Development and application research of the intervention program for medication compliance of endocrine therapy in breast cancer patients based on the ICAMO model.

Abstract

e24099 Background: Hormone receptor-positive breast cancer is the most common cancer among women globally. Adjuvant endocrine therapy (AET) is a key treatment that reduces the risk of recurrence and improves survival rates. However, medication adherence remains a significant challenge, influenced by multiple factors. Existing research often focuses on measuring the effectiveness of interventions but tends to overlook the contextual and mechanistic aspects that influence their success. Objective: This study aims to explore how to optimize adherence interventions for breast cancer patients undergoing AET, analyze the mechanisms and contextual factors involved, and verify the effectiveness of these interventions through clinical practice. Methods: The study uses Realist Synthesis (RS) methodology, analyzing the ICAMO model (Intervention-Context-Actors-Mechanism-Outcomes) to understand the mechanisms behind adherence interventions. Data was integrated from systematic literature reviews, expert interviews, and stakeholder feedback to identify the key mechanisms driving successful outcomes and evaluate their effectiveness in promoting AET adherence. The evidence was then translated into clinical practice through an evidence-based clinical translation model to validate the intervention’s effectiveness. Results: The findings from the RS revealed that key mechanisms for improving adherence include enhancing patient beliefs about treatment efficacy, improving symptom management, providing behavioral cues, and offering emotional and social support. Contextual interventions tailored to individual patient needs and specific circumstances were found to be more effective than generalized approach. Particularly, interventions combining psychological support and symptom management had a greater impact on long-term adherence. Clinical practice verification showed that personalized interventions and regular follow-ups significantly improved adherence. The interventions included regular medication reminders, education on side effects, psychological support, and enhancing patient self-efficacy. Continuous involvement of healthcare providers and emotional support played a critical role in improving adherence. Conclusions: The application of the ICAMO model integrates various intervention strategies into a comprehensive framework, providing a holistic solution for improving AET adherence in breast cancer patients. By focusing on the mechanisms and contextual factors influencing adherence, the implementation of personalized and multi-layered intervention strategies plays a crucial role in enhancing medication adherence, ultimately improving patient outcomes in breast cancer care. This study provides important insights for optimizing clinical practice and policy recommendations. Clinical trial information: IRB#2021-07-05.