Background: Literature consistently shows high discontinuation and non-adherence rates for patients taking endocrine therapy (ET) for breast cancer treatment. The aim of this study is to understand from the breast cancer survivor perspective which modifiable aspects have the greatest impact on the likelihood of ET continuation. Methods: Twenty-two hormone receptor-positive breast cancer survivors under age 64 who had been prescribed ET since 2000 were recruited for participation in focus groups conducted in four South Carolina locations. Qualitative data analysis was completed by a three-member team using an inductive narrative approach. Themes were examined by participant decision to continue or discontinue ET. Results: Participants’ conversations centered around a quality of life cost-benefit analysis that they felt was unique to the individual and could not be generalized by providers. Main themes included the significance of the patient/provider relationship, the desire for a more holistic approach to care, and the need for affirmation in the decision to take ET (i.e. through breast cancer social network, family, faith, research). There was clear support for the utility of multidisciplinary cancer care teams. The roles of nurse navigator and rural pharmacist were specifically highlighted. Participants expressed concerns regarding ET’s damage to their bodies, and participants discussed the dilemma of not having enough time to spend caring for self. Conclusions: The few studies that have addressed currently used interventions to improve adherence showed little to no improvement over usual care. It is imperative that research be conducted that employs a patient-centered perspective. Knowledge gained through further study exploring patient concerns, multidisciplinary teams, and holistic care are needed. There is also a need for novel patient-centered interventions in research to improve compliance and enhance the ET experience for breast cancer survivors.