to understand these changes in detail via qualitative interviews, as presented here.

METHODS

A singular interview was offered to participants who had expressed an interest at the point of consent. These were all conducted remotely using a semi-structured interview topic guide.

RESULTS

Twenty interviews were completed and analysed using a framework approach to thematic analysis. Eight themes were developed-COVID-19, experience of MBC, side effects, side effect management, treatment information and support, relationship impacts, impact on daily life, and finances and employment.

CONCLUSIONS

It was apparent that participants faced side effects from treatment but undertook steps to manage these as much as possible. Adaptations were often led by a belief about the benefits of remaining on treatment. Adjustments ranged from modifying routines to carrying personal hygiene supplies when out in public in case of diarrhoea. While this was anticipated, other side effects were less well known with variable clinical support and available information. Family support was raised frequently, predominantly in relation to the impact MBC had on roles and relationships. Themes from this work can be thought of via theories about treatment belief and adherence, such as the common-sense and self-regulation models, as participants reflected on both emotional and cognitive coping strategies. Trial registration - ISRCTN17281696.

The Impact of Illness Perception on Medication Adherence to Inhaler Therapy in Elderly Individuals With COPD

Background: Medication adherence to inhaler therapy is pivotal for optimizing the management of COPD. Individuals with COPD often have suboptimal adherence behaviors to inhaler therapy. Illness perception and beliefs about medicines have been proved to be associated with medication adherence. Nevertheless, the influence of illness perception and medication beliefs on adherence to inhaler therapy among elderly individuals with COPD in China remains unclear. Methods: A cross-sectional study was conducted in 252 elderly subjects with COPD in China from June 2022-September 2023. The Test of Adherence to Inhalers, the Brief Illness Perception Questionnaire, and the Belief About Medicines Questionnaire (BMQ) were utilized. Spearman correlations, regression analysis, and parallel mediation analysis were employed to assess the correlations and mediating effects among beliefs about medicines, illness perception, and medication adherence to inhaler therapy. Results: Medication adherence to inhaler therapy exhibited a negative correlation with concerns beliefs, while showing positive correlations with illness perception, necessity beliefs, and total BMQ scores. Mediating effects of concerns beliefs and necessity beliefs were observed in the relationship between perception of illness and medication adherence to inhaler therapy. Conclusions: This study suggests that essential interventions targeting beliefs about medicines in elderly individuals with COPD should be implemented to optimize the level of their inhaler adherence, particularly in those with low levels of necessity beliefs or high levels of concerns beliefs.

Development and psychometric evaluation of the adjuvant endocrine therapy beliefs scale for breast cancer survivors

PURPOSE

Adjuvant endocrine therapy has a vital role in reducing breast cancer mortality. The beliefs in adjuvant endocrine therapy is a very important factor in the medication adherence of breast cancer survivors. Therefore, it is necessary to develop a standardized scale for assessment of adjuvant endocrine therapy. The purpose of this study was to identify the attributes of adjuvant endocrine therapy beliefs, and to evaluate adjuvant endocrine therapy beliefs scale psychometric properties.

METHODS

A hybrid model was applied to identify the concept of adjuvant endocrine therapy beliefs and measurement question were developed by the scale development process. Statistical analysis using validity analysis and Rasch analysis based on item response theory were performed. A total of 228 breast cancer survivors in South Korea participated in the study.

RESULTS

The finally developed adjuvant endocrine therapy beliefs scale consisted of 22 items. The items extracted by 4 factors explained 59.72% of the total variance. The model fit showed an acceptable level. The adjuvant endocrine therapy beliefs scale was excellent in convergent and discriminant validity with reliability.

CONCLUSION

This scale is expected to be practical and useful in identifying adjuvant endocrine therapy beliefs and developing intervention strategies to promote adjuvant endocrine therapy adherence. In addition, continuous education and support should be accompanied so that breast cancer survivors can maintain positive beliefs in adjuvant endocrine therapy adherence.

Medication perceptions mediate the association between illness perceptions and adherence to oral anticancer agents among patients with gastrointestinal tract cancer: A cross-sectional study

PURPOSE

Patients with gastrointestinal tract cancer reported suboptimal adherence to oral anticancer agents, reducing the therapeutic benefit and increasing mortality risk. The Common-Sense Model of Self-Regulation highlights patients' perceptions of illness and treatment influence adherence. However, how these perceptions influence adherence remains unknown among this population. This study aimed to explore whether illness perceptions influence adherence via their effect on medication perceptions.

METHODS

A multi-center cross-sectional study design was conducted. Between July and August 2023, a questionnaire was administered to patients from four tertiary hospitals in Mainland China. Illness perceptions were assessed using the Brief Illness Perceptions Questionnaire. Medication perceptions were measured in medication belief and self-efficacy using the Belief about Medicines Questionnaire and Self-efficacy for Appropriate Medication Use Scale, respectively. Adherence was evaluated using the Morisky 4-item Medication Adherence Scale. Mediation analyses were conducted.

RESULTS

In total, 253 participants were recruited. Patients with worse negative illness perceptions reported higher concern, lower self-efficacy, and poorer adherence. Medication self-efficacy was positively associated with adherence, whereas the necessity and concern belief of taking oral anticancer agents were not. Illness perceptions, including the cognitive and emotional dimensions, had direct and indirect effects on adherence via its effects on medication self-efficacy. The indirect effect explained 26.63% of the total effect.

CONCLUSIONS

The association between illness perceptions and adherence is partially mediated by medication self-efficacy. Strategies to foster positive illness perceptions may contribute to better medication self-efficacy and adherence. Attention should be equally focused on both the emotional and cognitive dimensions of illness perceptions.

Path analysis of illness perception, medication beliefs, family support on inhaler adherence in elderly COPD patients: Based on triadic reciprocal determinism

OBJECTIVE

This study aimed to explore the pathways through which personal factors (demographic characteristics, illness perception, medication beliefs) and environmental factors (family support) influence adherence to inhaler therapy among Chinese elderly patients with chronic obstructive pulmonary disease (COPD) based on the triadic reciprocal determinism.

METHODS

A cross-sectional survey was conducted from June 2022 to December 2023 using the Test of Adherence to Inhalers (TAI), the Beliefs about Medicines Questionnaire (BMQ), the Brief Illness Perception Questionnaire (B-IPQ) and the Family Support Scale to investigate 305 elderly COPD patients (mean age 70.96 years, 213 males) from the Department of Respiratory Medicine of a comprehensive hospital in Anhui, China mainland. Path analysis was performed using AMOS 22.0.

RESULTS

Path analysis showed that illness perception, necessity beliefs, concerns beliefs and family support all had direct effects on inhaler adherence, while age had an indirect effect on adherence. Additionally, necessity beliefs and concerns beliefs exhibited significant mediating effects between illness perception and inhaler adherence. Family support respectively mediated the relationships between necessity beliefs, concerns beliefs and inhaler adherence.

CONCLUSION

A multidimensional approach targeting cognitive, belief and family factors holds promise for substantially improving inhaler adherence among elderly COPD populations.

PRACTICE IMPLICATIONS

This study provided new perspectives for improving inhaler adherence in COPD patients. Healthcare providers should emphasize improving patients' illness perception and medication beliefs, considering the important impact of family support on inhaler adherence.

Identification of patient subgroups who benefit from a behavioral intervention to improve adjuvant endocrine therapy adherence: a randomized-controlled trial

PURPOSE

Adjuvant endocrine therapy (AET) reduces breast cancer morbidity and mortality; however, adherence is suboptimal. Interventions exist, yet few have improved adherence. Patient characteristics may alter uptake of an intervention to boost adherence. We examined moderators of the effect of a virtual intervention (STRIDE; #NCT03837496) on AET adherence after breast cancer.

METHODS

At a large academic medical center, patients taking AET (N = 100; Mage = 56.1, 91% White) were randomized to receive STRIDE versus medication monitoring. All stored their medication in digital pill bottles (MEMS Caps) which captured objective adherence. Participants self-reported adherence (Medication Adherence Report Scale) at 12 weeks post-baseline. Moderators included age, anxiety, and depressive symptoms (Hospital Anxiety and Depression Scale), AET-related symptom distress (Breast Cancer Prevention Trial Symptom Scale), and AET-specific concerns (Beliefs about Medications Questionnaire). We used hierarchical linear modeling (time × condition × moderator) and multiple regression (condition × moderator) to test the interaction effects on adherence.

RESULTS

Age (B = 0.05, SE = 0.02, p = 0.003) and AET-related symptom distress (B = -0.04, SE = 0.02, p = 0.02) moderated condition effect on self-reported adherence while anxiety (B = -1.20, SE = 0.53, p = 0.03) and depressive symptoms (B = -1.65, SE = 0.65, p = 0.01) moderated objective adherence effects. AET-specific concerns approached significance (B = 0.91, SE = 0.57, p = 0.12). Participants who received STRIDE and were older or presented with lower anxiety and depressive symptoms or AET-related symptom distress exhibited improved adherence. Post hoc analyses revealed high correlations among most moderators.

CONCLUSIONS

A subgroup of patients who received STRIDE exhibited improvements in AET adherence. The interrelatedness of moderators suggests an underlying profile of patients with lower symptom burden who benefitted most from the intervention.

STUDY REGISTRATION

NCT03837496.

Optimization of an Information Leaflet to Influence Medication Beliefs in Women With Breast Cancer: A Randomized Factorial Experiment

BACKGROUND

Adherence to adjuvant endocrine therapy (AET) is low in women with breast cancer. Negative beliefs about the necessity of AET and high concerns are barriers to adherence.

PURPOSE

To use the multiphase optimization strategy to optimize the content of an information leaflet intervention, to change AET beliefs.

METHODS

We conducted an online screening experiment using a 25 factorial design to optimize the leaflet. The leaflet had five components, each with two levels: (i) diagrams about AET mechanisms (on/off); (ii) infographics displaying AET benefits (enhanced/basic); (iii) AET side effects (enhanced/basic); (iv) answers to AET concerns (on/off); (v) breast cancer survivor (patient) input: quotes and photographs (on/off). Healthy adult women (n = 1,604), recruited via a market research company, were randomized to 1 of 32 experimental conditions, which determined the levels of components received. Participants completed the Beliefs about Medicines Questionnaire before and after viewing the leaflet.

RESULTS

There was a significant main effect of patient input on beliefs about medication (β = 0.063, p < .001). There was one significant synergistic two-way interaction between diagrams and benefits (β = 0.047, p = .006), and one antagonistic two-way interaction between diagrams and side effects (β = -0.029, p = .093). There was a synergistic three-way interaction between diagrams, concerns, and patient input (β = 0.029, p = .085), and an antagonistic four-way interaction between diagrams, benefits, side effects, and concerns (β = -0.038, p = .024). In a stepped approach, we screened in four components and screened out the side effects component.

CONCLUSIONS

The optimized leaflet did not contain enhanced AET side effect information. Factorial experiments are efficient and effective for refining the content of information leaflet interventions.