PDF(Pubmed)
Abstract：
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).
CONCLUSIONS: The evidence-base on ET adherence determinants is extensive. Future empirical studies should focus on less well-researched areas and settings. The determinants themselves are numerous and complex in indicating that adherence support should be multifaceted, addressing multiple determinants.
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).
CONCLUSIONS: The evidence-base on ET adherence determinants is extensive. Future empirical studies should focus on less well-researched areas and settings. The determinants themselves are numerous and complex in indicating that adherence support should be multifaceted, addressing multiple determinants.
摘要：
背景：在雌激素受体阳性乳腺癌中，每日口服辅助内分泌治疗(ET)至少5年可显著降低复发风险和乳腺癌特异性死亡率.然而,许多女性对ET的依从性很差。发展有效的坚持支持需要全面了解对坚持的影响。我们进行了全面审查，以确定ET依从性的决定因素。
方法：我们搜索了PubMed，Embase,CINAHL,PsycINFO,Cochrane和PROSPERO（从08/2022开始）确定影响ET依从性的因素的系统评价。抽象的决定因素被映射到世界卫生组织的依从性维度。对评论进行了质量评估和重叠评估。
结果：在筛选的5732篇引文中，17篇评论符合条件（9篇定量主要研究；4篇定性主要研究；4篇定性或定量研究），包括215篇主要论文。所有五个WHO维度都影响ET不依从性：最一致的非依从性决定因素是患者相关因素（例如，较低的感知ET必要性，更多的治疗问题，对ET\'cons\'的看法与\'pros\')。医疗保健系统/医疗保健专业相关因素(例如，感知质量较低的健康专业互动/关系)也很重要，在较小的程度上，社会经济因素（例如，社会/经济/物质支持水平较低）。关于药物相关和病情相关因素的证据更加混杂，但其中一些可能是相关的(例如经历副作用，成本)。潜在可修改因素比不可修改/固定因素(例如患者特征)更有影响力。
结论：关于ET依从性决定因素的证据是广泛的。未来的实证研究应该集中在研究较少的领域和环境上。决定因素本身是众多而复杂的，表明坚持支持应该是多方面的，解决多个决定因素。
方法：我们搜索了PubMed，Embase,CINAHL,PsycINFO,Cochrane和PROSPERO（从08/2022开始）确定影响ET依从性的因素的系统评价。抽象的决定因素被映射到世界卫生组织的依从性维度。对评论进行了质量评估和重叠评估。
结果：在筛选的5732篇引文中，17篇评论符合条件（9篇定量主要研究；4篇定性主要研究；4篇定性或定量研究），包括215篇主要论文。所有五个WHO维度都影响ET不依从性：最一致的非依从性决定因素是患者相关因素（例如，较低的感知ET必要性，更多的治疗问题，对ET\'cons\'的看法与\'pros\')。医疗保健系统/医疗保健专业相关因素(例如，感知质量较低的健康专业互动/关系)也很重要，在较小的程度上，社会经济因素（例如，社会/经济/物质支持水平较低）。关于药物相关和病情相关因素的证据更加混杂，但其中一些可能是相关的(例如经历副作用，成本)。潜在可修改因素比不可修改/固定因素(例如患者特征)更有影响力。
结论：关于ET依从性决定因素的证据是广泛的。未来的实证研究应该集中在研究较少的领域和环境上。决定因素本身是众多而复杂的，表明坚持支持应该是多方面的，解决多个决定因素。
