Network Modeling of Complex Time-Dependent Changes in Patient Adherence to Adjuvant Endocrine Treatment in ER+ Breast Cancer

Eileen H. Shinn, Brooke E. Busch, Neda Jasemi, Cole A. Lyman, J. Tory Toole, Spencer C. Richman, William Fraser Symmans, Mariana Chavez-MacGregor, Susan K. Peterson, Gordon Broderick

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Early patient discontinuation from adjuvant endocrine treatment (ET) is multifactorial and complex: Patients must adapt to various challenges and make the best decisions they can within changing contexts over time. Predictive models are needed that can account for the changing influence of multiple factors over time as well as decisional uncertainty due to incomplete data. AtlasTi8 analyses of longitudinal interview data from 82 estrogen receptor-positive (ER+) breast cancer patients generated a model conceptualizing patient-, patient-provider relationship, and treatment-related influences on early discontinuation. Prospective self-report data from validated psychometric measures were discretized and constrained into a decisional logic network to refine and validate the conceptual model. Minimal intervention set (MIS) optimization identified parsimonious intervention strategies that reversed discontinuation paths back to adherence. Logic network simulation produced 96 candidate decisional models which accounted for 75% of the coordinated changes in the 16 network nodes over time. Collectively the models supported 15 persistent end-states, all discontinued. The 15 end-states were characterized by median levels of general anxiety and low levels of perceived recurrence risk, quality of life (QoL) and ET side effects. MIS optimization identified 3 effective interventions: reducing general anxiety, reinforcing pill-taking routines, and increasing trust in healthcare providers. Increasing health literacy also improved adherence for patients without a college degree. Given complex regulatory networks’ intractability to end-state identification, the predictive models performed reasonably well in identifying specific discontinuation profiles and potentially effective interventions.

Original languageEnglish (US)
Article number856813
JournalFrontiers in Psychology
Volume13
DOIs
StatePublished - Jul 12 2022

Keywords

  • adherence
  • behavioral feedback network
  • computational modeling
  • forecast prediction
  • hormone receptor-positive breast cancer
  • rescue strategy

ASJC Scopus subject areas

  • General Psychology

Fingerprint

Dive into the research topics of 'Network Modeling of Complex Time-Dependent Changes in Patient Adherence to Adjuvant Endocrine Treatment in ER+ Breast Cancer'. Together they form a unique fingerprint.

Cite this