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Effects of Patient Education on Medication Adherence in
Hematology-Oncology
Rachel Myers
Question
P: In hematology-oncology patients,
I: what is the effect of individualized education
O: on medication adherence of oral chemotherapy agents and adjuvant
medications at home?
Background
Becoming more common in the setting of hematology-oncology for patients to
receive oral chemotherapy drugs and complex medication regimens upon
discharge. The issue of medication adherence at home can be linked to high 30-day
readmission rates in this patient population. The goal of this research is to study the
effects of individualized education on overall patient self-management of oral
medications.
Implications/Conclusions
•Knowledge of patient medication adherence and current policies on patient education was stronger following
the educational flyer
•Continuous education needs to be implemented in order to ensure full medication regimen adherence within
hematology-oncology units
Review of the Literature
Study: author,
Year
Sommers, R. M.,
Miller, K., & Berry, D.
L. (2012).
Case-Control Study
Methods
•Anonymous pre- & post-survey which includes experience, knowledge and practice
•Educational brochure on proper policy and procedure of patient and family
education and current literature of medication adherence
•From adult and pediatric Hem-Onc units
•N=19 pre-survey
•N=16 post-survey
Results
•84%: 1-15 years of experience
•0% answered that it was not necessary to assess education for readmitted patients
•Teach Back is best teaching method per Hershey policies and procedures
•79% of participants agreed in the pre-survey whereas, 100% agreed in the
post-survey
•Post-survey: 56% said they use the Teach Back method quite often, while 44%
said they use it every time upon discharge
•79% of participants in the pre-survey believed that education had significant effects
on medication adherence, while 100% believed that in the post-survey
Sui-Fun, W.,
Bounthavong, M.,
Cham, N., Bechtoldt,
K., & Hernandez, E.
(2014)
Observation Cohort
Wu, S., Chee, D.,
Ugalde, A., Butow, P.,
Seymour, J., &
Schofield, P. (2015)
Qualitative Study
Subjects
Interventions/
Control Groups
N=30 patients with
Verbal and written
gastrointestinal cancer education
who
and a nurse-initiated
were prescribed at
educational telephone
least one oral
call within 72
chemotherapy agent
hours of receiving
education.
N=30 clinic patients (9 Comprehensive
men and 21 women
medication therapy
with a mean age of
management (MTM)
64.5 years): majority
had advanced-stage
cancer and no live-in
caregiver.
N=16 patients and
N/A
N=10 health
professionals
(hematologists n = 4,
nurses n = 3,
pharmacists n = 3)
Outcome Measures
A medication diary at home during the
first cycle and the
eight-item Morisky Medication
Adherence Scale (MMAS-8)
Significant Results
* include p values
At the end of the first cycle of therapy,
MMAS-8 adherence
scores were high (X = 7.89, SD = 0.55).
Intervention outcomes were collected at Rates of optimal oral chemotherapy adherence
baseline and at follow-up
and persistence increased by70%.
visits/interviews for up to three months
Semi-structured qualitative interviews
were recorded, transcribed, and
manually analyzed using interpretive
phenomenological analysis
Reasons for unintentional nonadherence
included forgetfulness related to variations of
routine and doctor–patient communication
issues.
Reasons for intentional nonadherence
included desires to reduce dose-dependent
side effects and insufficient support.
References
Sommers, R. M., Miller, K., & Berry, D. L. (2012). Feasibility pilot on medication adherence and knowledge in ambulatory patients with gastrointestinal
cancer. Oncology Nursing Forum, 39(4), E373-9.
Sui-Fun, W., Bounthavong, M., Cham, N., Bechtoldt, K., & Hernandez, E. (2014). Implementation and preliminary outcomes of a comprehensive oral
chemotherapy management clinic. American Journal Of Health-System Pharmacy, 71(11), 960-965. doi:10.2146/ajhp130278
Wu, S., Chee, D., Ugalde, A., Butow, P., Seymour, J., & Schofield, P. (2015). Lack of congruence between patients' and health professionals'
perspectives of adherence to imatinib therapy in treatment of chronic myeloid leukemia: A qualitative study. Palliative & Supportive Care, 13(2),
255-263. doi:10.1017/S1478951513001260