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Development of the HT&Me intervention to support women with breast cancer to adhere to adjuvant endocrine therapy and improve quality of life

Lookup NU author(s): Dr Morven BrownORCiD, Mark Turner, Henry Cain, Professor Linda Sharp



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2023Background: Breast cancer is the most common cancer in women worldwide. Approximately 80% of breast cancers are oestrogen receptor positive (ER+). Patients treated surgically are usually recommended adjuvant endocrine therapy (AET) for 5–10 years. AET significantly reduces recurrence, but up to 50% of women do not take it as prescribed. Objective: To co-design and develop an intervention to support AET adherence and improve health-related quality-of-life (QoL) in women with breast cancer. Methods: Design and development of the HT&Me intervention took a person-based approach and was guided by the Medical Research Council framework for complex interventions, based on evidence and underpinned by theory. Literature reviews, behavioural analysis, and extensive key stakeholder involvement informed ‘guiding principles’ and the intervention logic model. Using co-design principles, a prototype intervention was developed and refined. Results: The blended tailored HT&Me intervention supports women to self-manage their AET. It comprises initial and follow-up consultations with a trained nurse, supported with an animation video, a web-app and ongoing motivational ‘nudge’ messages. It addresses perceptual (e.g. doubts about necessity, treatment concerns) and practical (e.g. forgetting) barriers to adherence and provides information, support and behaviour change techniques to improve QoL. Iterative patient feedback maximised feasibility, acceptability, and likelihood of maintaining adherence; health professional feedback maximised likelihood of scalability. Conclusions: HT&Me has been systematically and rigorously developed to promote AET adherence and improve QoL, and is complemented with a logic model documenting hypothesized mechanisms of action. An ongoing feasibility trial will inform a future randomised control trial of effectiveness and cost-effectiveness.

Publication metadata

Author(s): Stewart S-JF, Slodkowska-Barabasz J, McGeagh L, Moon Z, Brett J, Wells M, Brown MC, Turner M, Horne R, Fenlon D, Rehman F, Cain H, Donnelly P, Harmer V, Turner L, Rose J, Sharp L, Watson E, SWEET Research Team

Publication type: Article

Publication status: Published

Journal: Breast

Year: 2023

Volume: 70

Pages: 32-40

Print publication date: 01/08/2023

Online publication date: 27/05/2023

Acceptance date: 26/05/2023

Date deposited: 04/08/2023

ISSN (print): 0960-9776

ISSN (electronic): 1532-3080

Publisher: Churchill Livingstone


DOI: 10.1016/j.breast.2023.05.007

PubMed id: 37300986


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Funder referenceFunder name
National Institute for Health Research