Professor Parastou Donyai, Dr. Nilesh Patel and Dr. Nicola Stoner
Reading School of Pharmacy, University of Reading, Reading, RG6 6UB. UK
Background: Depending on the researchers’ epistemological position, meta-syntheses of qualitative studies have used different approaches that include grounded theory synthesis. Numerous stand-alone qualitative studies have examined non-adherence to long-term hormonal treatment in breast cancer but no qualitative synthesis on this topic existed.
Objective: To theorise about why and how women experience non-adherence to hormonal treatment in breast cancer using published qualitative reports.
Methods: Qualitative reports were retrieved using 10 databases that included PubMed, CINAHL and PsycINFO. Primary reports written in English that encompassed qualitative descriptions of women’s non-adherence to hormonal therapy in the management of breast cancer were included. In total 21 articles published 2010-2018 were included. A first order interpretation of quotes (n= 767) in these publications was first completed and then compared against the original authors’ analyses. Quotations and interpretations were reinterpreted in NVivo using open, axial and selective coding to develop new categories. Causal conditions, actions/interactions, consequences and mediating factors were then identified for each of three emerging categories using the paradigm model.
Results: Three main categories were identified describing the 1) initial consideration of hormone therapy; 2) adhering to prescribed treatment; and 3) stopping hormone therapy. The core category explored whether and where the patient’s decision to take the medication was akin to Hobson’s choice or a horned dilemma. Hobson’s choice describes a situation where only one real viable option is offered, and encapsulates the decision
faced by many at the start of the treatment. A horned dilemma in contrast is facing two equally bad options and relates to later experiences of having to tolerate medication side effects or stop the treatment and risk losing the prophylactic cover afforded by the
Discussion: It was possible to uncover a world of collectively shared experiences and understandings in this area by examining commonalities in existing published papers. The core category explained the difficulties women face with the initial decision to accept long term hormonal treatment and then the everyday challenge of continuing with the treatment or stopping it prematurely.