Planning and Developing a Symptom Diary Intervention for Breast Cancer Survivors With Concerns About Medication Brands (ENABLE Study): User-Centered Design Approach

Sep 23, 2026

Uploaded by Mabel

Background: Approximately 80% of breast cancers are estrogen receptor positive, and after initial treatment many patients receive hormone therapy (HT) for 5–10 years. HT drugs can cause side effects, and evidence suggests that switching to generic medication brands may negatively affect side effects, attitudes, and acceptance. Objective: Explore whether a symptom diary is acceptable to patients and pharmacists, and report coproduced planning and development stages. Methods: Person-based design using forum analysis, interviews, scoping review, workshops, triangulation, and iterative stakeholder consultation. Results: Community pharmacies were preferred; diaries support awareness of drug-related symptoms and problem-solving before consultations. Conclusions: A self-monitoring diary intervention was preliminarily developed as engaging, relevant, and acceptable, with further revisions planned after ENABLE testing.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages20

Reading Time50 min

AccessFree to download

Abstract

Background

Objective

Methods

Results

Conclusions

Introduction

Breast cancer and hormone therapy adherence context

Community pharmacy and generic brand switching

JMIR CANCER Eraso et al Original Paper Planning and Developing a Symptom Diary Intervention for Breast Cancer Survivors With Concerns About Medication Brands (ENABLE Study): User-Centered Design Approach | Yolanda Eraso 1, PhD; Duncan Stewart1, PhD; Ruth Edwards2, PhD; Bal Nanray3 ; Jacqueline Cochrane4, MBPsS | | --- | | 1School of Social Sciences and Professions, London Metropolitan University, London, England, United Kingdom 2Department of Pharmacy, University ofWolverhampton, Wolverhampton, United Kingdom
3Patient representative, Essex, United Kingdom
4The Open University, Milton Keynes, England, United Kingdom
Corresponding Author:
Yolanda Eraso, PhD
School of Social Sciences and Professions London Metropolitan University
166-220 Holloway Road London, England, N7 8DB United Kingdom
Phone: 44 20 7133 2623
[Email:](Email: y.eraso@londonmet.ac.uk)[ ](Email: y.eraso@londonmet.ac.uk)[y.eraso@londonmet.ac.uk](Email: y.eraso@londonmet.ac.uk)
Abstract | Background: Approximately 80% of breast cancers are estrogen receptor positive, and following initial tumor treatment, patients are prescribed hormone therapy (HT) drugs (tamoxifen, letrozole, anastrozole, and exemestane) for 5-10 years. These drugs are known to cause several side effects. Additionally, a small number of studies have identified that changing medication brands (generics) can negatively affect patients’side effects, attitudes, and acceptance ofHT. However, no effective intervention currently exists to address patients’ concerns about generic switching. Objective: This study explores whether a symptom diary appears to be an acceptable approach for patients and pharmacists to address brand concerns, and provides a detailed report of the planning and development stages ofa coproduced diary intervention. Methods: This paper presents the studies conducted during the planning and development stages ofthe symptom diary, following the person-based approach, which combines theory-, evidence-, and person-based approaches to ensure interventions are acceptable and easy to implement. The study included the following stages: (1) the planning stage, which involved analysis of an online patient forum (n=277), interviews with patients (n=9), and interviews with pharmacists (n=7) . Data triangulation was used to present an integrated set of findings. (2) The development stage, which involved a rapid scoping review of the literature on the use of diaries among patients with cancer, coproduction workshops with patients and pharmacists (n=17), pharmacist interviews (n=11), and consultation with our patient advisory group (n=5). Analysis was informed by evidence synthesis, behavior change analyses, and iterative stakeholder consultations. Results: In the intervention planning stage, patients and pharmacists perceived community pharmacies as the ideal setting for HT medication consultations. Both groups proposed using a patient diary to support awareness and attribution of drug-related symptoms. Pharmacists described patients’ requests for specific brands as difficult to manage, whereas patients reported that switching brands undermined confidence in medication-taking. In the development stage, the scoping review (n=29 papers) identified barriers and facilitators related to diary use, and workshops explored diary format and content. These findings informed the intervention planning table and the first diary prototype. Pharmacist interviews and patient feedback informed the development of 2 further prototypes. The symptom diary is a self-monitoring tool designed to enhance self-efficacy in HT medication-taking behaviors. It includes recording side effects from brands alongside physical, psychological, and environmental factors; actions taken to manage symptoms; and problem-solving and planning before a medication consultation to facilitate personalized feedback from pharmacists. Conclusions: We preliminarily developed an intervention that appears e

FAQs

Where did participants consider the ideal setting for hormone therapy consultations?

Both patients and pharmacists perceived community pharmacies as the ideal setting for hormone therapy medication consultations, and they proposed using the diary to support symptom awareness and attribution.

Sep 23, 2026

Uploaded by Mabel