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01-12-2017 | Original Article

Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management

Authors: Cleo A. Samuel, Kea Turner, Heidi A. S. Donovan, Ellen Beckjord, Alexandra Cardy, Mary Amanda Dew, G. J. van Londen

Published in: Supportive Care in Cancer | Issue 12/2017

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.

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Turner K, Samuel CA, Donovan HA, Beckjord E, Cardy A, Dew MA, van Londen GJ (2016) Provider perspectives on patient-provider communication for adjuvant endocrine therapy symptom management. Support Care Cancer 25(4):1055-1061. doi:10.1007/s00520-016-3491-9

Title: Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management
Authors: Cleo A. Samuel
Kea Turner
Heidi A. S. Donovan
Ellen Beckjord
Alexandra Cardy
Mary Amanda Dew
G. J. van Londen
Publication date: 01-12-2017
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 12/2017
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-017-3799-0

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