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Eraso, Yolanda, Stewart, Duncan, Edwards, Ruth, Nanray, Balwinder and Cochrane, Jacqueline (2026) Medication brand changes in hormone therapy for breast cancer: a community pharmacy intervention development to improve patients’ adherence and quality of life: ENABLE. Project Report. National Institute for Health and Care Research, Leeds. (Submitted)
BACKGROUND
Hormone therapy (HT) drugs to prevent breast cancer (BC) recurrence are known to cause several side-effects, and switching HT generic drugs can have a negative impact on treatment acceptance, adherence and quality of life. The aim of the study was to co-produce with BC patients and pharmacists an intervention to improve medication brand change consultations in community pharmacies.
Objectives were to:
1. Co-develop intervention content (symptom diary and pharmacist’s consultation skills) with patients and pharmacists;
2. Design an e-learning resource to upskill pharmacist in HT consultations;
3. Explore with pharmacists (professional bodies and community) barriers and facilitators of intervention implementation;
4. Test and assess patient and pharmacist’s engagement and acceptability of the intervention;
5. Integrate feedback for intervention refinement.
METHODS
A multi-methods study, using co-production and the Person-Based Approach. ISRCTN15089342.
1. A rapid scoping review on diary interventions in cancer survivors.
2. Two co-production workshops with BC patients and pharmacists to design a patient Symptom Diary, an e-learning package, and a Medication Consultation Guide [MCG].
3. Testing the e-learning package with pharmacists and interviews.
4. Pharmacist interviews to explore barriers and facilitators for ENABLE implementation.
5. Testing the intervention in 5 community pharmacies in North London, including interviews with participants to optimise design.
KEY FINDINGS
The scoping review (29 articles) identified evidence of diary use in cancer survivors as improving self-management and healthcare professional communication, alongside diary engagement and acceptability. Workshop participants (n=31) identified the usefulness of journaling symptoms as ‘evidence’ and ‘reflection’, and as 'pharmacist's awareness' of brand-side effects, relevance of pharmacist feedback, and communication skills. Pharmacist interviews (n=11) confirmed the value of diary use and confidence in pharmacists’ skills for HT consultations, although time constraints were a concern. Pharmacists feedback post e-learning testing (n=9) indicated greater appreciation of the ‘patient journey’ and how the MCG can engage patients beyond discussions of brand accessibility. Most envisioned implementation as improving medication adherence. Pharmacists (4) and patients (14) tested the intervention. Diary data showed high levels of completion (79%). All patients would recommend the diary to others with brand concerns. The majority (77%) found the diary helpful and were satisfied with the consultation (85%). Pharmacists’ perceived benefits were agreed plans with patients during consultations, improved practice changes to patients’ brand requests, and MCG use. Participants considered ENABLE as filling a gap in service provision.
OUTPUTS, IMPACT AND DISSEMINATION
Publications (under review and planned) include the development of intervention components and optimisation study. Impact: raising awareness about HT brand changes; pharmacists' improved consultation management, and patient satisfaction. Dissemination: ENABLE website; sharing findings with participants; workshops discussing findings and future plans with patient groups and stakeholders; academic presentations.
CONCLUSIONS
This is the first intervention addressing BC patients’ concerns with HT medication brand changes. ENABLE was co-produced by 113 contributions from a diverse group of individuals, grounded in behavioural and context analysis. Patients and pharmacists were highly satisfied with the consultation outcomes, making it potentially beneficial for improving adherence and quality of life. The findings have been shown to be suitable for further exploration in a feasibility study.
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NIHR206589-Final Report-11_05_2026 10_36_18.pdf - Accepted Version
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