Dr Lucy McGeagh

Objectives: As part of a wider study describing the impact of a breast cancer diagnosis on lifestyle behaviours, this paper describes the impact of a breast cancer diagnosis on alcohol consumption and factors influencing consumption.

Methods: Cross-sectional online survey of 140 people (138 women) and interviews with 21 women diagnosed with breast cancer in the last 10 years.

Results: Of the 100 survey participants who drank alcohol 25% were drinking at increasing or higher risk levels and 17% strongly wanted to change their drinking behaviour. The habitual aspects of alcohol consumption were the strongest predictor of current alcohol consumption behaviours. Social norms and perceptions about conflicting information were substantial barriers to change.

Conclusions: Breast cancer survivors need accurate information about the risks of alcohol consumption and guidelines in order to make informed decisions about making changes to their behaviour. Interventions to support breast cancer survivors to reduce alcohol consumption need to focus on the development of healthy habits and may benefit from a focus which includes partners and friends.

Aim:

To explore patients’ and community nurses’ perceptions and experiences of shared decision-making in the home.

Design:

Integrative review.

Data Sources

CINAHL, British Nursing Index, Psycinfo, Medline and Social Services Abstracts were searched for qualitative, quantitative and mixed methods papers published between 1st December 2001 and 31st October 2023.

Review Methods

A systematic search of electronic databases was undertaken using defined inclusion criteria. The included papers were appraised for quality using the Joanna Briggs Institute critical appraisal checklist for qualitative research. Relevant data was extracted and thematically analysed.

Results

14 papers comprising 13 research studies were included. Patients attached great importance to their right to be involved in decision-making and noted feeling valued as a unique individual. Communication and trust between the patient and nurse was perceived as fundamental. However, shared decision-making does not always occur in practice. Nurses described a tension in managing patients’ involvement in decision-making.

Conclusion

The findings demonstrate that although patients and community nurses appreciate participating in shared decision-making within the home, there are obstacles to achieving a collaborative process. This is especially relevant when there are fundamentally different perspectives on the decision being made. More research is needed to gain further understanding of how shared decision-making plays out in practice and to understand the tensions that patients and nurses may experience.

Implications for the profession and/or patient care

This paper argues that shared decision-making is more than the development of a relationship where the patient can express their views (though of course this is important). Shared decision-making requires acknowledgement that the patient has the right to full information and should be empowered to choose between options. Nurses should not assume that shared decision-making in community nursing is easy to facilitate and should recognise the tensions that might exist when true patient choice is enabled.

Background: In  oestrogen-  receptor  positive  breast  cancer,  daily  oral  adjuvant  endocrine therapy (ET) for at least 5 years significantly reduces risks of recurrence and breast cancer- specific mortality. However, many women are poorly adherent to  ET.  Development  of  effective  adherence  support  requires  comprehensive  understanding of influences on adherence. We undertook an umbrella review to identify determinants of ET adherence.Methods: We  searched  PubMed,  Embase,  CINAHL,  PsycINFO,  Cochrane  and  PROSPERO  (inception  to  08/2022)  to  identify  systematic  reviews  on  factors  influencing  ET  adherence.  Abstracted  determinants  were  mapped  to  the  World  Health Organization's dimensions of adherence. Reviews were quality appraised and overlap assessed.Results: Of  5732  citations  screened,  17  reviews  were  eligible  (9  quantitative  primary  studies;  4  qualitative  primary  studies;  4  qualitative  or  quantitative  studies) including 215 primary papers. All five WHO dimensions influenced ET non-  adherence:  The  most  consistently  identified  non-  adherence  determinants  were  patient-  related  factors  (e.g.  lower  perceived  ET  necessity,  more  treatment  concerns,  perceptions  of  ET  ‘cons’  vs.  ‘pros’).  Healthcare  system/healthcare  professional-  related  factors  (e.g.  perceived  lower  quality  health  professional  interaction/relationship)  were  also  important  and,  to  a  somewhat  lesser  extent,  socio-  economic  factors  (e.g.  lower  levels  of  social/economic/material  support).  Evidence  was  more  mixed  for  medication-  related  and  condition-  related  factors,  but  several  may  be  relevant  (e.g.  experiencing  side-  effects,  cost).  Potentially  modifiable  factors  are  more  influential  than  non-  modifiable/fixed  factors  (e.g.  patient characteristics).

Background: Breast cancer is the most common cancer in women worldwide. Approximately 80% of breast cancers are oestrogen receptor positive (ER+). Patients treated surgically are usually recommended adjuvant endocrine therapy (AET) for 5-10 years. AET significantly reduces recurrence, but up to 50% of women do not take it as prescribed.

Objective: To co-design and develop an intervention to support AET adherence and improve health-related quality-of-life (QoL) in women with breast cancer.

Methods:  Design and development of the HT&Me intervention took a person-based approach and was guided by the Medical Research Council framework for complex interventions, based on evidence and underpinned by theory. Literature reviews, behavioural analysis, and extensive key stakeholder involvement informed ‘guiding principles’ and the intervention logic model. Using co-design principles, a prototype intervention was developed and refined. 

Results: The blended tailored HT&Me intervention supports women to self-manage their AET. It comprises initial and follow-up consultations with a trained nurse, supported with an animation video, a web-app and ongoing motivational ‘nudge’ messages. It addresses perceptual (e.g. doubts about necessity, treatment concerns) and practical (e.g. forgetting) barriers to adherence and provides information, support and behaviour change techniques to improve QoL. Iterative patient feedback maximised feasibility, acceptability, and likelihood of maintaining adherence; health professional feedback maximised likelihood of scalability.

Conclusions: HT&Me has been systematically and rigorously developed to promote AET adherence and improve QoL, and is complemented with a logic model documenting hypothesised mechanisms of action. An ongoing feasibility trial will inform a future randomised control trial of effectiveness and cost-effectiveness.