Development and refinement of a nurse-led, culturally sensitive intervention for adjuvant endocrine therapy initiation among patients with breast cancer

Adjuvant endocrine therapy (AET) is a critical component of hormone receptor-positive (HR+) breast cancer treatment, yet many patients do not start these medications. Patients from racial or ethnic minority communities are less likely to initiate AET and are at greater risk for poor breast cancer outcomes. Interventions are needed to increase AET initiation. The purpose of this study was to adapt an existing AET adherence intervention to enhance cultural sensitivity and target specific barriers that patients from minority communities are likely to experience.

From 8/2021-6/2022, we developed a brief, behavioral, and culturally sensitive intervention by following two adaptation frameworks: the ADAPT Guidance and the Typology of Adaptation Model. Within these frameworks, we conducted a qualitative study using semi-structured interviews to understand the barriers and facilitators to AET initiation and intervention preferences in a diverse sample of patient stakeholders with HR + breast cancer (N = 10).

The finalized intervention ("INITIATE") includes two evidence-based, nurse-led telehealth sessions delivered in the weeks preceding a patient's planned AET start date. Culturally sensitive content includes diverse representation in patient materials and vignettes, tailored psychoeducation regarding AET non-initiation and breast cancer disparities, and the translation and delivery of INITIATE in both English and Spanish.

Tailoring an existing intervention to address culturally relevant barriers to AET initiation is a crucial step in optimizing patient engagement, improving breast cancer outcomes, and reducing breast cancer disparities. We are currently conducting a pilot study to evaluate the feasibility and acceptability of the INITIATE intervention. Clinical Trials Registration # (INITIATE pilot study) - NCT05465408.