The Attitudes, Communication, Treatment, and Support Intervention to Reduce Breast Cancer Treatment Disparity

Purpose/Objectives: To test the effect of a supportive, one-time psychoeducational intervention on treatment adherence among African American women receiving first adjuvant therapy for breast cancer.

Design: A pilot, randomized, controlled clinical trial, two-group design, with one-time intervention and four data collection points.

Setting: Two University of Pittsburgh Cancer Institute clinics.

Sample: 24 African American women.

Methods: The Attitudes, Communication, Treatment, and Support (ACTS) intervention is a 45-minute one-on-one session with an African American woman recommended to have chemotherapy for breast cancer. The interventionist is an African American breast cancer survivor. The intervention consists of a discussion about chemotherapy and the importance of communicating knowledge needs and distress, an explanation of the specific treatment plan according to pathology, and support through the survivor testimonial and video clips from the African American community.

Main Research Variables: Dose of chemotherapy received and dose of chemotherapy prescribed.

Findings: Twenty patients completed chemotherapy, and four chose not to begin or discontinued recommended chemotherapy. The groups were equal in key sociodemographic variables. Compared to usual care, the ACTS intervention participants demonstrated trends toward initiation of chemotherapy (100% versus 82%), overall adherence to chemotherapy (92% versus 73%), and percentage of total dose of chemotherapy received or prescribed (94% versus 74%). Compared to usual care, the ACTS intervention participants demonstrated more rapid initiation of chemotherapy and better overall adherence to chemotherapy.

Conclusions: The pilot ACTS intervention shows promise as a psychoeducational intervention to assist with chemotherapy decision making among African American women.

Implications for Nursing: African American women are at high risk of not receiving the full dose of prescribed chemotherapy for breast cancer for multiple reasons. Nurses must be sensitive to the unique fears and concerns of this population regarding chemotherapy decisions. An intervention addressing these fears and concerns may help to increase adherence.