The effect of symptom distress on medication adherence in patients with breast cancer undergoing endocrine therapy: A moderated mediation model

IF 2.4 3区医学 Q1 NURSING

Asia-Pacific Journal of Oncology Nursing Pub Date : 2025-04-15 DOI:10.1016/j.apjon.2025.100701

Huanxi Li , Chunlei Liu , Sangsang Ke , Linna Cui , Mengying Sun , Ying Bian , Yanru Song , Qian Lu

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Abstract

Objective

Poor medication adherence is common among breast cancer patients undergoing endocrine therapy. Although previous studies have shown that symptom distress, illness perception, and fear of recurrence can have a connection with medication adherence, the underlying mechanism remains unclear. This study explored the effect of symptom distress on medication adherence, the mediating role of illness perception between symptom distress and medication adherence, and the moderating role of fear of recurrence among those factors.

Methods

Symptom distress, illness perception, fear of recurrence, and medication adherence were assessed in 405 patients. A structural equation model verified the mediating role of illness perception, and a multi-cluster analysis tested the moderating role of fear of recurrence.

Results

Illness perception had a mediating effect between symptom distress and medication adherence (effect size: −0.213), accounting for 28% of the total effect. A significant difference was observed in the path coefficient of “illness perception → medication adherence” between the low and high fear of recurrence group (CR = |-3.578| > 1.96, P < 0.05). In the high fear of recurrence group, the association between symptom distress and medication adherence was mediated by illness perception, while in the low fear of recurrence group, medication adherence was only connected by symptom distress.

Conclusions

The links of symptom distress and medication adherence were mediated by illness perception, whereas fear of recurrence moderated this relationship. To improve medication adherence, oncology nurses should alleviate symptom distress and implement interventions for patients with high fear of recurrence to reduce negative illness perception.

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乳腺癌内分泌治疗患者症状困扰对药物依从性的影响：一个有调节的中介模型

目的乳腺癌内分泌治疗患者药物依从性较差。尽管先前的研究表明，症状困扰、疾病感知和对复发的恐惧可能与药物依从性有关，但其潜在机制尚不清楚。本研究旨在探讨症状困扰对药物依从性的影响，疾病知觉在症状困扰与药物依从性之间的中介作用，以及复发恐惧在这些因素中的调节作用。方法对405例患者进行症状困扰、疾病感知、复发恐惧及药物依从性评估。结构方程模型验证了疾病知觉的中介作用，多聚类分析检验了复发恐惧的调节作用。结果疾病知觉在症状困扰和药物依从性之间具有中介作用（效应量为- 0.213），占总效应的28%。低恐惧复发组与高恐惧复发组的“疾病感知→服药依从性”路径系数(CR = |-3.578| >；1.96, P <；0.05)。在高恐惧复发组中，症状困扰与药物依从性之间的关联通过疾病感知介导，而在低恐惧复发组中，药物依从性仅通过症状困扰介导。结论症状困扰与药物依从性的关系受疾病知觉的调节，而复发恐惧调节了两者之间的关系。为提高依从性，肿瘤科护士应减轻患者的症状困扰，并对复发高度恐惧的患者实施干预措施，以减少对疾病的负面认知。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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