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Oral Endocrine Therapy Nonadherence, Adverse Effects, Decisional Support, and Decisional Needs in Women With Breast Cancer

Milata, Jennifer, L., MSN, RN; Otte, Julie, L., PhD, RN, OCN; Carpenter, Janet, S., PhD, RN, FAAN

doi: 10.1097/NCC.0000000000000430

Background: Oral endocrine therapy (OET) such as tamoxifen or aromatase inhibitors reduces recurrence and mortality for the 75% of breast cancer survivors (BCSs) with a diagnosis of estrogen receptor–positive breast cancer. Because many BCSs decide not take OET as recommended because of adverse effects, understanding BCSs’ decisional supports and needs is foundational to supporting quality OET decision making about whether to adhere to OET.

Objective: The aim of this study was to examine literature pertaining to OET nonadherence and adverse effects using the Ottawa Decision Support Framework categories of decisional supports and decisional needs because these factors potentially influence OET use.

Methods: A systematic literature search was performed in PubMed and CINAHL using combined search terms “aromatase inhibitors and adherence” and “tamoxifen and adherence.” Studies that did not meet criteria were excluded. Relevant data from 25 publications were extracted into tables and reviewed by 2 authors.

Results: Findings identified the impact of adverse effects on OET nonadherence, an absence of decisional supports provided to or available for BCSs who are experiencing OET adverse effects, and the likelihood of unmet decisional needs related to OET.

Conclusions: Adverse effects contribute to BCSs decisions to stop OET, yet there has been little investigation of the process through which that occurs. This review serves as a call to action for providers to provide support to BCSs experiencing OET adverse effects and facing decisions related to nonadherence.

Implications for Practice: Findings suggest BCSs prescribed OET have unmet decisional needs, and more decisional supports are needed for BCSs experiencing OET adverse effects.

Author Affiliations: Department of Science of Nursing Care, Indiana University School of Nursing, Indianapolis.

This project was supported by the Agency for Healthcare Research and Quality (grant R36HS024241 to Jennifer L. Milata [principal investigator]), the National Institute of Nursing Research (grant 2T32 NR007066 to Rawl, principal investigator), a research doctorate scholarship from the Oncology Nursing Society Foundation, and research incentive funding from the Indiana University School of Nursing.

The authors have no conflicts of interest to disclose.

The content is solely the responsibility of the author and does not necessarily represent the official views of the Agency for Healthcare Research and Quality or of the National Institute of Nursing Research.

Correspondence: Jennifer L. Milata, MSN, RN, Indiana University School of Nursing, 1111 Middle Dr, NU 338, Indianapolis, IN 46202 (

Accepted for publication May 22, 2016.

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