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A Pilot Study of an Automated Voice Response System and Nursing Intervention
to Monitor Adherence to Oral Chemotherapy Agents
Sandra Spoelstra, MSN, RN; Charles Given, PhD; Emily Miezio, MSN, RN; Renee Bremer, MS; Mei You, MS; Veronica Decker, MS, RN; Barbara Given, PhD, RN, FAAN.
Affiliations: Michigan State University College of Nursing
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Introduction
Increasing use of oral agents creates a new paradigm in cancer care.
Patients fill prescriptions, implement complex dosing regimens, and self
monitoring symptoms, side effects and adverse events.
The more adherent to oral chemotherapy agents, the more symptoms
experienced.
Patients self-titrate does to manage symptoms, not adhering to prescribed
regimens.
A disconnect between chemo received and clinicians assumptions.
Failure to achieve therapeutic dose.
Design and Conceptual Framework
Exploratory, longitudinal study.
Modified health belief model that builds on Cognitive Behavioral
Intervention framework for symptom management.
Research Questions
1) Can adherence be defined and measured?
2) What is symptom severity at intake, 4-, 6-, 8- weeks, and exit.
3) Comparison of adherent with non-adherent patients.
Results
Setting and Sample
National Cancer Institute Community Clinical Oncology Program site.
University Cancer Center.
Non-hormonal oral chemotherapeutic agents. N=30
Measures
Intake and 10-week Exit Interview:
Symptom Experience Inventory: prevalence 15 symptoms past 7 days,
severity 0-10 point scale, and interference with daily activities.
Adherence : to prescribed oral chemo on each call.
Depression: CESD 20 and Functional Status: SF-12
Utilization of ER, Hospital, and Physician services
Beliefs about Medicines Questionnaire and Out of Pocket Costs
Weekly AVR Calls for 8 weeks:
Symptom Experience Inventory and Adherence with oral chemo
Medical Record Audit:
Enrollment: Cancer site, stage, oral therapy, number of pills prescribed
per day, times per day, number of pills per time, interval between doses.
Exit: Change in dose, pills per day, dose delays, and stoppage.
Satisfaction Survey: with AVR and Nursing Interventions.
Adherence
Non-adherence
- 7 out of 30 (23%) non-adherence
- 5 of 7 “forgot” to take the pills
No significance: type of cancer, demographics, symptom
severity, out-of-pocket costs, depression, functional status, belief
about medications, or services utilization.
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Sociodemographic
Adherence
Non-adherence
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Patient Symptoms >=4
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Pre Symptom >=4
Post Symptom
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Conclusion
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Fatigue
Pain
Lack of Appetite
Numbness
Symptoms
Diarrhea
Distress
Skin Rash
Constipation
Patients are assumed to be motivated to take their oral chemotherapy,
however, adherence should never be assumed.
Pilot study demonstrated feasibility of accruing patients
undergoing non-hormonal oral chemotherapy to develop and test
an AVR system, complemented by a Symptom Management
Toolkit and nursing intervention to improve adherence to the oral
chemo protocol and symptom management.
Funding Source: Michigan State University College of Nursing
Acknowledgement: Pilot study was conducted in affiliation with the Walther Cancer Institute, located in Indianapolis, Indiana.