Health and Technology

, Volume 9, Issue 2, pp 175–184 | Cite as

Providers’ perspectives on adherence to hormonal therapy in breast cancer survivors. Is there a role for the digital health feedback system?

  • Alejandra Hurtado-de-MendozaEmail author
  • Mark L. Cabling
  • Asma Dilawari
  • Jeanine Warisse Turner
  • Nicole C. Fernández
  • Alesha Henderson
  • Qi Zhu
  • Sara Gómez-Trillos
  • Vanessa B. Sheppard
Original Paper


Despite the benefits of hormonal therapy (HT) adherence remains suboptimal in ER positive breast cancer patients. Medication adherence is challenging to assess and tends to be overestimated. The Digital Health Feedback System (DHFS) consists of an ingestible sensor attached to a pill that sends intake date and time to a smart phone or computer. Patients can share this information with health care providers and other persons. The DHFS can also send reminders. This mixed methods study examined providers’ perceptions of HT medication adherence. The potential role of the DHFS in enhancing medication tracking and adherence was also explored. We conducted semi-structured interviews with key informants (N = 10). Questions examined perceptions about adherence barriers and facilitators, challenges tracking adherence, and views on the DHFS. Findings informed the development of a survey that was administered online (N = 19). Providers emphasized the importance of fostering open and trustful communication around adherence. The most mentioned challenges to assessing adherence were the patient not disclosing discontinuation immediately (78.9%) and over-reporting adherence (57.9%). The perceived potential benefits of DHFS were the ability to track adherence better (94.7%) and reminders to take the medication (68.4%). Safety to ingest a sensor was a major perceived barrier (8 4.2%). Interventions that target providers and doctor-patient communication are warranted to enhance adherence and reduce communication delays around HT discontinuation. DHFS has the potential to enhance HT adherence by directly targeting barriers. Future studies should also examine the feasibility of adopting the DHFS with cancer patients.


Patient-doctor communication Hormonal therapy adherence Digital health feedback system 



The project described was supported by the National Cancer Institute (Sheppard: PI, grant number: R01CA154848). This project was also supported by the Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS) by Federal Funds, National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH), through the Clinical and Translational Science Awards Program (CTSA) (Award Numbers: KL2TR001432; PI Hurtado de Mendoza) and Georgetown University Internal Grant (‘Reflective Engagement for the Public Interest’, MPIs Sheppard and Hurtado-de-Mendoza). The content is solely responsibility of the authors and does not necessarily represent the official views of the National Center for Advancing Translational Science, the National Institute of Health.

Compliance with ethical standards

The study was approved by Georgetown University Institutional Review Board.

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures in this study have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable standards.


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Copyright information

© IUPESM and Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Alejandra Hurtado-de-Mendoza
    • 1
    Email author
  • Mark L. Cabling
    • 2
  • Asma Dilawari
    • 3
  • Jeanine Warisse Turner
    • 4
  • Nicole C. Fernández
    • 4
  • Alesha Henderson
    • 5
  • Qi Zhu
    • 1
  • Sara Gómez-Trillos
    • 1
  • Vanessa B. Sheppard
    • 5
  1. 1.Georgetown University Medical CenterWashingtonUSA
  2. 2.King’s College LondonLondonUK
  3. 3.MedStar Georgetown UniversityWashingtonUSA
  4. 4.Communication, Culture & Technology ProgramGeorgetown UniversityWashingtonUSA
  5. 5.Virginia Commonwealth UniversityRichmondUSA

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