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FEATURE ARTICLE Downloaded on 08 12 2017. Single-user license only. Copyright 2017 by the Oncology Nursing Society. For permission to post online, reprint, adapt, or reuse, please email [email protected] This material is protected by U.S. copyright law. Unauthorized reproduction is prohibited. To purchase reprints or request permission to reproduce, e-mail [email protected]. Patient Education: The Cornerstone of Successful Oral Chemotherapy Treatment Kristine Hartigan, RN, BA, OCN ® he number of patients sis found that actual compliance receiving oral chemoBecause patients with cancer self-administer oral chemowas less than half that suggested therapy agents and the by patients’ self-reports. Howtherapy, they typically do not receive the same amount of intensity of these agents are preever, the researchers also found teaching and monitoring as patients receiving IV chemodicted to increase in the near futhat measures designed to intherapy. Patient education is vital to promote patient ture. Oral chemotherapy offers crease compliance, including many potential advantages, such patient education, home psychosafety, optimal dosing, and adherence to the treatment as patient convenience, eliminalogical support, and exercises in plan. Oncology nurses need to tailor their patient education of the need for IV access, pill taking, were able to increase tion efforts to the individual needs of each patient and and the ability to achieve suscompliance nearly threefold use resources such as medication information sheets to tained drug levels. One draw(Levine et al.). back, however, is the likelihood Measuring compliance is reinforce teaching. This article reviews the process of that oral chemotherapy treatment challenging at best. Pill counts teaching patients about oral chemotherapy and disdistances patients from their can be unreliable because pacusses the unique patient education challenges associhealthcare providers and, theretients can manipulate them, fore, changes the way patients ated with orally administered chemotherapy. especially when they know their are monitored. Opportunities for pills will be counted. Also, pill Key Words: Patient education, patient compliance, self professional assessment may be counts do not confirm adherence fewer and farther between than care to a particular dosing schedule. assessments of patients who reThe microelectronic monitoring been described in the literature and the in- system (MEMS) is a newer method to asceive IV chemotherapy (Birner, 2003). Patient education, therefore, becomes the formation can be used to guide the teaching sess compliance. The system uses an cornerstone of successful oral chemotherapy of patients receiving oral chemotherapy. “intelligent” tablet bottle that electronically Clinicians generally assume that patients records the date and time (to the nearest treatment. Effective patient teaching about oral chemotherapy promotes patient safety, are taking medications as prescribed and be- hour) when the cap is removed. Data are coloptimal dosing, adherence to the treatment lieve their patients when they say they are lected for up to several weeks, recorded, and plan, accurate assessment of side effects and doing so (Partridge, Avorn, Wang, & Winer, processed by a computer to generate a list toxicities, and implementation of self-care 2002). In chronic medical conditions, such of the dates and times of bottle openings and as diabetes and hypertension, estimates of a graph of the number of doses taken daily, measures. medication nonadherence range from 15%– the number of missed or extra doses, and the 93% (Myers & Midence, 1998). Although dosing intervals (Partridge et al., 2002). AlMedication Adherence patients with cancer are thought to be highly though opening a pill container does not The issue of medication adherence is a mi- motivated by the gravity of their disease necessarily mean that the patient ingested the nor one with regard to IV chemotherapy but (Waterhouse, Calzone, Mele, & Brenner, pill as prescribed, MEMS may help to proa potentially large one with oral chemo- 1993), a noncompliance rate of 43% was re- vide a more accurate assessment of a therapy administration. In many cases, the ported in a study of 51 outpatients with patient’s medication compliance. degree of patient adherence with an oral che- breast cancer who received 26 weeks of oral Noncompliance affects all age groups, motherapy regimen is related directly to the cyclophosphamide (Lebovits et al., 1990). but older patients are more vulnerable to degree of treatment success. Nonadherence A study examining allopurinol and predto a prescribed oral chemotherapy treatment nisone compliance in a cohort of outpatients Mention of specific products and opinions plan generally will result in ineffective or in- who received concomitant chemotherapy related to those products do not indicate or adequate treatment. for hematologic malignances found that, imply endorsement by the Clinical Journal of Adherence issues are not well understood, with no interventions, complete compliance Oncology Nursing or the Oncology Nursing and the specific process of medication ad- with the oral medication regimen occurred Society. herence is difficult to measure with any de- in only 17% of the patients (Levine et al., gree of accuracy. However, this concept has 1987). Furthermore, pharmacokinetic analy- Digital Object Identifier: 10.1188/03.CJON.S6.21-24 T CLINICAL JOURNAL OF ONCOLOGY NURSING • SUPPLEMENT TO VOLUME 7, NUMBER 6 • PATIENT EDUCATION 21