Effects of a Medication Management Program for Cancer Patients Receiving Oral Chemotherapy

Han Sooyoung; Kim Sue; Lee Yoonjung

doi:10.5388/aon.2018.18.2.94

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Sooyoung, Sue, and Yoonjung: Effects of a Medication Management Program for Cancer Patients Receiving Oral Chemotherapy

Original Article

Asian Oncol Nurs 2018;18(2):94-103.

Published online: 5 June 2018

DOI: https://doi.org/10.5388/aon.2018.18.2.94

Effects of a Medication Management Program for Cancer Patients Receiving Oral Chemotherapy

Han Sooyoung¹, Kim Sue², Lee Yoonjung¹

¹Department of Nursing, Yonsei University Graduate School, Seoul, Korea.

²Yonsei University College of Nursing, Seoul, Korea.

Address reprint requests to: Lee, Yoonjung Department of Nursing, Yonsei University Graduate School. (Yonsei University College of Nursing, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Korea. Tel: +82-2-2228-4940 Fax: +82-2-2227-6548 E-mail: Yjlee99@yuhs.ac

Received 14 May 201827 Jun 2018 Accepted 27 Jun 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Purpose

The purpose of this study was to assess the effects of a medication management program on oral chemotherapy patients.

Methods

A nonequivalent control group ppretest-posttest design was used. Participants were 60 cancer patients (intervention group: 30, control group: 30). The medication management program was provided for 6 weeks. Collected data were analyzed using the SPSS/ WIN 21.0 program.

Results

Although there were no statistically significant differences, scores of self-efficacy (t=-0.12, p=.902), knowledge (t=0.62, p=.537), medication adherence (t=0.51, p=.610), and staff satisfaction (t=1.44, p=.156) were higher in the experimental group than in the control group.

Conclusion

There was no significant difference in self-efficacy, knowledge, symptom experience, medication adherence and staff satisfaction. This can be explained by both groups having already received initial instruction concerning basic care when they started to receive chemotherapy. Considering the positive outcome of the medication management program, a specialist nursing effort is needed to improve symptoms and medication adherence. Furthermore, a medication counseling hotline is needed to support the medical staff.

Keywords: Medication Adherence, Medication Therapy Management, Mouth, Neoplasms

REFERENCES

1. National Cancer Information Center (KR). Causes of death statistics [Internet]. Available from. http://kosis.kr/statisticsList/statisticsList_01List.jsp?vwcd=MT_ZTITLE&parmTabId=M_01_01. [Accessed May 25, 2016].

2. Weingart SN, Brown E, Bach PB, Eng K, Johnson SA, Kuzel TM, et al. NCCN task force report: oral chemotherapy. J Natl Compr Canc Netw. 2008; 6(Suppl 3):S1–14.

3. Banna GL, Collovà E, Gebbia V, Lipari H, Giuffrida P, Cavallaro S, et al. Anticancer oral therapy: emerging related issues. Cancer Treat Rev. 2010; 36:595–605.

4. Bestvina CM, Zullig LL, Rushing C, Chino F, Samsa GP, Altomare I, et al. Patient-oncologist cost communication, financial distress, and medication adherence. J Oncol Pract. 2014; 10:162–7.

5. Spoelstra SL, Given BA, Given CW, Grant M, Sikorskii A, You M, et al. An intervention to improve adherence and management of symptoms for patients prescribed oral chemotherapy agents: an exploratory study. Cancer Nurs. 2013; 36:18–28.

6. Foulon V, Schöffski P, Wolter P. Patient adherence to oral anticancer drugs: an emerging issue in modern oncology. Acta Clin Belg. 2011; 66:85–96.

7. Verbrugghe M, Verhaeghe S, Lauwaert K, Beeckman D, Van Hecke A. Determinants and associated factors influencing medication adherence and persistence to oral anticancer drugs: a systematic review. Cancer Treat Rev. 2013; 39:610–21.

8. Barclay TR, Hinkin CH, Castellon SA, Mason KI, Reinhard MJ, Mar-ion SD, et al. Age-associated predictors of medication adherence in HIV-positive adults: health beliefs, self-efficacy, and neurocognitive status. Health Psychol. 2007; 26:40–9.

9. Shin JH, Kim GS, Lee JH, Oh SJ. The effects of periodic reminding interventions on medication adherence, self-efficacy, and pain for home-based lung cancer patients. J Korean Clin Nurs Res. 2013; 19:443–54.

10. Lee YH, Jeong IS. Factors influencing medication adherence to oral anticancer drugs. Asian Oncol Nurs. 2013; 13:201–9.

11. Choi JS. Adherence to oral anticancer drugs in elderly cancer patients [dissertation]. Seoul: Seoul National Univ.;2012.

12. Lee ER. Patient compliance with oral anticancer drug medication and factors affecting compliance with medication [dissertation]. Seoul: Seoul National Univ.;2006.

13. Kim JH. A model for medication adherence in cancer patients receiving oral chemotherapy [dissertation]. Seoul: Chung-Ang Univ.;2012.

14. Ruddy K, Mayer E, Partridge A. Patient adherence and persistence with oral anticancer treatment. CA Cancer J Clin. 2009; 59:56–66.

15. Seo MA. A structural equation model explaining medication compliance of schizophrenia. Korean J Nurs Query. 2002; 11:138–67.

16. Spoelstra SL, Given CW. Assessment and measurement of adherence to oral antineoplastic agents. Semin Oncol Nurs. 2011; 27:116–32.

17. Regnier Denois V, Poirson J, Nourissat A, Jacquin JP, Guastalla JP, Chauvin F. Adherence with oral chemotherapy: results from a qualitative study of the behaviour and representations of patients and oncolo-gists. Eur J Cancer Care (Engl). 2011; 20:520–7.

18. Lee YH. The development and evaluation of motivational interviewing based medication management program for cancer patients taking oral anticancer agents [dissertation]. Busan: Pusan Univ.;2015.

19. Lee HJ. Factors affecting medication compliance of hypertensive patients [dissertation]. Seoul: Dankook Univ.;2002.

20. Kwon YS. A study on the effect of information on knowledge level and anxiety in cancer patients receiving chemotherapy [dissertation]. Seoul: Yonsei Univ.;1988.

21. Samarel N, Leddy SK, Greco K, Cooley ME, Torres SC, Tulman L, et al. Development and testing of the symptom experience scale. J Pain Symptom Manage. 1996; 12:221–8.

22. Park JH. Patterns and related factors of fatigue during radiotherapy in patients with breast cancer [dissertation]. Seoul: Yonsei Univ.;2002.

23. La Monica EL, Oberst MT, Madea AR, Wolf RM. Development of a patient satisfaction scale. Res Nurs Health. 1986; 9:43–50.

24. Choi EJ, Jang IS, Hwang JH, Kang YA, Kim SR, Nho JH, et al. Patient satisfaction with advanced practice nurse in a tertiary hospital. J Korean Clin Nurs Res. 2015; 21:335–46.

25. Branch RM. Instructional design: the ADDIE approach. New York, NY: Springer;2009.

26. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977; 84:191–215.

27. Kripalani S, Yao X, Haynes RB. Interventions to enhance medication adherence in chronic medical conditions: a systematic review. Arch In-tern Med. 2007; 167:540–50.

28. Boucher J, Lucca J, Hooper C, Pedulla L, Berry DL. A structured nursing intervention to address oral chemotherapy adherence in patients with non-small cell lung cancer. Oncol Nurs Forum. 2015; 42:383–9.

29. Spoelstra SL, Given CW, Sikorskii A, Coursaris CK, Majumder A, DeKoekkoek T, et al. Feasibility of a text messaging intervention to pro-mote self-management for patients prescribed oral anticancer agents. Oncol Nurs Forum. 2015; 42:647–57.

Table 1.

Research Design

Group	Pretest	Posttest	Pretest	Intervention	Posttest
Control group	C1	C2
Experimental group			E1	X	E2

C= Control group; E= Experimental group; C1, E1= Pretest (Individual and disease characteristics, Depression, Social support, Knowledge, Self-efficacy); C2, E2= Posttest (Knowledge, Self-efficacy, Symptom experience, Medication Adherence, Satisfaction); X= Treatment (Medication Management Program for Cancer Patients Receiving Oral Chemotherapy).

Table 2.

Medication Administration Management Program for Oral Anti-cancer Drugs

Session (duration)	Topic/Goal	Content	Method
Session 1 1st week (10min)	Understanding the program	1. Describe the rationale of the program and introduce the program schedule and investigator	Face-to-face counseling^∗
		2. Assess the patient's preparation, perceived importance, and confidence about taking oral anti-cancer drugs 3. Assess the support system and which family members will participate in helping the patient take oral anti-cancer medications and manage side effects 4. Provide a guidelines and medication schedule and establish practical goals to solve any problems with taking oral anti-cancer drugs	Text message
Session 2 2nd week (15min)	Understanding the ac-curate drug administration method and side effects (1)	1. Check whether the patient had taken their oral anti-cancer medications and verify the reason if the patient missed a dose or took the medications inappropriately	Phone counseling^†
		2. Check the symptoms and side effects of oral anti-cancer medications and discuss the possible countermeasures 3. Help the patient express any ambivalent feelings about taking oral-anticancer drugs and the benefits and losses caused by changes, and engage in reflective listening	Text message
Session 3 3rd week (30min)	Understanding the ac-curate drug administration method and side effects (2)	1. Reeducate about the method of taking the prescribed oral anti-cancer drugs and managing side effects	Face-to-face counseling^∗
		2. Check the patient's readiness, perceived importance, and confidence about taking oral anti-cancer drugs 3. Check the support system and family members who participate in helping the patient take oral anti-cancer medications and manage side effects 4. Introduce the case of “overcoming drug therapy”posted on the Cancer Information Center website, and helps the patients to view and participate.5. Check the medication schedule and re-establish the practical goals to solve any problems about taking oral anti-cancer medications 6. Review the written pledge for adhering to the oral anti-cancer administration schedule and provide motivations to the patient	Text message
Session 4 4th week (15min)	Self-management (1)	1. Check whether the patient had taken their oral anti-cancer medications and verify the reason if the patient missed a dose or took the medications inappropriately	Phone counseling^†
		2. Check the symptoms and side effects of oral anti-cancer medications and discuss the possible countermeasures	Text message
Session 5 5th week	Self-management (2)	1. Send a text message with details about the appropriate dose, time, and method for the prescribed oral anti-cancer medications along with a note of encouragement.	Text message
Session 6 6th week (30min)	Completion	1. To understand the patients and build a rapport, prompt the patients to talk about the topics they want to express and engage in reflective listening	Face-to-face counseling^∗
		2. Discuss the pros and cons of the program 3. Give the patient the written pledge for adhering to the oral anti-cancer medication schedule and encourage them to continue to fulfill their pledge 4. Administer a post-program questionnaire	Text message

^∗ Face-to-face counseling required materials: PPT for drug education, leaflets for patients, medication schedule, written pledge

^† Phone counseling required materials: phone counseling recording template.

Table 3.

Homogeneity Test of General, Disease Related Characteristics and Dependent Variables between Experimental and Control Group (N =60)

Characteristics	Categories	Exp. (n=30)	Cont. (n=30)	p
Characteristics	Categories	n(%) or M ± SD	n(%) or M ± SD	p
Age(year)		58.2 ± 9.7	56.9 ± 12.6	.918
	＜50	4 (13.3)	4 (13.2)
	＜50~60	12 (40.0)	10 (33.4)
	60~70	10 (33.4)	10 (33.4)
	＞70	4 (13.3)	6 (20.0)
Gender	Male	15 (50.0)	19 (63.3)	.435
	Female	15 (50.0)	11 (36.7)
Education	Low	22 (73.3)	20 (66.7)	.317^∗
	High	8 (26.7)	10 (33.3)
Married	Yes	27 (90.0)	27 (90.0)	＞.999^∗
	No	3 (10.0)	3 (10.0)
Job	Yes	10 (66.7)	18 (60.0)	.038^∗
	No	20 (33.3)	12 (40.0)
Type of cancer	GI tract cancer	21 (76.7)	23 (76.7)	.559^∗
	Other cancer	9 (23.3)	7 (23.3)
Stage of cancer	1	3 (10.0)	1 (3.3)	.612^∗
	2	4 (13.3)	2 (6.7)
	3	13 (43.4)	16 (53.3)
	4	10 (33.3)	11 (36.7)
Type of anticancer treatment	IV combination	23 (76.7)	13 (43.3)	.008
	Oral only	7 (23.3)	17 (56.7)
Type of oral chemotherapy	Xeloda	25 (83.3)	24 (80.0)	.786
	Iressa	2 (6.7)	4 (13.3)
	Nexavar	3 (10.0)	2 (6.7)
Self-efficacy		38.27 ± 2.78	38.10 ± 2.98	.818
Knowledge		7.00 ± 2.42	7.37 ± 1.93	.460

^∗ Fisher's exact test; GI= Gastrointestinal; IV= Intravenous injection.

Table 4.

Comparison of Change in Self-efficacy, Knowledge between Experimental and Control Group (N =60)

Variables	Groups	Pretest	Posttest	t	p	Difference	t	p
Variables	Groups	M ± SD	M ± SD	t	p	M ± SD	t	p
Self-efficacy	Exp.(n=30)	38.27 ± 2.78	39.07 ± 2.98	1.79	.197	1.03 ± 3.12	0.28	.781
	Cont.(n=30)	38.10 ± 2.82	39.06 ± 1.98	0.86	.399	0.80 ± 3.32
Knowledge	Exp.(n=30)	7.00 ± 2.42	7.37 ± 1.93	1.32	.398	0.43 ± 2.75	1.20	.234
	Cont.(n=30)	7.46 ± 2.36	7.03 ± 2.22	0.85	.434	0.36 ± 2.32

Table 5.

Comparison of Post Instrumental Variables between Experimental and Control Group (N =60)

Instrumental variables	Exp. (n=30)	Cont. (n=30)	t	p
Instrumental variables	M ± SD	M ± SD	t	p
Symptom experience	32.27 ± 15.56	31.60 ± 15.32	0.17	.868
Adherence	97.40 ± 6.20	96.55 ± 6.66	0.51	.610
Satisfaction	66.47 ± 6.16	63.93 ± 7.42	1.44	.156

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