Observational studyBreast (Edinburgh, Scotland)2026
Autonomous motivation and adherence intention in long-term breast cancer treatment: a self-determination theory model.
Observational study in Breast (Edinburgh, Scotland), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundNon-adherence to long-term oral therapies in breast cancer, adjuvant endocrine therapy and oral targeted therapies in metastatic disease, affects 30-50% of patients and is associated with increased recurrence risk or poorer disease control. Socio-economic and clinical determinants are well documented, but the motivational mechanisms linking them to adherence remain insufficiently modelled.
methodsCross-sectional observational study in two phases. Adult women with breast cancer treated for ≥6 months were recruited via Seintinelles (France). Phase 1 (n = 89) validated an SDT instrument. Phase 2 (n = 412) tested a structural motivational model using partial least squares structural equation modelling (PLS-SEM). An exploratory multigroup analysis compared patients with <3 vs ≥ 3 treatment lines.
resultsThe model supported a fully mediated motivational chain: social relatedness → competence → autonomy → autonomous motivation → treatment intention. Autonomous motivation was the sole significant predictor of intention (β = 0.687); controlled motivation had no significant effect (β = 0.016, ns). The oncologist's attitude was the strongest contextual predictor (β = 0.764 on social relatedness). Side effects acted indirectly, via psychological burden eroding perceived competence. In patients with ≥3 treatment lines, the effect of autonomy on autonomous motivation was stronger (β = 0.902 vs 0.653; p = 0.002).
conclusionsWhat sustains adherence is not how strongly patients are motivated, but whether their motivation is autonomous. Autonomy-supportive communication by the oncologist and proactive management of symptoms and their psychological burden emerge as the most actionable clinical levers, especially as disease burden accumulates.
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