Improving medication adherence to endocrine therapy in breast cancer patients: a mixed-methods systematic review of effective communication strategies for healthcare providers
Melissa Smits, Lemonitsa H. Mammatas, Lisette Schoonhoven, Sigrid C. J. M. Vervoort
Abstract
BACKGROUND: Breast cancer is the most common cancer in women worldwide. Adjuvant endocrine therapy (AET) improves survival, but adherence often declines, increasing mortality risk. While previous research has focused on technological and educational approaches to reduce this decline, this review examines the role of effective communication in improving medication adherence in breast cancer patients AIM: This review explores key aspects of effective communication to enhance AET adherence in breast cancer patients, offering strategies for healthcare providers (HCPs) to better support patients in managing their treatment. DESIGN: A mixed-methods systematic review was conducted following the Joanna Briggs Institute (JBI) approach to qualitative synthesis, reported according to the PRISMA statement. Registered in PROSPERO (#CRD42024480202). DATA SOURCES: A search in PubMed, EMBASE, CINAHL, Psycinfo, Cochrane and Web of Science identified studies on HCP-patient communication and medication adherence in breast cancer patients using AET. The quality was assessed using JBI tools. RESULTS: Fifteen studies (one mixed-methods, five qualitative, six quantitative and three (systematic) reviews/meta-analysis) were included. Three synthesized findings were identified: 1) Content of communication (discussions on the importance and necessity of AET and adherence, AET-related side effects, and strategies to adhere to AET); 2) Process of communication (building a trusting relationship, fostering open and mutual communication, engaging patients, and aligning with patients); and 3) Contextual preconditions (time constraints and ongoing support). CONCLUSION: Effective communication between HCPs and patients is vital for improving medication adherence. Training HCPs and providing consistent support, especially from nurses, enhances patient care and quality of life.