Understanding barriers to oral medication adherence in adults with acute myeloid leukemia (AML).

Abstract

106 Background: AML is a disease of older adults (median age 67 years). Although standard AML treatment is intravenous (IV) chemotherapy, availability of oral anti-cancer medications has increased , providing benefits and risks to patients. Patients prefer their convenience, absence of IV infusions, potential for fewer clinic visits, and increased subjective feeling of control over their disease. Poor adherence can increase toxicity risk and compromise treatment effectiveness. We aim to identify barriers to adherence to oral medications in patients with AML and proposed solutions for improvements. Methods: Following IRB approval, patients with AML and their caregivers were recruited to participate in focus groups. An experienced moderator conducted the groups using an interview guide developed by AML experts. Participants received gift cards for their participation. Sessions were digitally recorded, transcribed verbatim, and analyzed for thematic content using Dedoose qualitative software. Results: 11 patients (5 <65 years; 6 >65 years) and 4 caregivers participated in sessions lasting 60-75 minutes. Three central themes emerged: medication adherence challenges, managing an oral adherence plan, and strategies to improve oral adherence. Adherence challenges: number and size of pills, different directions, cost, availability, and side effects. An adherence plan was recommended: written schedules, take medications around meals, and use of pillboxes and alarms. Main sources of information: health care team and bottle directions. Recommendations for providing adherence assistance included better instructions, assistance with scheduling, making pills smaller, and consistency in packaging. Conclusions: Patients are an important source of insight into barriers and solutions to oral medication adherence. These responses were used to develop a survey to be administered to 100 patients with AML. Results will inform development of an intervention to improve oral medication adherence in the AML population.

Patient Perceptions of CAR-T Therapy in the USA: Findings from In-Depth Interviews

“…In our case, snowball sampling involved asking individuals who had completed the study to refer us to others or to post an announcement in their local patient support groups on our behalf. These additional recruiting efforts enabled us to meet our recruitment goal of 18 total participants, which is similar to the number of patients enrolled in other qualitative studies [ 15 , 16 ].…”

Patient, Caregiver, and Clinician Experience with a Technologically Enabled Pillbox: A Qualitative Study

“…Our study's focus on implementation of technologically enabled pillboxes at the time of hospital discharge adds to existing qualitative studies in the ambulatory setting. 19,22,[27][28][29][30][31][32][33][34][35][36] These studies have examined the use of a smart pillbox in a variety of geographic locations (e.g., U.S. academic medical centers, clinics in sub-Saharan Africa, urban clinics in India) for a variety of conditions. Similar to what we found in our study, these studies also identified technology and tools as a prominent barrier to implementation.…”

“…[12][13][14] Several studies to date have touted the success of such interventions in reducing medication discrepancies and, in some cases, improving chronic disease control in the ambulatory setting for a wide range of conditions such as hypertension, 15,16 diabetes, 15,17 human immunodeficiency virus (HIV), 12,[18][19][20][21][22][23][24] tuberculosis (TB), 18,25 multiple myeloma, 26 and post-kidney transplantation. 15 Additionally, and importantly given the novelty of smart pillbox devices, several studies have also explored user perspectives of this technology, the majority of which have focused on patient 19,22,[27][28][29][30][31][32][33][34][35][36] rather than clinician 32,35,37 perspectives.…”