Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management
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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.
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.
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.
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.
KeywordsSymptom management Adjuvant endocrine therapy Provider perspectives Breast cancer Survivorship care
This study was supported by the following funding sources: American Federation for Aging Research/John A. Hartford Foundation, the Magee-Women’s Research Institute and Foundation, the University of Pittsburgh Multidisciplinary Clinical Research Scholars Program–National Institutes of Health Clinical and Translational Science Award (CTSA) (grant number: 05 KL2 RR024154), the National Cancer Institute Cancer Center Support Grant (grant number: P30 CA047904), and the National Cancer Institute Award Diversity Supplement Award (grant number: 3 R01 CA150980-04S1).
Compliance with ethical standards
The University of Pittsburgh’s Institutional Review Board approved this study.
Conflict of interest
The authors declare that they have no conflict of interest.
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