{"id":{"repo_id":"umkc","oai_identifier":"oai:mospace.umsystem.edu:10355/96480"},"canonical_url":"https://search.dev.ndltd.org/etd/umkc/oai:mospace.umsystem.edu:10355/96480","repository":{"repo_id":"umkc","name":"University of Missouri - Kansas City","base_url":"https://mospace.umsystem.edu/oai/request"},"display":{"title":"The RESILIENT Study: A Retrospective, Descriptive, Correlational Investigation of Rate and Correlates of Oral Endocrine Therapy Adherence in Older Women with Breast Cancer","abstract":"Breast cancer is the most prevalent and costly cancer among females. About 80% of breast cancer patients take oral endocrine therapy (OET), such as anastrozole, letrozole, tamoxifen, and exmestane. These medications increase survival, improve quality-of-life and decrease healthcare costs, yet many patients do not take it properly. The purpose of this study is to identify rates of and multi-level determinants influencing OET non-adherence (NA) among older women with breast cancer enrolled in Medicare Part-D. It is important to consider older women with breast cancer; the medium breast cancer patient age was 62 and more than 20% of newly diagnosed patients were older than 70 in 2021. Most existing research on OET-NA has been conducted on small samples at single sites and has focused predominantly on patient issues rather than exploring multi-level determinants. Despite their unique needs due to aging effects, there are no specific guidelines or known OET-NA determinants for older women with breast cancer. To resolve this, I utilized a large data set with theoretical frameworks (World Health Organization’s five-dimensional-model of factors and Bronfenbrenner’s ecological system theory) to understand multi-level determinants through a secondary data analysis of the Surveillance-Epidemiology-End-Results Medicare database (average age 69). All women in the database with a cancer diagnosis were identified using ICD-9 and ICD-10 codes in Medicare Part-D to identify ten years of OET-NA rates. I then focused on the most recently released data from 2019 to identify up-to-date trends in OET-NA determinants. Results demonstrated that OET-NA was significantly affected by (a) patient-related factors of ethnicity and psychological issues, (b) socioeconomic-related factors of marital status, and lifestyle, (c) therapy-related factors of switching OET medications and increased number of drug therapy experiences, (d) condition-related factors of cancer stage and comorbidities, and (e) health care team/system-related factors of characteristics of healthcare team and system. The first steps in developing interventions for better nursing practice based on strong theoretical frameworks were determining rates and multi-level determinants of OET-NA on older women. This study can also support the implementation of better nursing policies to improve patient education and OET adherence— ultimately decreasing morbidity and mortality, and increasing quality-of-life.","abstract_html":"Breast cancer is the most prevalent and costly cancer among females. About 80% of breast cancer patients take oral endocrine therapy (OET), such as anastrozole, letrozole, tamoxifen, and exmestane. These medications increase survival, improve quality-of-life and decrease healthcare costs, yet many patients do not take it properly. The purpose of this study is to identify rates of and multi-level determinants influencing OET non-adherence (NA) among older women with breast cancer enrolled in Medicare Part-D. It is important to consider older women with breast cancer; the medium breast cancer patient age was 62 and more than 20% of newly diagnosed patients were older than 70 in 2021. Most existing research on OET-NA has been conducted on small samples at single sites and has focused predominantly on patient issues rather than exploring multi-level determinants. Despite their unique needs due to aging effects, there are no specific guidelines or known OET-NA determinants for older women with breast cancer. To resolve this, I utilized a large data set with theoretical frameworks (World Health Organization’s five-dimensional-model of factors and Bronfenbrenner’s ecological system theory) to understand multi-level determinants through a secondary data analysis of the Surveillance-Epidemiology-End-Results Medicare database (average age 69). All women in the database with a cancer diagnosis were identified using ICD-9 and ICD-10 codes in Medicare Part-D to identify ten years of OET-NA rates. I then focused on the most recently released data from 2019 to identify up-to-date trends in OET-NA determinants. Results demonstrated that OET-NA was significantly affected by (a) patient-related factors of ethnicity and psychological issues, (b) socioeconomic-related factors of marital status, and lifestyle, (c) therapy-related factors of switching OET medications and increased number of drug therapy experiences, (d) condition-related factors of cancer stage and comorbidities, and (e) health care team/system-related factors of characteristics of healthcare team and system. The first steps in developing interventions for better nursing practice based on strong theoretical frameworks were determining rates and multi-level determinants of OET-NA on older women. This study can also support the implementation of better nursing policies to improve patient education and OET adherence— ultimately decreasing morbidity and mortality, and increasing quality-of-life.","abstract_has_math":false,"creators":["Ruggeri, Sunny Yoo"],"institution":"University of Missouri--Kansas City","degree_name":"Ph.D. (Doctor of Philosophy)","degree_level":"Doctoral","degree_discipline":"Nursing (UMKC)","degree_department":null,"school":null,"contributors":[],"advisors":["Russell, Cynthia L."],"committee_chairs":[],"committee_members":[],"year":2023,"date_issued":"2023","date_published":"2023","updated_at":"2026-07-24T05:16:57Z","subjects":[],"languages":[],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://hdl.handle.net/10355/96480","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.advisor","label":"Advisor","values":["Russell, Cynthia L."]},{"key":"dc:creator","label":"Author","values":["Ruggeri, Sunny Yoo"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2023-08-22T16:18:54Z"]},{"key":"dc:date.available","label":"Dc Date Available","values":["2023-08-22T16:18:54Z"]},{"key":"dc:date.issued","label":"Date","values":["2023"]},{"key":"thesis:degree_discipline","label":"Discipline","values":["Nursing (UMKC)"]},{"key":"thesis:degree_level","label":"Degree Level","values":["Doctoral"]},{"key":"thesis:degree_name","label":"Degree Name","values":["Ph.D. (Doctor of Philosophy)"]},{"key":"thesis:institution_name","label":"Thesis Institution Name","values":["University of Missouri--Kansas City"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["https://hdl.handle.net/10355/96480"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["Title from PDF of title page, viewed September 18, 2023","Dissertation advisor: Cynthia L. Russell","Vita","Includes bibliographical references (pages 225-273)","Dissertation (Ph.D.)--School of Nursing and Health Studies. University of Missouri--Kansas City, 2023"]},{"key":"dc:description.abstract","label":"Abstract","values":["Breast cancer is the most prevalent and costly cancer among females. About 80% of breast cancer patients take oral endocrine therapy (OET), such as anastrozole, letrozole, tamoxifen, and exmestane. These medications increase survival, improve quality-of-life and decrease healthcare costs, yet many patients do not take it properly. The purpose of this study is to identify rates of and multi-level determinants influencing OET non-adherence (NA) among older women with breast cancer enrolled in Medicare Part-D. It is important to consider older women with breast cancer; the medium breast cancer patient age was 62 and more than 20% of newly diagnosed patients were older than 70 in 2021. Most existing research on OET-NA has been conducted on small samples at single sites and has focused predominantly on patient issues rather than exploring multi-level determinants. Despite their unique needs due to aging effects, there are no specific guidelines or known OET-NA determinants for older women with breast cancer. To resolve this, I utilized a large data set with theoretical frameworks (World Health Organization’s five-dimensional-model of factors and Bronfenbrenner’s ecological system theory) to understand multi-level determinants through a secondary data analysis of the Surveillance-Epidemiology-End-Results Medicare database (average age 69). All women in the database with a cancer diagnosis were identified using ICD-9 and ICD-10 codes in Medicare Part-D to identify ten years of OET-NA rates. I then focused on the most recently released data from 2019 to identify up-to-date trends in OET-NA determinants. Results demonstrated that OET-NA was significantly affected by (a) patient-related factors of ethnicity and psychological issues, (b) socioeconomic-related factors of marital status, and lifestyle, (c) therapy-related factors of switching OET medications and increased number of drug therapy experiences, (d) condition-related factors of cancer stage and comorbidities, and (e) health care team/system-related factors of characteristics of healthcare team and system. The first steps in developing interventions for better nursing practice based on strong theoretical frameworks were determining rates and multi-level determinants of OET-NA on older women. This study can also support the implementation of better nursing policies to improve patient education and OET adherence— ultimately decreasing morbidity and mortality, and increasing quality-of-life."]},{"key":"dc:title","label":"Title","values":["The RESILIENT Study: A Retrospective, Descriptive, Correlational Investigation of Rate and Correlates of Oral Endocrine Therapy Adherence in Older Women with Breast Cancer"]}]}],"canonical_facts":{"dc:contributor.advisor":["Russell, Cynthia L."],"dc:creator":["Ruggeri, Sunny Yoo"],"dc:date.accessioned":["2023-08-22T16:18:54Z"],"dc:date.available":["2023-08-22T16:18:54Z"],"dc:date.issued":["2023"],"dc:description":["Title from PDF of title page, viewed September 18, 2023","Dissertation advisor: Cynthia L. Russell","Vita","Includes bibliographical references (pages 225-273)","Dissertation (Ph.D.)--School of Nursing and Health Studies. University of Missouri--Kansas City, 2023"],"dc:description.abstract":["Breast cancer is the most prevalent and costly cancer among females. About 80% of breast cancer patients take oral endocrine therapy (OET), such as anastrozole, letrozole, tamoxifen, and exmestane. These medications increase survival, improve quality-of-life and decrease healthcare costs, yet many patients do not take it properly. The purpose of this study is to identify rates of and multi-level determinants influencing OET non-adherence (NA) among older women with breast cancer enrolled in Medicare Part-D. It is important to consider older women with breast cancer; the medium breast cancer patient age was 62 and more than 20% of newly diagnosed patients were older than 70 in 2021. Most existing research on OET-NA has been conducted on small samples at single sites and has focused predominantly on patient issues rather than exploring multi-level determinants. Despite their unique needs due to aging effects, there are no specific guidelines or known OET-NA determinants for older women with breast cancer. To resolve this, I utilized a large data set with theoretical frameworks (World Health Organization’s five-dimensional-model of factors and Bronfenbrenner’s ecological system theory) to understand multi-level determinants through a secondary data analysis of the Surveillance-Epidemiology-End-Results Medicare database (average age 69). All women in the database with a cancer diagnosis were identified using ICD-9 and ICD-10 codes in Medicare Part-D to identify ten years of OET-NA rates. I then focused on the most recently released data from 2019 to identify up-to-date trends in OET-NA determinants. Results demonstrated that OET-NA was significantly affected by (a) patient-related factors of ethnicity and psychological issues, (b) socioeconomic-related factors of marital status, and lifestyle, (c) therapy-related factors of switching OET medications and increased number of drug therapy experiences, (d) condition-related factors of cancer stage and comorbidities, and (e) health care team/system-related factors of characteristics of healthcare team and system. The first steps in developing interventions for better nursing practice based on strong theoretical frameworks were determining rates and multi-level determinants of OET-NA on older women. This study can also support the implementation of better nursing policies to improve patient education and OET adherence— ultimately decreasing morbidity and mortality, and increasing quality-of-life."],"dc:identifier.uri":["https://hdl.handle.net/10355/96480"],"dc:title":["The RESILIENT Study: A Retrospective, Descriptive, Correlational Investigation of Rate and Correlates of Oral Endocrine Therapy Adherence in Older Women with Breast Cancer"],"thesis:degree_discipline":["Nursing (UMKC)"],"thesis:degree_level":["Doctoral"],"thesis:degree_name":["Ph.D. (Doctor of Philosophy)"],"thesis:institution_name":["University of Missouri--Kansas City"]},"updated_at":"2026-07-24T05:16:57Z"}