Anderson Janeane N, Krukowski Rebecca A, Paladino Andrew J, Graff J Carolyn, Schwartzberg Lee, Curry Andrea N, Vidal Gregory A, Jones Tameka N, Waters Teresa M, Graetz Ilana
Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
Department of Health Promotion and Disease Prevention, College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA.
J Hosp Manag Health Policy. 2021 Mar;5. doi: 10.21037/jhmhp-20-103. Epub 2021 Mar 25.
Women with hormone receptor-positive, early-stage breast cancer who adhere to adjuvant endocrine therapy (AET) reduce the risk of cancer recurrence and mortality. AET, however, is associated with adverse symptoms that often result in poor adherence. We applied participatory action research (PAR) principles to conduct focus groups and interviews to refine and enhance a web-enabled app intervention that facilitates patient-provider communication about AET-related symptoms and other barriers to adherence.
We conducted four focus groups with women with early-stage breast cancer on AET (N=28), stratified by race (Black and White) and length of time on AET (<6 months and >6 months), to determine preferences and refine the app-based intervention. A fifth mixed-race focus group was convened (N=6) to refine THRIVE app content using high-fidelity mock-ups and to develop new, tailored feedback messages. We also conducted interviews with oncology nurses (N=5) who participated in the THRIVE randomized controlled trial.
Participants reported preferences for weekly reminder messages to use the THRIVE app, a free-text option to write in AET-related symptoms, and app aesthetics. Other requested app features included: a body map for identifying pain, sleep and dental problems on the symptom list, a dashboard, tailored feedback messages, and information about social support resources. Participants also developed new intervention messages, decided which messages to keep, and edited language for appropriateness and sensitivity. They also discussed the type of electronic pill monitor and incentive plan to be used in the intervention. Nurses reported THRIVE alerts integrated seamlessly into their clinical workflow and increased patient-provider communication, facilitating quicker response to patients' reported symptoms. Nurses reported no negative feedback or usability concerns with the app.
THRIVE app content reflects researchers' partnership with a racially diverse sample of breast cancer survivors and healthcare providers and adherence to participatory design by incorporating patient-requested app features, app aesthetics, and message content. The app has the potential to improve AET adherence and quality of life among breast cancer survivors and reduce disparities in mortality rates for Black women by facilitating communication with healthcare providers.
激素受体阳性的早期乳腺癌女性坚持辅助内分泌治疗（AET）可降低癌症复发和死亡风险。然而，AET会引发不良症状，常导致依从性差。我们应用参与式行动研究（PAR）原则开展焦点小组讨论和访谈，以完善和增强一款基于网络的应用程序干预措施，该措施有助于患者与医护人员就AET相关症状及其他依从性障碍进行沟通。
我们针对接受AET的早期乳腺癌女性开展了四个焦点小组讨论（N = 28），按种族（黑人和白人）以及接受AET的时长（<6个月和>6个月）进行分层，以确定偏好并完善基于应用程序的干预措施。召开了第五个混合种族焦点小组讨论（N = 6），使用高保真模型完善THRIVE应用程序内容，并制定新的、量身定制的反馈信息。我们还对参与THRIVE随机对照试验的肿瘤学护士进行了访谈（N = 5）。
参与者表示希望每周收到使用THRIVE应用程序的提醒信息、有一个可输入AET相关症状的自由文本选项以及应用程序的美观性。其他要求的应用程序功能包括：一个用于在症状列表中识别疼痛、睡眠和牙齿问题的身体地图、一个仪表板、量身定制的反馈信息以及有关社会支持资源的信息。参与者还制定了新的干预信息，决定保留哪些信息，并编辑语言以确保恰当性和敏感性。他们还讨论了干预中使用的电子药丸监测器类型和激励计划。护士们报告说，THRIVE警报无缝集成到了他们的临床工作流程中，增加了患者与医护人员的沟通，便于更快地回应患者报告的症状。护士们对该应用程序没有负面反馈或可用性方面的担忧。
THRIVE应用程序的内容反映了研究人员与不同种族的乳腺癌幸存者及医疗保健提供者样本之间的合作关系，并且通过纳入患者要求的应用程序功能、应用程序美观性和信息内容，坚持了参与式设计。该应用程序有潜力提高乳腺癌幸存者的AET依从性和生活质量，并通过促进与医疗保健提供者的沟通来降低黑人女性的死亡率差异。
