A Mobile TXT-based Intervention to Improve Adherence to Adjuvant Hormone Therapy and Symptom Management for BCa Survivors

基于移动 TXT 的干预措施可提高 BCa 幸存者对辅助激素治疗和症状管理的依从性

基本信息

批准号：
10177879
负责人：
Kuang-Yi Wen
金额：
$ 48.39万
依托单位：
THOMAS JEFFERSON UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-06-11 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10177879
关键词：
Address Adherence Adjuvant Adopted Affective Age Behavioral Belief Breast Cancer Patient Breast Cancer survivor Breast Cancer therapy Caring Chronic Disease Clinical Cognitive Communication Cues Data Diagnosis Disease Disease Management Distress Dose Effectiveness Ethnic Origin Evaluation Family Feeling Focus Groups Fox Chase Cancer Center Fright Funding Future Goals Health Intervention Knowledge Lead Maintenance Measures Mediating Mediator of activation protein Minority Modeling Oncology Oral Outcome Participant Patient-Focused Outcomes Patients Pharmaceutical Preparations Phase Pilot Projects Population Preventive Process Provider Psychosocial Assessment and Care Race Randomized Randomized Clinical Trials Recurrence Recurrent disease Regimen Reporting Research Sampling Self Management Social support Subgroup Symptoms System Text Messaging Time Treatment Efficacy University Hospitals Wireless Technology Woman adherence rate anti-cancer base cancer recurrence cancer therapy cancer type clinical efficacy community setting compliance behavior cost effective design effective intervention efficacy evaluation efficacy testing evidence base experience family support group intervention health communication hormone receptor-positive hormone therapy improved information processing innovation intervention effect intervention participants mHealth malignant breast neoplasm medication compliance mortality negative affect novel patient oriented patient-level barriers pill post intervention prevent recruit satisfaction side effect skills social social cognitive theory success successful intervention survival outcome symptom management symptomatic improvement systematic review text messaging intervention theories therapy adherence therapy design tool treatment as usual uptake young woman

项目摘要

PROJECT SUMMARY/ABSTRACT Substantial evidence reports that adjuvant hormone therapy (AHT) decrease breast cancer (BCa) recurrence and mortality, however, rates of adherence to AHT have reported to be as low as 25%, which can lead to poor survival outcomes. Side effects from AHT can negatively affect HRQOL and are one of the most commonly cited reasons for nonadherence to AHT. Patients also reported a range of barriers to AHT adherence, including: at the cognitive level, women report negative beliefs about the efficacy of AHT, low cancer recurrence fears, and a lack of behavioral cues to prevent unintentionally missing doses. At the affective level, barriers include distress about side effects and high concerns regarding the impact of its long-term use. At the interpersonal level, low family support and poor communication with providers have been associated with AHT nonadherence. However, little is known about effective AHT adherence-promoting interventions. Guided by our team’s Cognitive-Social Health Information Processing Model and health communication best practices, an evidence-based mobile text messaging intervention (Txt2Adhere) was iteratively developed with patient- centered input and clinical and behavioral evaluation. The goal of Txt2Adhere is to address 1) cognitive barriers by increasing knowledge about AHT, reinforcing AHT benefits, and providing skills for medication uptake; 2) affective barriers by normalizing feelings and providing self-management skills to manage distress and symptoms; and 3) interpersonal barriers by enhancing women’s communication skills with families and providers. In a pilot study, Txt2Adhere participants reported significantly higher adherence to AHT at 2 months, compared with a UC group. The proposed study innovatively builds on the success of our pilot study by: 1) expanding the intervention period to six months; 2) following participants for 1 year; 3) adding a wireless smart pill bottle component; and 4) including a larger sample. For the phase 1 of the proposed study, focus groups and a behavioral scientific advisory panel review will be conducted to finalize the refinement and enhancement of Txt2Adhere. During phase 2, we will evaluate the efficacy of Txt2Adhere on a diverse group of BCa patients (N=300) in comparison with a UC group, recruited from Fox Chase Cancer Center and Temple University Hospital. A total of four assessments will be conducted: baseline, 3-months, 6-months, and 12-months (6- months post-intervention) follow-ups. Outcome and process variables include assessment of AHT adherence rate (measured by AdhereTech smart pill bottles), symptom distress, theory-based variables, intervention participant satisfaction with and usage of the intervention. We hypothesize that Txt2Adhere participants will report significantly higher levels of AHT adherence rates and lower levels of symptom distress than the UC group. We will determine if the reduction in cognitive-affective barriers mediates the effects of the intervention. We will explore if being minority, younger or older moderate the effects of the intervention. The study is significant because Txt2Adhere has the potential to reduce persistent AHT nonadherence among BCa women.