Refining and optimising a behavioural intervention to support endocrine therapy adherence (ROSETA) in UK women with breast cancer : protocol for a pilot fractional factorial trial

Smith, Samuel G and Green, Sophie M C and Ellison, Rachel and Foy, Robbie and Graham, Christopher D and Mason, Ellen and French, David P and Hall, Louise H and Wilkes, Hollie and McNaught, Emma and Raine, Erin and Walwyn, Rebecca and Howdon, Daniel and Clark, Jane and Rousseau, Nikki and Buxton, Jacqueline and Moore, Sally J.L. and Parbutt, Catherine and Velikova, Galina and Farrin, Amanda and Collinson, Michelle (2023) Refining and optimising a behavioural intervention to support endocrine therapy adherence (ROSETA) in UK women with breast cancer : protocol for a pilot fractional factorial trial. BMJ open, 13 (2). e069971. ISSN 2044-6055 (

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Introduction Women with breast cancer who do not adhere to adjuvant endocrine therapy (AET) have increased risks of mortality and recurrence. There are multiple barriers to AET adherence, including medication side-effects, beliefs about medication, memory and psychological distress. We developed four intervention components, each targeting a different barrier. This pilot trial is part of the preparation phase of the Multiphase Optimisation Strategy, and aims to establish key trial parameters, establish intervention component adherence, establish availability and feasibility of outcome and process data, estimate variability in planned outcome measures and estimate cost of developing and delivering each intervention component. Methods and analysis The four intervention components are as follows: short message service text reminders (target: memory); a written information leaflet (target: medication beliefs); a guided self-help Acceptance and Commitment Therapy programme (target: psychological flexibility to reduce distress) and a self-management website (target: side-effect management). To evaluate the feasibility of recruitment, acceptability of the intervention components and the availability of outcome data, we will conduct a multisite, exploratory pilot trial using a 2 4-1 fractional factorial design, with a nested process evaluation. We will randomise 80 women with early-stage breast cancer who have been prescribed AET to one of eight experimental conditions. This will determine the combination of intervention components they receive, ranging from zero to four, with all conditions receiving usual care. Key outcomes of interest include medication adherence and quality of life. Progression to the optimisation phase will be based on predefined criteria for consent rates, patient adherence to intervention components and availability of medication adherence data. Ethics and dissemination The study was reviewed by the Wales Research Authority Research Ethics Committee 3 (21/WA/0322). Written informed consent will be obtained from all patients before randomisation. The results of this trial will be disseminated in a peer-reviewed journal. Trial registration number ISRTCN10487576.