Encounters between medical and lay knowledge in therapeutic patient education. A qualitative study based on an oral chemotherapy program

Towards a patient-centred approach in therapeutic patient education. A qualitative study exploring health care professionals' practices and related representations

OBJECTIVES

This study aimed to explore the practice-representation links among Health Care Professionals (HCP)s practising Therapeutic Patient Education (TPE). Understanding these links might actually help to address the challenges of TPE implementation, particularly the patient-centred dimension.

METHODS

A qualitative study using individual interviews was conducted with HCPs practising in French-speaking Belgium or in France. Data analysis was carried out in two steps: to draw up a typology of educational practices (including variations) and, in line with the Social Representation Theory, to identify possible related social representations.

RESULTS

The typology, based on HCP-Patient power distribution, was built from 26 interviews. Four types and nine subtypes were identified. Besides the power distribution, practice (sub)types were also specific regarding communication modes, consideration for patients' representations, motivational approach, personalization, complexity of methods and learning contents, and practice reflexivity. Practices were seldom constant. Three variations were highlighted: within a subtype, between different subtypes, and between education and technical care. Both practice subtypes and variations were related to specific decisive representations.

DISCUSSION

Representations related to practices and those related to practices variations offer new perspectives for TPE implementation. There is no panacea for achieving more patient-centred approaches; tailored strategies based on practice subtypes are needed.

A Qualitative Exploration of Medication Experience and Factors Contributing to Adherence to Oral-Targeted Therapy Among Lung Cancer Survivors

OBJECTIVES

The introduction of oral-targeted therapy for cancer improves survival while adherence also presents as a challenge to patients. Current studies on oral anticancer agents are primarily limited to patients from developed countries with breast cancer and chronic myeloid leukemia receiving oral chemotherapy and hormonal therapy. This study explored experience of oral-targeted therapy adherence among Chinese patients with nonsmall cell lung cancer and its contributing factors by using a qualitative research.

DATA SOURCES

Semi-structured interviews with 16 patients and 7 family caregivers at a tertiary tumor hospital in China were conducted to understand their experience and perceptions of oral-targeted therapy. Thematic analysis was applied to generate the themes and to identify underlying factors associated with the adherence.

CONCLUSION

The lung cancer survivors struggled with ambivalence between survival and relief during taking targeted anticancer medication and showed diverse models of nonadherence, including intentionally or unintentionally intermittent medication and overadherence. Three main themes were identified: (1) cancer-related distresses, (2) inadequate social support, and (3) forgetfulness, together with seven subthemes, representing factors impeding patients' medication adherence. The themes demonstrate complicated and interrelated factors from personal, interpersonal, sociocultural, and structural forces contributing to patients' poor adherence.

IMPLICATIONS FOR NURSING PRACTICE

The findings suggest the imperativeness of reinforcing community- or home-based oral-targeted medication management in which nurses play a principal role to implement strategies of patient education, symptom management, reminder prompts, and monitoring to improve adherence.

Self-care behaviors in patients with cancer treated with oral anticancer agents: a systematic review

PURPOSE OF REVIEW

Continuous progress in cancer care has led to its increased use in oral anticancer agents that are easily managed by patients at home with fewer costs and hospitalizations. However, correct self-care behaviors are needed for the safe use of these medications. This review aimed to synthesize studies on self-care behaviors in patients treated with oral anticancer agents.

METHODS

This systematic review used a convergent qualitative synthesis design for mixed studies. Studies on adult patients with cancer using any kind of oral anticancer agent and describing self-care maintenance, self-care monitoring, and/or self-care management behaviors were searched on PubMed, EMBASE, and CINAHL. After data extraction, the findings were retained for qualitative synthesis.

FINDINGS

Of 3419 records, 19 studies were included in this review. From the qualitative synthesis, all the retrieved behaviors were synthesized in the three self-care dimensions. Five themes and 18 subthemes were identified. Self-care maintenance included "adherence to the medications" and "prevention." Self-care monitoring consisted of "health surveillance and recognition of illness changes." Self-care management included "seeking help" and "autonomous management of side effects." Overall, most of the behaviors described focused only on adherence.

CONCLUSION

The findings of this systematic review could guide future studies on self-care and drive future interventions aimed at improving self-care in this vulnerable population. Nurses and other healthcare professionals should provide self-care support to patients taking oral anticancer agents. In particular, they should promote behaviors aimed at improving well-being, preserving health, or managing side effects.

Associations of readiness for hospital discharge with symptoms and non-routine utilization of post-discharge services among cancer patients receiving oral chemotherapy at home: A prospective study

BACKGROUND

Readiness for hospital discharge is associated with patients' health outcomes after they return home. However, little is known about this association among cancer patients receiving oral chemotherapy at home. This study aimed to examine whether patients' reported readiness for hospital discharge was associated with symptoms and non-routine utilization of post-discharge services among cancer patients receiving oral chemotherapy at home.

METHODS

A prospective study was conducted, and 151 cancer patients receiving oral chemotherapy were recruited from a provincial level hospital in South China between October 2018 and December 2019. The primary outcome was readiness for hospital discharge assessed by the Readiness for Hospital Discharge Scale-Short Form on the day of discharge. The secondary endpoints were symptoms assessed by MD Anderson Symptom Inventory and non-routine utilization of post-discharge services within one cycle of chemotherapy at home (21 days).

RESULTS

Among these 151 participants, 74.2% of them reported as ready for discharge. Patients who were employed, lived in suburban area or villages, had a higher Eastern Cooperative Oncology Group score, took Tegafur as oral chemotherapy, and took oral chemotherapy for the first time reported lower readiness for hospital discharge. These five factors explained 28.1% of variance in readiness for hospital discharge. Patients who were not ready for discharge were prone to report higher symptom severity (p = 0.038). No differences in non-routine utilization of post-discharge services were found between the readiness versus non-readiness for discharge groups (p = 0.891).

CONCLUSIONS

Most cancer patients receiving oral chemotherapy at home were ready for discharge, which was influenced by employment status, residence status, Eastern Cooperative Oncology Group score, type of oral chemotherapy drug, and the experience of taking oral chemotherapy at home. Patients with lower readiness reported worse symptom severity at home. Routine assessment was suggested to recognize unready patients, and more extensive preparations for discharge were recommended to help them manage symptoms at home.

Nanomedicine for increasing the oral bioavailability of cancer treatments

Abstract

Oral administration is an appealing route of delivering cancer treatments. However, the gastrointestinal tract is characterized by specific and efficient physical, chemical, and biological barriers that decrease the bioavailability of medications, including chemotherapeutics. In recent decades, the fields of material science and nanomedicine have generated several delivery platforms with high potential for overcoming multiple barriers associated to oral administration. This review describes the properties of several nanodelivery systems that improve the bioavailability of orally administered therapeutics, highlighting their advantages and disadvantages in generating successful anticancer oral nanomedicines.

Graphical Abstract

Evaluation of interprofessional care processes for patients treated with oral anticancer drugs

Information on interprofessional team composition and functioning in the care for patients on oral anticancer drugs (OACDs), and how healthcare professionals (HCPs) evaluate in-hospital care processes is scarce. We aimed to investigate interprofessional care processes for OACD-patients in a partially mixed-methods study. A combination of (a) the CareProces Self-Evaluation Tool (CPSET), completed by HCP-team members by health profession who were either currently involved in care processes (oncologists and nurses) or potentially involved in future care (pharmacists, psychologists, social workers), and by hospital managers (N = 87) and (b) semi-structured interviews in a subsample of oncologists, nursing staff, and pharmacists (N = 26) were used. Care process coordination was evaluated poorly, mainly by nurses, pharmacists, and psychologists. Nurses and pharmacists believed that they were not engaged in the organization of OACD care, lacked role clarity, and perceived no meaningful interprofessional practice. HCPs had different perceptions toward timing and planning of patient education and follow-up. Monitoring of care processes occurred only occasionally and was unstructured resulting in apoor complication-management and variance within care processes. Care processes for OACD-patients showed opportunities for optimization of interprofessional practice in timing, planning, and monitoring. Rethinking care processes through co-design is needed.

Psychosocial determinants of adherence with oral anticancer treatment: 'we don't need no education'

INTRODUCTION

Given the potentially fatal consequences of inadequate adherence with oral anticancer treatment in persons with cancer, understanding the determinants of adherence is vital. This paper aims at identifying psychosocial determinants of adherence to oral anticancer treatment.

METHODS

We reviewed the literature on psychosocial determinants of adherence with oral anticancer treatment, based on published literature in English, from 2015 to present. Literature searches were performed in PubMed, Embase, Web of Science, Cochrane library, Emcare, and PsychINFO, with 'cancer', 'medication adherence', 'psychology', and 'oral anticancer treatment' as search terms. The obtained 608 papers were screened by two independent reviewers.

RESULTS

In the 25 studies identified, illness perceptions, medication beliefs, health beliefs, and depression were found to be the major psychosocial determinants of adherence to oral anticancer treatment; sociodemographic and clinical characteristics were found to be of no major importance. The quality of the identified studies as assessed by two independent reviewers was found to be acceptable overall. The majority of papers were from North America and focused on patients with breast cancer; sample size varied from 13 to 1371; adherence was assessed with questionnaires derived from various theoretical models, pill counts and electronic pharmacy records; illness perceptions reflecting adaptive coping, and medication beliefs reflecting high necessity and low concerns were found to be associated with adherence.

CONCLUSION

Psychosocial concepts are major determinants of adherence with oral anticancer treatment. 'Beliefs about medicines' and 'illness perceptions' in particular determine adherence with this treatment. Studies aiming at impacting adherence would benefit from interventions with a solid basis in behavioral theory in order to help health care providers explore and address illness perceptions and medication beliefs. Pre-consultation screening of adherence behavior may be a helpful supportive approach to improve adherence. Blaming the victim ('patients should be educated about the importance of adherence') is better replaced by encouraging health professionals to identify and address maladaptive psychosocial determinants of adherence.