Uptake of breast cancer preventive therapy in the UK: results from a multicentre prospective survey and qualitative interviews

Purpose: Uptake of preventive therapy for women at increased breast cancer risk in England is unknown following the introduction of UK clinical guidelines in 2013. Preventive therapy could create socioeconomic inequalities in cancer incidence if it is more readily accepted by particular socio-demographic groups. In this multicentre study, we investigated uptake of tamoxifen and evaluated socio-demographic and clinical factors associated with initiation. We explored women’s experiences of treatment decision-making using qualitative interview data. Methods: Between September 2015 and December 2016, women (n=732) attending an appointment at one of 20 centres in England to discuss breast cancer risk were approached to complete a survey containing socio-demographic details and nulliparity. Of the baseline survey respondents (n=408/732, 55.7% response rate), self-reported uptake of tamoxifen at 3-month follow-up was reported in 258 (63.2%). Sixteen women participated in semi-structured interviews. Results: One in seven (38/258=14.7%) women initiated tamoxifen. Women who had children were more likely to report use of tamoxifen than those without children (OR=5.26; 95%CI: 1.13–24.49, p=0.035). Interview data suggested that women weigh up risks and benefits of tamoxifen within the context of familial commitments, with exposure to significant other’s beliefs and experiences of cancer and medication a basis for their decision. Conclusions: Uptake of tamoxifen is low in clinical practice. There were no socio-demographic differences in uptake, suggesting that the introduction of breast cancer preventive therapy is unlikely to create socioeconomic inequalities in cancer incidence. Women’s decision-making was influenced by familial priorities, particularly having children

Beliefs About Medication and Uptake of Preventive Therapy in Women at Increased Risk of Breast Cancer: Results From a Multicenter Prospective Study

Introduction Uptake of preventive therapies for breast cancer is low. We examined whether women at increased risk of breast cancer can be categorized into groups with similar medication beliefs, and whether belief group membership was prospectively associated with uptake of preventive therapy. Patients and Methods Women (n = 732) attending an appointment to discuss breast cancer risk were approached; 408 (55.7%) completed the Beliefs About Medicines and the Perceived Sensitivity to Medicines questionnaires. Uptake of tamoxifen at 3 months was reported in 258 (63.2%). The optimal number of belief groups were identified using latent profile analysis. Results Uptake of tamoxifen was 14.7% (38/258). One in 5 women (19.4%; 78/402) reported a strong need for tamoxifen. The model fit statistics supported a 2-group model. Both groups held weak beliefs about their need for tamoxifen for current and future health. Group 2 (38%; 154/406 of the sample) reported stronger concerns about tamoxifen and medicines in general, and stronger perceived sensitivity to the negative effects of medicines compared with group 1 (62%; 252/406). Women with low necessity and lower concerns (group 1) were more likely to initiate tamoxifen (18.3%; 33/180) than those with low necessity and higher concerns (group 2) (6.4%; 5/78). After adjusting for demographic and clinical factors, the odds ratio was 3.37 (95% confidence interval, 1.08-10.51; P = .036). Conclusion Uptake of breast cancer preventive therapy was low. A subgroup of women reported low need for preventive therapy and strong medication concerns. These women were less likely to initiate tamoxifen. Medication beliefs are targets for supporting informed decision-making

Development and evaluation of the IMPACT programme patient resources to increase understanding of psoriasis and its management: a mixed-methods feasibility study

Psoriasis is a complex skin condition associated with comorbidities, unhealthy lifestyle behaviours and psychological distress. Patients’ understanding of psoriasis is low and self-management is often challenging. The Common-Sense Self-Regulatory Model (CS-SRM) of Health and Illness emphasizes the role an individual’s illness/treatment beliefs play in coping and self-management. A set of new patient resources (Pso Well�; Psoriasis and Wellbeing) informed by the CS-SRM addressed psoriasis as a long-term condition, along with medication management and lifestyle behaviours. This study investigated whether these resources (i) can broaden understanding of psoriasis and its comorbidities without increasing anxiety; (ii) are acceptable/ usable; and (iii) help patients to identify putative mechanisms of change following exposure to specific content. Pso Well� patient resources were designed in iterative phases by theorymapping concepts to components of the CS-SRM and modifying content/design following extensive collaboration with clinicians and patients. Resources were evaluated in a primary-care-based cohort of patients with psoriasis. Psoriasis severity was assessed with the Simplified Psoriasis Index (SPI-s) at baseline. The Revised Illness Perceptions Questionnaire (IPQ-R modified for psoriasis) and the Hospital Anxiety and Depression Scale (HADS) were administered pre- and postexposure to the new resources. Visual analogue scales (VASs) assessed patients’ perceptions of change in understanding and anxiety. In-depth qualitative interviews using principles of framework analysis with a purposively sampled subset of participants explored the acceptability, usability and perceived active ingredients of the resources. Fifty-five patients completed the pre- and postintervention questionnaires (56% female; mean age 58 years; SPI-s severity: 87% mild, 9% moderate, 4% severe). Postexposure, a large effect size was indicated in two domains of the IPQ-R: illness coherence [t(55) = �3�48, P < 0�01 (two-tailed), eta2 = 0�19) and personal control [t(55) = �2�98, P < 0�01 (two-tailed), eta2 = 0�14]; and a medium effect size in one domain: treatment control [t(55) = �2�08, P = 0�04 (twotailed), eta2 = 0�08]. Neither anxiety nor depression scores increased for HADS. For VAS scores, 80% of participants reported that their understanding of psoriasis had increased and 16% reported feeling less anxious. Interviews with 19 patients indicated that the new resources were acceptable and usable. Components of the materials perceived to promote change were relevance of content, coherent linking of disease aspects, trustworthiness, design values and ease of reading. This feasibility study suggests that carefully designed, theory-based, written psoriasis resources are acceptable to patients and can improve understanding, coherence and sense of control of their disease without corresponding increases in anxiety