Theory guided integrative systematic review of the psychosocial determinants associated with non-adherence to adjuvant hormonal therapy among breast cancer population

Abstract

BACKGROUND: Suboptimal adherence to 5 years adjuvant hormonal therapy (AHT) is prevalent among people with breast cancer. Non-adherence to prescribed AHT medication is linked to increased recurrence rates, lower survival rates and wasted healthcare resources. Targeting the modifiable psychosocial factors has been heralded as a means to improve the phenomenon of suboptimal medication-taking behaviour. This thesis aims to conduct a theory-guided integrative systematic review to identify (I) psychosocial factors that are associated with treatment initiation, adherence, persistence and premature discontinuation, (II) modifiable barriers and facilitators of medication-taking behaviour and (III) intervention strategies that can be used to target the psychosocial barriers. METHOD: This integrative review follows PRISMA-P guidance and the review protocol was registered in PROSPERO (CRD42018102035). Systematic searches were conducted in 7 databases (MEDLINE, EMBASE, Web of Science Cochrane Library, CENTRAL, PsycINFO, PsycARTICLE and CINAHL). Only studies that addressed the following are eligible for inclusion: (I) examined associations between cognitive, behavioural, emotional, or social factors with non-initiation, non-adherence, non-persistence or discontinuation (II) published from 1998- 2018 papers and (III) study population that have clinically diagnosed breast cancer patient groups. Mixed Methods Appraisal Tool (version 2018) was used to access the quality of the included evidence. The Behaviour Change Wheel (BCW), made up of an inner layer of Theoretical Domains Framework (TDF), middle layer of Capabilities, Opportunities, Motivation and Behaviour (COM-B), and circled by a layer of intervention functions, was used to structure the design and analysis of the three research questions. TDF was used to frame the behavioural subgroup analysis, anchor the results, COM-B model and intervention functions were subsequently used to map the identified barriers with the intervention options and solution. RESULT: Of the 1229 papers screened, 58 articles (43 quantitative studies, 13 qualitative studies and 2 mixed method studies) were included and analyzed. TDF collated the key psychosocial factors from the included studies into 11 domains (Knowledge; Skills; Beliefs about capabilities; Beliefs about Consequences; Reinforcement; Intention and goals, Memory, attention and decision process; Environmental contexts and resources; Social Influences; Emotion; and Behavioural regulation). In conformity with the TDF result, COM- B model has identified the psychological capabilities (knowledge of side effects, memory, decision making), reflective motivation (perceptions and expectations, behavioural barriers), automatic motivation (intention, negative emotion), physical opportunity (resources) and social opportunity (clinical support) as the modifiable components. Based on the collective findings of the TDF and COM-B model, 4 intervention functions (Education, Persuasion, Training, Enablement) were matched into the relative components. CONCLUSION: This review is novel as it proposes a multilayer psychological understanding of nonadherence behaviour and provides a thorough overview of the behaviour change techniques that help to formulate future interventions. The cornerstone to improving optimal medication-taking behaviour is to educate patients on the knowledge of side effects seek to adjust the patients’ psychological adaptation and provide communication skills training among healthcare providers. These results are pertinent to healthcare providers, researchers and stakeholders who are likely to initiate interventions