Cleo A Samuel1,2, Kea Turner3, Heidi A S Donovan4, Ellen Beckjord5, Alexandra Cardy5, Mary Amanda Dew6,7, G J van Londen7. 1. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105F McGavran-Greenberg Hall, CB# 7411, Chapel Hill, NC, 27599-7411, USA. cleo_samuel@unc.edu. 2. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, USA. cleo_samuel@unc.edu. 3. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105F McGavran-Greenberg Hall, CB# 7411, Chapel Hill, NC, 27599-7411, USA. 4. University of Pittsburgh Medical Center Cancer Center, School of Nursing, University of Pittsburgh, 415 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, USA. 5. University of Pittsburgh Medical Center Health Plan, University of Pittsburgh, 600 Grant Street, Pittsburgh, PA, USA. 6. Department of Psychiatry, Psychology, Epidemiology, Biostatistics, and Clinical and Translational Science, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, USA. 7. Department of Medicine, University of Pittsburgh, A. 140 Cooper Pavilion, 5115 Centre Avenue, Pittsburgh, PA, USA.
Abstract
PURPOSE: Adjuvant endocrine therapy (AET) utilization is linked to improved clinical outcomes among breast cancer survivors (BCS); yet, AET adherence rates remain suboptimal. Little is known about provider perspectives regarding barriers and facilitators to AET-related symptom management (SM). In this study, we examined provider perspectives on the barriers and facilitators to AET-related SM among BCS and opportunities for improvement. METHODS: We conducted three focus groups (FGs) with a multidisciplinary group of healthcare providers (n = 13) experienced in caring for BCS undergoing AET. We utilized semi-structured discussion guides to elicit provider perspectives on AET-related SM. FGs were audiotaped, transcribed, and analyzed using qualitative software to identify key themes. RESULTS: Providers described patient-, provider-, and system-level barriers and facilitators to AET-related SM. At the patient-level, barriers included competing demands, limited time/resources, and possible misattribution of some symptoms to AET, while family/social relationships and insurance emerged as important facilitators. Discomfort with SM, limited time, and challenges distinguishing AET-related symptoms from other conditions were key provider-level barriers. Provider-level facilitators included routine symptom documentation and strong provider relationships. Care fragmentation and complexity of the cancer care delivery system were described as system-level barriers; however, survivor clinics were endorsed by providers. CONCLUSIONS: Provider perspectives on AET-related SM can shed light on SM barriers and facilitators spanning multiple levels of the cancer care delivery system. Strategies for improving AET-related SM in BCS include increasing patients' knowledge and engagement in SM, equipping providers with efficient SM strategies, and improving coordination of symptom-related services through survivorship programs.
PURPOSE: Adjuvant endocrine therapy (AET) utilization is linked to improved clinical outcomes among breast cancer survivors (BCS); yet, AET adherence rates remain suboptimal. Little is known about provider perspectives regarding barriers and facilitators to AET-related symptom management (SM). In this study, we examined provider perspectives on the barriers and facilitators to AET-related SM among BCS and opportunities for improvement. METHODS: We conducted three focus groups (FGs) with a multidisciplinary group of healthcare providers (n = 13) experienced in caring for BCS undergoing AET. We utilized semi-structured discussion guides to elicit provider perspectives on AET-related SM. FGs were audiotaped, transcribed, and analyzed using qualitative software to identify key themes. RESULTS: Providers described patient-, provider-, and system-level barriers and facilitators to AET-related SM. At the patient-level, barriers included competing demands, limited time/resources, and possible misattribution of some symptoms to AET, while family/social relationships and insurance emerged as important facilitators. Discomfort with SM, limited time, and challenges distinguishing AET-related symptoms from other conditions were key provider-level barriers. Provider-level facilitators included routine symptom documentation and strong provider relationships. Care fragmentation and complexity of the cancer care delivery system were described as system-level barriers; however, survivor clinics were endorsed by providers. CONCLUSIONS: Provider perspectives on AET-related SM can shed light on SM barriers and facilitators spanning multiple levels of the cancer care delivery system. Strategies for improving AET-related SM in BCS include increasing patients' knowledge and engagement in SM, equipping providers with efficient SM strategies, and improving coordination of symptom-related services through survivorship programs.
Authors: G J van Londen; Heidi S Donovan; Ellen B Beckjord; Alexandra L Cardy; Dana H Bovbjerg; Nancy E Davidson; Jennifer Q Morse; Galen E Switzer; Irma M Verdonck-de Leeuw; Mary Amanda Dew Journal: Oncol Nurs Forum Date: 2014-11-01 Impact factor: 2.172
Authors: Kristen J Wells; Tracy A Battaglia; Donald J Dudley; Roland Garcia; Amanda Greene; Elizabeth Calhoun; Jeanne S Mandelblatt; Electra D Paskett; Peter C Raich Journal: Cancer Date: 2008-10-15 Impact factor: 6.860
Authors: Michelle van Ryn; Sean M Phelan; Neeraj K Arora; David A Haggstrom; George L Jackson; S Yousuf Zafar; Joan M Griffin; Leah L Zullig; Dawn Provenzale; Mark W Yeazel; Rahul M Jindal; Steven B Clauser Journal: J Clin Oncol Date: 2014-02-03 Impact factor: 44.544
Authors: Lorena Rocha Ayres; André de Oliveira Baldoni; Anna Paula de Sá Borges; Leonardo Régis Leira Pereira Journal: Int J Clin Pharm Date: 2013-08-11
Authors: G J van Londen; E B Beckjord; M A Dew; K L Cooper; N E Davidson; D H Bovbjerg; H S Donovan; R C Thurston; J Q Morse; S Nutt; R Rechis Journal: Support Care Cancer Date: 2013-11-24 Impact factor: 3.603
Authors: Alison Harrow; Ruth Dryden; Colin McCowan; Andrew Radley; Mark Parsons; Alastair M Thompson; Mary Wells Journal: BMJ Open Date: 2014-06-12 Impact factor: 2.692
Authors: Leah K Lambert; Lynda G Balneaves; A Fuchsia Howard; Stephen L K Chia; Carolyn C Gotay Journal: Curr Oncol Date: 2021-04-09 Impact factor: 3.677