Data Science Centre, School of Population Heath Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada.
Support Care Cancer. 2023 Mar 4;31(3):200. doi: 10.1007/s00520-023-07658-x.
To inform intervention development, we measured the modifiable determinants of endocrine therapy (ET) non-adherence in women with breast cancer, using the Theoretical Domains Framework (TDF) and examined inter-relationships between these determinants and non-adherence using the Perceptions and Practicalities Approach (PAPA).
Women with stages I-III breast cancer prescribed ET were identified from the National Cancer Registry Ireland (N = 2423) and invited to complete a questionnaire. A theoretically based model of non-adherence was developed using PAPA to examine inter-relationships between the 14 TDF domains of behaviour change and self-reported non-adherence. Structural equation modelling (SEM) was used to test the model.
A total of 1606 women participated (response rate = 66%) of whom 395 (25%) were non-adherent. The final SEM with three mediating latent variables (LVs) (PAPA Perceptions: TDF domains, Beliefs about Capabilities, Beliefs about Consequences; PAPA Practicalities: TDF domain, Memory, Attention, Decision Processes and Environment) and four independent LVs (PAPA Perceptions: Illness intrusiveness; PAPA Practicalities: TDF domains, Knowledge, Behaviour Regulation; PAPA External Factors: TDF domain, Social Identity) explained 59% of the variance in non-adherence and had an acceptable fit (χ(334) = 1002, p < 0.001; RMSEA = 0.03; CFI = 0.96 and SRMR = 0.07) Knowledge had a significant mediating effect on non-adherence through Beliefs about Consequences and Beliefs about Capabilities. Illness intrusiveness had a significant mediating effect on non-adherence through Beliefs about Consequences. Beliefs about Consequences had a significant mediating effect on non-adherence through Memory, Attention, Decision Processesg and Environment.
By underpinning future interventions, this model has the potential to improve ET adherence and, hence, reduce recurrence and improve survival in breast cancer.
为了指导干预措施的制定，我们使用理论领域框架（TDF）来衡量乳腺癌女性内分泌治疗（ET）不依从的可改变决定因素，并使用感知与实践方法（PAPA）来研究这些决定因素与不依从之间的相互关系。
从爱尔兰国家癌症登记处（N = 2423）中确定了接受 ET 治疗的 I-III 期乳腺癌女性，并邀请她们完成一份问卷。使用 PAPA 来构建一个基于理论的不依从模型，以研究行为改变的 14 个 TDF 领域与自我报告的不依从之间的相互关系。结构方程模型（SEM）用于检验模型。
共有 1606 名女性参与（应答率为 66%），其中 395 名（25%）不依从。最终的 SEM 模型包含三个中介潜在变量（PAPA 感知：TDF 领域、能力信念、后果信念；PAPA 实践：TDF 领域、记忆、注意力、决策过程和环境）和四个独立潜在变量（PAPA 感知：疾病侵扰；PAPA 实践：TDF 领域、知识、行为调节；PAPA 外部因素：TDF 领域、社会认同），解释了不依从的 59%，且具有可接受的拟合度（χ(334) = 1002，p < 0.001；RMSEA = 0.03；CFI = 0.96，SRMR = 0.07）。知识通过后果信念和能力信念对不依从有显著的中介作用。疾病侵扰通过后果信念对不依从有显著的中介作用。后果信念通过记忆、注意力、决策过程和环境对不依从有显著的中介作用。
通过为未来的干预措施提供依据，该模型有可能提高 ET 依从性，从而降低乳腺癌的复发率并提高生存率。
