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Feasibility Pilot on Medication Adherence and Knowledge in Ambulatory Patients With Gastrointestinal Cancer

Robin Sommers

Kathleen Miller

Donna L. Berry

gastrointestinal, treatment adherence
ONF 2012, 39(4), E373-E379. DOI: 10.1188/12.ONF.E373-E379

Purpose/Objectives: To evaluate the feasibility of face-to-face education, a nurse-initiated telephone call, and patient use of medication diaries to support patients' self-reported medication adherence and knowledge of oral chemotherapy.

Design: Descriptive, feasibility pilot study.

Setting: An outpatient oncology unit at a National Cancer Institute-designated comprehensive cancer center.

Sample: 30 patients with gastrointestinal cancer who were prescribed at least one oral chemotherapy agent.

Methods: Participants received verbal and written education and a nurse-initiated educational telephone call within 72 hours of receiving education. Each was asked to complete a medication diary at home during the first cycle and the eight-item Morisky Medication Adherence Scale (MMAS-8) at the end of the first cycle of oral chemotherapy.

Main Research Variables: Verbal and written education, telephone contacts, drug diary, self-reported medication adherence, and patient knowledge.

Findings: Most patients (n = 29) received both verbal and written education, participated by telephone (n = 25), and completed the medication diaries (n = 21) correctly. Seventeen participants documented side effects within the first 72 hours of treatment initiation, with eight participants needing additional assistance with management of side effects. At the end of the first cycle of therapy, MMAS-8 adherence scores were high (X = 7.89, SD = 0.55).

Conclusions: This study demonstrated the feasibility of a nurse-initiated educational and monitoring protocol for patients with gastrointestinal cancer receiving oral chemotherapy. In addition, the adapted MMAS-8 was a feasible adherence measure.

Implications for Nursing: Pilot findings support targeted nurse interventions with face-to-face and telephone education to enhance self-monitoring and adherence for patients with gastrointestinal cancer receiving oral chemotherapy.

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    Bangalore, S., Kamalakkannan, G., Parker, S., & Messerli, F. (2007). Fixed dosed combinations improve medication compliance: A meta-analysis. American Journal of Medicine, 120, 713-719.
    Bartel, S. (2007). Safe practices and financial considerations in using oral chemotherapeutic agents. American Journal of Health-System Pharmacy, 64(9, Suppl. 5), S8-S14. doi:10.2146/ajhpo70036
    Bennett, J.W., & Glasziou, P.P. (2003). Computerised reminders and feedback in medication management: A systematic review of randomized controlled trials. Medical Journal of Australia, 172, 217-222.
    Courtney, L.J. (2009). Improving symptom management with ambulatory patients with a follow-up call [Abstract 3633]. Oncology Nursing Forum, 36, 3.
    Cunningham, T., Henson, C., Sikma, M., Hammer, M., & Berry, D. (2008). Improving discharge medication use and knowledge in adult patient at the Seattle Cancer Care Alliance (SCCA) [Abstract 2808]. Oncology Nursing Forum, 35, 513.
    Curley, M.A. (2007). Synergy: The unique relationship between nurses and patients. Indianapolis, IN: Sigma Theta Tau International.
    D'Amato, S. (2008, July/August). Improving patient adherence with oral chemotherapy. Oncology Issues, 42-45.
    Decker, V., Spoelstra, S., Miezo, E., Bremer, R., You, M., Given, C., & Given, B. (2009). A pilot study of an automated voice response system and nursing intervention to monitor adherence to oral chemotherapy agents. Cancer Nursing, 32, E20-E29.
    DiMatteo, M.R., Haskard, K.B., & Williams, S.L. (2007). Health beliefs, disease severity, and patient adherence: A meta-analysis. Medical Care, 45, 521-528.
    Gehlbach, S. (2006). Interpreting the medical literature(5th ed.). New York, NY: McGraw Hill.
    Given, B.A., Spoelstra, S.L., & Grant, M. (2011). The challenges of oral agents as antineoplastic treatments. Seminars in Oncology Nursing, 27, 93-103.
    Given, C., Given, B., Rahbar, M., Jeon, S., McCorkle, R., Cimprich, B., … Bowie, E. (2004). Effect of a cognitive behavioral intervention on reducing symptom severity during chemotherapy. Journal of Clinical Oncology, 22, 507-516. doi:10.1200/JCO.2004.01.241
    Graham, I.D., & Logan, J. (2004). Innovations in knowledge transfer and continuity of care. Canadian Journal of Nursing Research, 36, 89-103.
    Haynes, R.B., Ackloo, E., Sahota, N., McDonald, H.P., & Yao, X. (2008). Interventions for enhancing medication adherence. Cochrane Database of Systematic Reviews, 2, CD000011. doi:10.1002/14651858.CD000011.pub3
    Lebovits, A.H., Strain, J.J., Schleifer, S.J., Tanaka, J.S., Bhardwaj, S., & Messe, M.R. (1990). Patient noncompliance with self-administered chemotherapy. Cancer, 65, 17-22.
    Levine, A.M., Richardson, J.L., Marks, G., Chan, K., Graham, J., Selser, J.M., … Johnson, C.A. (1987). Compliance with oral drug therapy in patients with hematologic malignancies. Journal of Clinical Oncology, 5, 1469-1476.
    Mahtani, K.R., Heneghan, C.J., Glasziou, P.P., & Perera, R. (2011). Reminder packaging for improving adherence to self-administered long-term medications. Cochrane Database of Systematic Reviews, 9, CD005025. doi:10.1002/14651858.CD005025.pub3
    Marquez Contreras, E., Vegazo Garcia, O., Claros, N.M., Gil Guillen, V., de las Figuera von Wichmann, M., Casado Martinez, J.J., & Fernandez, R. (2005). Efficacy of telephone and mail intervention in patient compliance with antihypertensive drugs in hypertension. ETECUM-HTA study. Blood Pressure, 14, 151-158. doi:10.1080/08037050510008977
    McCorkle, R., Dowd, M., Ercolano, E., Schulman-Green, D., Williams, A.L., Siefert, M.L.… Schwartz, P. (2009). Effects of a nursing intervention on quality of life outcomes in post-surgical women with gynecological cancers. Psycho-Oncology, 18, 62-70. doi:10.1002/pon.1365
    McDonnell, P.J., & Jacobs, M.R. (2002). Hospital admissions resulting from preventable adverse drug reactions. Annals of Pharma-cotherapy, 36, 1331-1336. doi:10.12345/aph.1A333
    Morisky, D.E., Ang, A., Krousel-Wood, M., & Ward, H. (2008). Predictive validity of a medication adherence measure in an outpatient setting. Journal of Clinical Hypertension, 10, 348-354. doi:10.1111/j.1751-7176.2008.07572.x
    Morisky, D.E., Green, L.W., & Levine, D.M. (1986). Concurrent and predictive validity of a self-reported measure of medication adherence. Medical Care, 24, 67-74.
    Partridge, A., Avorn, J., Wang, P.S., & Winer, E.P. (2002). Adherence to therapy with oral antineoplastic agents. Journal of the National Cancer Institute, 94, 652-661. doi:10.1093/jnci/94.9.652
    Partridge, A., Wang, P., Winer, E., & Avorn, J. (2003). Nonadherence to adjuvant tamoxifen therapy in women with primary breast cancer. Journal of Clinical Oncology, 21, 602-606. doi:10.1200/JCO.2003.07.071
    Partridge, A.H., Kato, P.M., & DeMichele, A. (2009). Adherence to oral cancer therapies: Challenges and opportunities. Retrieved from
    Reuda, S., Park-Wyllie, L.Y., Bayoumi, A.M., Tynan, A.M., Antoniou, T.A., Rourke, S.B., & Glazier, R.H. (2006). Patient support and education for promoting adherence to highly active antiretroviral therapy for HIV/AIDS. Cochrane Database of Systematic Reviews, 3, CD001442. doi:10.1002/14651858.CD001442.pub2
    Rudd, P., Miller, N.H., Kaufman, J., Kraemer, H.C., Bandura, A., Greenwald, G., & Debusk, R.F. (2004). Nurse management for hypertension. A systems approach. American Journal of Hypertension, 17, 921-927. doi:10.1016/j.amjhyper.2004.06.006
    Ruddy, K., Mayer, E., & Partridge, A. (2009). Patient adherence and persistence with oral anticancer treatment. CA: A Cancer Journal for Clinicians, 59, 56-66. doi:10.3322/caac.20004
    Sadik, A., Yousif, M., & McElnay, J.C. (2005). Pharmaceutical care of patients with heart failure. British Journal of Clinical Pharmacology, 60, 183-193. doi:10.1111/j.1365-2125.2005.02387.x
    Schedlbauer, A., Davies, P., & Fahey, T. (2010). Interventions to improve adherence to lipid lowering medication. Cochrane Database of Systematic Reviews, 3, CD004371. doi:10.1002/14651858.CD004371.pub3
    Schneider, S.M., Hess, K., & Gosselin, T. (2011). Interventions to promote adherence with oral agents. Seminars in Oncology Nursing, 27, 133-141.
    Schroeder, K., Fahey, T., & Ebrahim, S. (2008). Interventions for improving adherence to treatment in patients with high blood pressure in ambulatory settings. Cochrane Database of Systematic Reviews, 2, CD004804. doi:10.1002/14651858.CD004804
    Senst, B.L., Achusim, L.E., Genest, R.P., Cosentino, L.A., Ford, C.C., Little, J.A., … Bates, D.W. (2001). Practical approach to determining costs and frequency of adverse drug events in a health care network. American Journal of Health-System Pharmacy, 58, 1126-1132.
    Sikorskii, A., Given, C.W., Given, B., Jeon, S., Decker, V., Decker, D., … McCorkle, R. (2007). Symptom management for cancer patients: A trial comparing two multimodal interventions. Journal of Pain and Symptom Management, 34, 253-264. doi:10.1016/j.jpainsymman.2006.11.018
    Weingart, S.N., Brown, E., Bach, P.B., Eng, K., Johnson, S.A., Kuzel, T.M., … Walters, R.S. (2008). NCCN Task Force Report: Oral chemotherapy. Journal of the National Comprehensive Cancer Network, 6(Suppl. 3), S1-S15.
    Weingart, S.N., Flug, J., Brouillard, D., Morway, L., Partridge, A., Bartel, S., … Connor, M. (2007). Oral chemotherapy safety practices at U.S. cancer centers: Questionnaire survey. BMJ, 334, 407. doi:10.1136/bmj.39069.489757.55
    Williams, A., Manias, E., & Walker, R. (2008). Interventions to improve medication adherence in people with multiple chronic conditions: A systematic review. Journal of Advanced Nursing, 63, 132-143. doi:10.1111/j.1365-2648.2008.04656.x
    Winkeljohn, D.L. (2007). Oral chemotherapy medications: The need for a nurse's touch. Clinical Journal of Oncology Nursing, 11, 793-796.