A Pilot Study of an Automated Voice Response System and Nursing Intervention to Monitor Adherence to Oral Chemotherapy Agents

Abstract

Abstract:This study was designed to develop and test a system to monitor adherence with nonhormonal oral chemotherapeutic agents using an automated voice response (AVR) system plus nursing intervention. Participants received the Symptom Management This pilot study demonstrated the ability to accrue patients for a longitudinal trial and informed intervention design, while providing guidance for future interventions and research studies.

Assessment and Measurement of Adherence to Oral Antineoplastic Agents

“…The medical record is also a source of prescriptions ordered, modifications to the regimen, and adherence. [19][20][21][22][23][24][25][26][27] However, medical records are known to be incomplete or inaccurate. 28 When electronic medical records are fully implemented, this may become a more reliable source of information.…”

The Challenges of Oral Agents as Antineoplastic Treatments

“…[14][15][16] What is not clear in many of these studies is if under dosing or over dosing led to the nonadherence. Given and colleagues 24,91 conducted an intervention trial (n = 119) finding adherence was 88% (n = 50 of 57) for patients with a 28 day medication cycle, 36% (n=9 of 25) for patients with a 14 days on, 7 days off medication cycle, and 33% (n = 3 of 9) with a 7 days on, 7 days off medication cycle (full adherence was defined as 78% of medication taken).The low adherence rate found in these studies may compromise the therapeutic index needed when administering oral antineoplastic agents.…”

“…Over adherence was found at a rate of 48% (n = 12 of 25) for patients with 14 days on, 7 days off medication cycle, and at a rate of 67% (n = 6 of 9) with 7 days on, 7 days off medication cycle. 24,91 In a randomized control drug trial with adherence as a secondary endpoint, researchers found over adherence: days of taking medications beyond the end of an expected cycle; taking extra doses in one day; and missing a day and compensating with a double dose the next day. 92 The high rate of over adherence found may cause toxicity or lead to adverse events.…”

“…Three of the studies on oral antineoplastics collected information on patient-reported reasons for nonadherence. These reasons included reports of carelessness about taking medications (80%), 93 forgetting to take medication (30% to 60%), 91,93 purposely skipped doses (35%), 94 late dosing (26.7%), 94 concerns over side effects (16.6%) 94 and 20% not understanding written materials about the prescription. 94 One study also found the complexity of the regimen drastically reduced adherence.…”

“…Mixed results have been reported for interventions to improve medication adherence in general 91 Effective strategies are multidisciplinary and multimodal. 98,99 However, a recent systematic review of interventions to enhance patient adherence to medications concluded current methods are complex, laborintensive, and not predictably effective, therefore, not able to be used in the clinical setting.…”