Nurses' practice patterns in relation to adherence-enhancing interventions in stem cell transplant care: a survey from the Nurses Group of the European Group for Blood and Marrow Transplantation

Abstract

Recipients of stem cell transplants (SCT) must accurately manage multiple medications as non-adherence jeopardises treatment benefits. There is an evidence base for the efficacy of adherence-enhancing interventions; however, level of clinical implementation is unknown. This study aimed to identify patterns of practice in assessing medication adherence, screening for risk factors of non-adherence, interventions used in SCT to improve adherence and how nurses perceive the effectiveness of such interventions. A convenience sample of 143 European nurses completed a 29-item questionnaire measuring the frequency and perceived effectiveness of assessment/screening methods for adherence and three types of intervention (educational/cognitive, counselling/behavioural and psychological/affective). Questioning patients about adherence was the most regularly used assessment method (51.5%). Nurses used a median of seven interventions (interquartile range: six) 'frequently', the most popular being provision of reading materials (79%). The interventions perceived as most effective were; providing individual patient/family with teaching and reading materials. This is the first study exploring patterns of practice relating to adherence in SCT. Educational interventions were the most frequently employed style of intervention, which is at odds with recent data suggesting limited efficacy with this style of intervention. Combining educational, behavioural and psychological interventions would more accurately embrace current understanding.

Practice patterns to improve pre and post-transplant medication adherence in heart transplant centres: a secondary data analysis of the international BRIGHT study

“…Many more are used mainly during specific phases of the transplant continuum. 16 Contradicting previous smaller studies applying the same methodology after solid organ transplantation, 13 after stem cell transplantation, 14 and in cardiovascular care, 12 we found that the prevalence of educational/cognitive interventions (e.g. providing self-care reading materials, printed medication instructions, or individual teaching) has declined.…”

“…This finding is similar to those of earlier European studies in cardiovascular 12 and transplant patients. 13,14 In clinical practice, patient selfreport is an easily implemented approach that allows quick, economical assessment of medication adherence. 27 However, used alone, self-reporting commonly underestimates patients' non-adherence; 27 therefore, to increase its sensitivity, a combination of assessment strategies is recommended.…”

“…12 The questionnaire has already been used in different transplant populations. [12][13][14] Medication adherence was assessed using three methods: (a) questioning patients about medication adherence; (b) screening patients for risk factors for non-adherence (e.g. forgetfulness, busy lifestyle, complex treatment, etc.…”

“…11 However, no evidence is currently available as to how international practice guidelines are implemented along the heart Tx care continuum. Using a methodological approach similar to those used in cardiovascular care 12 and after solid organ 13 or stem cell Tx, 14 our research group cross-sectionally assessed post-transplant medication adherence in relation to practice patterns in heart Tx centres. In addition to mapping the adherence assessment methods used (e.g.…”

“…We refer to combinations of these categories as mixed interventions. Previous medication adherence practice pattern studies [12][13][14]16 showed that, regarding adherence-enhancing intervention strategies, clinicians applied mostly educational/cognitive strategies.…”