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Visintini C, Mansutti I, Palese A. What Are the Perceptions of Recipients of Allogeneic Hematopoietic Stem Cell Transplant About Medication Adherence?: A Synthesis of Qualitative Studies. Cancer Nurs 2024:00002820-990000000-00228. [PMID: 38498800 DOI: 10.1097/ncc.0000000000001344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Recipients of allogeneic hematopoietic stem cell transplant (HSCT) may encounter difficulties in adhering to their post-transplant medication as prescribed to avoid complications. Despite the relevance of patients' perspectives to inform the clinical practice, to date, no summary regarding their lived experience of oral medication adherence (MA) has been produced. OBJECTIVE To summarize the lived experience of MA by recipients of allogeneic HSCT as documented in qualitative studies. METHODS A systematic review and meta-synthesis of qualitative research was performed. Six databases were searched up to June 27, 2023. Four qualitative studies met eligibility and were included: those designed and conducted with scientifically sound methodologies and those regarding adult patients who had undergone allogeneic HSCT and required an oral medication regimen in the post-transplant phase. Data were extracted and synthesized using thematic analysis. RESULTS Four analytical themes were identified: "The initiation is a challenge," "Time as a new issue," "Internal and external obstacles threaten medication adherence," and "Different strategies are the answer to medication non-adherence." CONCLUSIONS Medication adherence in patients after HSCT is a complex phenomenon wherein different factors play a role. When designing targeted interventions to improve MA, it is imperative to start with patients' experiences and perspectives. IMPLICATIONS FOR PRACTICE Patients developed different strategies to deal with obstacles to MA that may inform daily practice. Before discharge, healthcare professionals should emphasize to both patients and carers the importance of MA.
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Affiliation(s)
- Chiara Visintini
- Author Affiliations: Department of Biomedicine and Prevention, University of Rome Tor Vergata (Ms Visintini); and School of Nursing, Department of Medical Sciences, University of Udine (Drs Mansutti and Palese), Italy
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McCune JS, Armenian SH, Nakamura R, Shan H, Kanakry CG, Mielcarek M, Gao W, Mager DE. Immunosuppressant adherence in adult outpatient hematopoietic cell transplant recipients. J Oncol Pharm Pract 2024; 30:322-331. [PMID: 37134196 PMCID: PMC10622331 DOI: 10.1177/10781552231171607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Medication nonadherence continues to be challenging for allogeneic hematopoietic cell transplant (HCT) recipients. The risk and severity of chronic graft-versus-host disease (GVHD) are associated with low immunosuppressant concentrations (which can be improved with model-informed precision dosing (MIPD)) and with immunosuppressant nonadherence (which can be improved with acceptable interventions). METHODS With the goals of improving adherence and achieving therapeutic concentrations of immunosuppressants to eliminate GVHD, we characterized the feasibility of using the Medication Event Monitoring (MEMS®) Cap in adult HCT recipients. RESULTS Of the 27 participants offered the MEMS® Cap at the time of hospital discharge, 7 (25.9%) used it, which is below our a priori threshold of 70%. These data suggest the MEMS® Cap is not feasible for HCT recipients. The MEMS® Cap data were available for a median of 35 days per participant per medication (range: 7-109 days). The average daily adherence per participant ranged from 0 to 100%; four participants had an average daily adherence of over 80%. CONCLUSIONS MIPD may be supported by MEMS® technology to provide the precise time of immunosuppressant self-administration. The MEMS® Cap was used by only a small percentage (25.9%) of HCT recipients in this pilot study. In accordance with larger studies using less accurate tools to evaluate adherence, immunosuppressant adherence varied from 0% to 100%. Future studies should establish the feasibility and clinical benefit of combining MIPD with newer technology, specifically the MEMS® Button, which can inform the oncology pharmacist of the time of immunosuppressant self-administration.
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Affiliation(s)
- Jeannine S. McCune
- Department of Hematologic Malignancies Translational Sciences, City of Hope, and Department of Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Saro H. Armenian
- Department of Population Sciences, City of Hope, and Department of Pediatrics, City of Hope Medical Center, Duarte, CA, USA
| | - Ryotaro Nakamura
- Department of Hematologic Malignancies Translational Sciences, City of Hope, and Department of Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Hayoue Shan
- Department of Biostatistics, City of Hope, Duarte, CA, USA
| | - Christopher G. Kanakry
- Experimental Transplantation and Immunotherapy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Marco Mielcarek
- Clinical Research Division, Fred Hutchinson Cancer Center and Department of Medical Oncology, University of Washington, Seattle, WA, USA
| | - Wei Gao
- Andrew and Peggy Cherng Department of Medical Engineering, Division of Engineering and Applied Science, California Institute of Technology, Pasadena, CA, USA
| | - Donald E. Mager
- Department of Pharmaceutical Sciences, University at Buffalo, SUNY, Buffalo, NY, USA
- Enhanced Pharmacodynamics, LLC, Buffalo, NY, USA
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Amato C, Iovino P, Longobucco Y, Salvadori E, Diaz RG, Castiglione S, Guadagno MG, Vellone E, Rasero L. Reciprocal associations between beliefs about medicines, health locus of control and adherence to immunosuppressive medication in allogeneic hematopoietic cell transplant patients: Findings from the ADE-TRAM study. Eur J Oncol Nurs 2023; 67:102410. [PMID: 37804755 DOI: 10.1016/j.ejon.2023.102410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/22/2023] [Accepted: 09/07/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Patients undergoing allogenic hematopoietic stem cell transplantation (allo-HSCT) are required to strictly adhere to immunosuppressive medications to avoid rejection and infective complications. Since medication adherence is among the most important modifiable behaviors to achieve better outcomes, the aims of this study were to measure the baseline and longitudinal trends of medication adherence and investigate the psychological factors associated with medication adherence in allo-HSCT patients. METHODS This was a single-center, longitudinal study of patients who underwent allo-HSCT to treat hematological malignancies at the University hospital of Florence (Italy). Adherence was measured with the Immunosuppressive Medication Self-Management Scale; psychological factors (i.e., beliefs about medicines and health locus of control) were measured with the Beliefs About Medicines Questionnaire and Multidimensional Health locus of Control Scale. Data were collected 1, 3, 6 and 12 months after discharge. A mixed effects model was performed after adjusting for demographic characteristics. RESULTS 50 adult patients were included in this study. Adherence to immunosuppressant was optimal and increased significantly 3 months after bone marrow transplantation (B = 0.23, p = 0.041). Patients with lower concerns about immunosuppressive medications were more likely to be adherent (B = 0.02, p = 0.040), while those having beliefs that their disease was due to external factors were less likely to be adherent (B = -0.02, p = 0.026) than their counterparts. CONCLUSIONS These results underline the importance of psychological factors in affecting adherence to immunosuppressants of allo-HSCT patients. Healthcare providers and researchers should target medication beliefs and reorient locus of control with appropriate interventions, in order to improve adherence.
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Affiliation(s)
- Carla Amato
- Health Sciences Department, University of Florence, Florence, Italy.
| | - Paolo Iovino
- Health Sciences Department, University of Florence, Florence, Italy.
| | - Yari Longobucco
- Health Sciences Department, University of Florence, Florence, Italy.
| | | | | | - Sabrina Castiglione
- Bone Marrow Transplantation Unit, Careggi University Hospital, Florence, Italy.
| | | | - Ercole Vellone
- Department of Biomedicine and Prevention University of Rome Tor Vergata, Rome, Italy; Department of Nursing and Obstetrics, Wroclaw Medical University, Poland.
| | - Laura Rasero
- Health Sciences Department, University of Florence, Florence, Italy.
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Ralph JE, Sezgin E, Stanek CJ, Landier W, Pai ALH, Gerhardt CA, Skeens MA. Improving medication adherence monitoring and clinical outcomes through mHealth: A randomized controlled trial protocol in pediatric stem cell transplant. PLoS One 2023; 18:e0289987. [PMID: 37590237 PMCID: PMC10434937 DOI: 10.1371/journal.pone.0289987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023] Open
Abstract
Medication non-adherence rates in children range between 50% and 80% in the United States. Due to multifaceted outpatient routines, children receiving hematopoietic stem cell transplant (HCT) are at especially high risk of non-adherence, which can be life-threatening. Although digital health interventions have been effective in improving non-adherence in many pediatric conditions, limited research has examined their benefits among families of children receiving HCT. To address this gap, we created the BMT4me© mobile health app, an innovative intervention serving as a "virtual assistant" to send medication-taking reminders for caregivers and to track, in real-time, the child's medication taking, barriers to missed doses, symptoms or side effects, and other notes regarding their child's treatment. In this randomized controlled trial, caregivers will be randomized to either the control (standard of care) group or the intervention (BMT4me© app) group at initial discharge post-HCT. Both groups will receive an electronic adherence monitoring device (i.e., medication event monitoring system "MEMS" cap, Medy Remote Patient Management "MedyRPM" medication adherence box) to store their child's immunosuppressant medication. Caregivers who agree to participate will be asked to complete enrollment, weekly, and monthly parent-proxy measures of their child's medication adherence until the child reaches Day 100 or complete taper from immunosuppression. Caregivers will also participate in a 15 to 30-minute exit interview at the conclusion of the study. Descriptive statistics and correlations will be used to assess phone activity and use behavior over time. Independent samples t-tests will examine the efficacy of the intervention to improve adherence monitoring and reduce readmission rates. The primary expected outcome of this study is that the BMT4me© app will improve the real-time monitoring and medication adherence in children receiving hematopoietic stem cell transplant following discharge, thus improving clinical outcomes.
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Affiliation(s)
- Jessica E. Ralph
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Emre Sezgin
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Charis J. Stanek
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Wendy Landier
- University of Alabama Birmingham School of Medicine, Birmingham, Alabama, United States of America
| | - Ahna L. H. Pai
- Cincinnati Children’s Hospital Medical Center & University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Cynthia A. Gerhardt
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Micah A. Skeens
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- The Ohio State University College of Medicine, Columbus, Ohio, United States of America
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Visintini C, Mansutti I, Palese A. Medication Adherence among Allogeneic Haematopoietic Stem Cell Transplant Recipients: A Systematic Review. Cancers (Basel) 2023; 15:cancers15092452. [PMID: 37173924 PMCID: PMC10177142 DOI: 10.3390/cancers15092452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
Recipients of a haematopoietic stem cell transplantation (HSCT) may experience issues in medication adherence (MA) when discharged. The primary aim of this review was to describe the oral MA prevalence and the tools used to evaluate it among these patients; the secondary aims were to summarise factors affecting medication non-adherence (MNA), interventions promoting MA, and outcomes of MNA. A systematic review (PROSPERO no. CRD42022315298) was performed by searching the Cumulative Index of Nursing and Allied Health (CINAHL), Cochrane Library, Excerpta Medica dataBASE (EMBASE), PsycINFO, PubMed and Scopus databases, and grey literature up to May 2022 by including (a) adult recipients of allogeneic HSCT, taking oral medications up to 4 years after HSCT; (b) primary studies published in any year and written in any language; (c) with an experimental, quasi-experimental, observational, correlational, and cross-sectional design; and (d) with a low risk of bias. We provide a qualitative narrative synthesis of the extracted data. We included 14 studies with 1049 patients. The median prevalence of MA was 61.8% and it has not decreased over time (immunosuppressors 61.5% [range 31.3-88.8%] and non-immunosuppressors 65.2% [range 48-100%]). Subjective measures of MA have been used most frequently (78.6%) to date. Factors affecting MNA are younger age, higher psychosocial risk, distress, daily immunosuppressors, decreased concomitant therapies, and experiencing more side effects. Four studies reported findings about interventions, all led by pharmacists, with positive effects on MA. Two studies showed an association between MNA and chronic graft-versus-host disease. The variability in adherence rates suggests that the issues are relevant and should be carefully considered in daily practice. MNA has a multifactorial nature and thus requires multidisciplinary care models.
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Affiliation(s)
- Chiara Visintini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Irene Mansutti
- School of Nursing, Department of Medical Sciences, University of Udine, 33100 Udine, Italy
| | - Alvisa Palese
- School of Nursing, Department of Medical Sciences, University of Udine, 33100 Udine, Italy
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Redondo S, De Dios A, Gomis-Pastor M, Esquirol A, Aso O, Triquell M, Moreno ME, Riba M, Ruiz J, Blasco A, Tobajas E, González I, Sierra J, Martino R, García-Cadenas I. Feasibility of a new model of care for allogeneic stem cell transplantation recipients facilitated by eHealth: The MY-Medula pilot study. Transplant Cell Ther 2023:S2666-6367(23)01175-2. [PMID: 36948273 DOI: 10.1016/j.jtct.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND The use of allogeneic stem cell transplantation (allo-SCT) for the treatment of hematologic diseases is steadily increasing. However, allo-SCT has the downside of causing considerable treatment-related morbidity and mortality. Mobile technology applied to healthcare (mHealth) has proven to be a cost-effective strategy to improve care and offer new services to people with multimorbidity, but there are few data on its usefulness in allo-SCT recipients. OBJECTIVE The aim of this report was to describe a new integrated healthcare model facilitated by an mHealth platform, named EMMASalud-MY-Medula, and to report the results of a le. STUDY DESIGN The MY-Medula platform development approach consisted of 4 phases. Firstly, patient and healthcare professional needs were identified and technological development and pre-testing tests were conducted (phases 1-3, January 2016-March 2021). Then, a non-randomized, prospective, observational, single-center pilot study was conducted (October 2021-January 2022) at the adult Stem Cell Transplant Unit of a tertiary university hospital. RESULTS Twenty-eight volunteer allo-SCT recipients were included in the pilot study. Fifty percent were outpatients in the first-year post-SCT and the remaining 50% were affected by steroid-dependent graft-versus-host disease (SR-GVHD). All patients used MY-Medula application during the two-month follow-up period with a median number of visits to the application of 143 (range 6-477). A total of 2067 self-monitoring records were made, and 205 text messages were received, most of them related to symptoms description (47%) and doubts about medication (21%). In 3.4% of the cases drug dose adjustments were performed by the pharmacist because of dosing errors or interactions. At the end of the study, a 6-question Likert-type questionnaire for patients and a 22-question test for healthcare professionals showed a high degree of satisfaction (95% and 100% respectively) with the new healthcare pathway. CONCLUSIONS Re-engineering allo-SCT recipients follow-up into an integrated, multidisciplinary model of care facilitated by mHealth tools is feasible and has been associated with a high usability and degree of satisfaction by patients and healthcare professionals. A randomized trial aiming to determine the cost-effectiveness of MY-Medula-based follow-up post-SCT is currently enrolling participants.
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Affiliation(s)
- S Redondo
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universitat Autónoma de Barcelona, Spain.
| | - A De Dios
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau.; Digital Health Department, Hospital de la Santa Creu i Sant Pau
| | - M Gomis-Pastor
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau.; Digital Health Department, Hospital de la Santa Creu i Sant Pau
| | - A Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universitat Autónoma de Barcelona, Spain
| | - O Aso
- Hematology Nursing Department, Hospital de la Santa Creu i Sant Pau
| | - M Triquell
- Hematology Nursing Department, Hospital de la Santa Creu i Sant Pau
| | - M E Moreno
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau
| | - M Riba
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau
| | - J Ruiz
- Nutrition and Dietetics Department, Hospital de la Santa Creu i Sant Pau
| | - A Blasco
- Nutrition and Dietetics Department, Hospital de la Santa Creu i Sant Pau
| | - E Tobajas
- Psycho-Oncology Department, Hospital de la Santa Creu i Sant Pau
| | - I González
- Hematology Nursing Department, Hospital de la Santa Creu i Sant Pau
| | - J Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universitat Autónoma de Barcelona, Spain
| | - R Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universitat Autónoma de Barcelona, Spain
| | - I García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universitat Autónoma de Barcelona, Spain
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Shen G, Moua KTY, Perkins K, Johnson D, Li A, Curtin P, Gao W, McCune JS. Precision sirolimus dosing in children: The potential for model-informed dosing and novel drug monitoring. Front Pharmacol 2023; 14:1126981. [PMID: 37021042 PMCID: PMC10069443 DOI: 10.3389/fphar.2023.1126981] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/14/2023] [Indexed: 04/07/2023] Open
Abstract
The mTOR inhibitor sirolimus is prescribed to treat children with varying diseases, ranging from vascular anomalies to sporadic lymphangioleiomyomatosis to transplantation (solid organ or hematopoietic cell). Precision dosing of sirolimus using therapeutic drug monitoring (TDM) of sirolimus concentrations in whole blood drawn at the trough (before the next dose) time-point is the current standard of care. For sirolimus, trough concentrations are only modestly correlated with the area under the curve, with R 2 values ranging from 0.52 to 0.84. Thus, it should not be surprising, even with the use of sirolimus TDM, that patients treated with sirolimus have variable pharmacokinetics, toxicity, and effectiveness. Model-informed precision dosing (MIPD) will be beneficial and should be implemented. The data do not suggest dried blood spots point-of-care sampling of sirolimus concentrations for precision dosing of sirolimus. Future research on precision dosing of sirolimus should focus on pharmacogenomic and pharmacometabolomic tools to predict sirolimus pharmacokinetics and wearables for point-of-care quantitation and MIPD.
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Affiliation(s)
- Guofang Shen
- Department of Hematologic Malignancies Translational Sciences, City of Hope, and Department of Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, United States
| | - Kao Tang Ying Moua
- Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA, United States
| | - Kathryn Perkins
- Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA, United States
| | - Deron Johnson
- Clinical Informatics, City of Hope Medical Center, Duarte, CA, United States
| | - Arthur Li
- Division of Biostatistics, City of Hope, Duarte, CA, United States
| | - Peter Curtin
- Department of Hematologic Malignancies Translational Sciences, City of Hope, and Department of Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, United States
| | - Wei Gao
- Division of Engineering and Applied Science, Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA, United States
| | - Jeannine S. McCune
- Department of Hematologic Malignancies Translational Sciences, City of Hope, and Department of Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, United States
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Kolgaeva EI, Drokov MY, Vybornykh DE. Treatment adherence in patients with blood system diseases and recipients of allogeneic organs and tissues. ONCOHEMATOLOGY 2023. [DOI: 10.17650/1818-8346-2023-18-1-132-141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- E. I. Kolgaeva
- National Medical Research Center for Hematology, Ministry of Health of Russia
| | - M. Yu. Drokov
- National Medical Research Center for Hematology, Ministry of Health of Russia
| | - D. E. Vybornykh
- National Medical Research Center for Hematology, Ministry of Health of Russia
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Visintini C, Mansutti I, Palese A. Medication adherence among allogeneic haematopoietic stem cell transplant recipients: a systematic review protocol. BMJ Open 2022; 12:e065676. [PMID: 36456011 PMCID: PMC9717329 DOI: 10.1136/bmjopen-2022-065676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Patients receiving a haematopoietic stem cell transplant (HSCT) are subjected to complex oral medications based on prophylactic and immunosuppressive treatments. Adherence to medication plays a role in survival, and medication non-adherence (MNA) is closely associated with graft-versus-host disease and other complications. The aim of this systematic review is to summarise the available evidence regarding prevalence rates of medication adherence, the risk factors of MNA, the effectiveness of interventions to increase medication adherence and the outcomes associated with MNA. METHODS AND ANALYSIS We designed a systematic review according to the Joanna Briggs Institute methodology. We will search the Cochrane Library and the CINAHL, EMBASE, MEDLINE via PubMed, PsycINFO and Scopus databases. We will include published and unpublished primary studies: (a) on humans, from inception until 10 May 2022; (b) written in any language; (c) experimental (randomised and non-randomised), observational (prospective, retrospective cohort and case-control), correlational, cross-sectional and longitudinal; and (d) with a low risk of bias, according to the quality assessment we perform. We will exclude secondary and qualitative studies, protocols, publications without original data, including paediatrics or related to autologous HSCT. The primary outcome will be the prevalence of oral medication adherence; the secondary outcomes will be the risk factors of MNA, the interventions aimed at increasing medication adherence and the outcomes of MNA. Two researchers will independently screen the eligible studies, then extract and describe the data. Disagreements will be resolved by a third researcher. We will provide a qualitative narrative synthesis of the findings. ETHICS AND DISSEMINATION Ethical approval is not required given that previously published studies will be used. We will disseminate the findings through conference presentations and publications in international peer-reviewed scientific journals. PROSPERO REGISTRATION NUMBER CRD42022315298.
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Affiliation(s)
- Chiara Visintini
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Irene Mansutti
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Alvisa Palese
- Department of Medical Sciences, University of Udine, Udine, Italy
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Mielke J, Leppla L, Valenta S, Zullig LL, Zúñiga F, Staudacher S, Teynor A, De Geest S. Unraveling implementation context: the Basel Approach for coNtextual ANAlysis (BANANA) in implementation science and its application in the SMILe project. Implement Sci Commun 2022; 3:102. [PMID: 36183141 PMCID: PMC9526967 DOI: 10.1186/s43058-022-00354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Designing intervention and implementation strategies with careful consideration of context is essential for successful implementation science projects. Although the importance of context has been emphasized and methodology for its analysis is emerging, researchers have little guidance on how to plan, perform, and report contextual analysis. Therefore, our aim was to describe the Basel Approach for coNtextual ANAlysis (BANANA) and to demonstrate its application on an ongoing multi-site, multiphase implementation science project to develop/adapt, implement, and evaluate an integrated care model in allogeneic SteM cell transplantatIon facILitated by eHealth (the SMILe project). METHODS BANANA builds on guidance for assessing context by Stange and Glasgow (Contextual factors: the importance of considering and reporting on context in research on the patient-centered medical home, 2013). Based on a literature review, BANANA was developed in ten discussion sessions with implementation science experts and a medical anthropologist to guide the SMILe project's contextual analysis. BANANA's theoretical basis is the Context and Implementation of Complex Interventions (CICI) framework. Working from an ecological perspective, CICI acknowledges contextual dynamics and distinguishes between context and setting (the implementation's physical location). RESULTS BANANA entails six components: (1) choose a theory, model, or framework (TMF) to guide the contextual analysis; (2) use empirical evidence derived from primary and/or secondary data to identify relevant contextual factors; (3) involve stakeholders throughout contextual analysis; (4) choose a study design to assess context; (5) determine contextual factors' relevance to implementation strategies/outcomes and intervention co-design; and (6) report findings of contextual analysis following appropriate reporting guidelines. Partly run simultaneously, the first three components form a basis both for the identification of relevant contextual factors and for the next components of the BANANA approach. DISCUSSION Understanding of context is indispensable for a successful implementation science project. BANANA provides much-needed methodological guidance for contextual analysis. In subsequent phases, it helps researchers apply the results to intervention development/adaption and choices of contextually tailored implementation strategies. For future implementation science projects, BANANA's principles will guide researchers first to gather relevant information on their target context, then to inform all subsequent phases of their implementation science project to strengthen every part of their work and fulfill their implementation goals.
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Affiliation(s)
- Juliane Mielke
- grid.6612.30000 0004 1937 0642Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland
| | - Lynn Leppla
- grid.6612.30000 0004 1937 0642Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland ,grid.7708.80000 0000 9428 7911Department of Medicine I, Faculty of Medicine, Medical Center University of Freiburg, Freiburg im Breisgau, Germany
| | - Sabine Valenta
- grid.6612.30000 0004 1937 0642Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland ,grid.410567.1Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Leah L. Zullig
- grid.26009.3d0000 0004 1936 7961Center for Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care & System, and Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC USA
| | - Franziska Zúñiga
- grid.6612.30000 0004 1937 0642Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland
| | - Sandra Staudacher
- grid.6612.30000 0004 1937 0642Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland ,grid.5012.60000 0001 0481 6099Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Alexandra Teynor
- grid.440970.e0000 0000 9922 6093University of Applied Sciences Augsburg, Faculty of Computer Science, Augsburg, Germany
| | - Sabina De Geest
- grid.6612.30000 0004 1937 0642Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland ,grid.5596.f0000 0001 0668 7884Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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De Geest S, Valenta S, Ribaut J, Gerull S, Mielke J, Simon M, Bartakova J, Kaier K, Eckstein J, Leppla L, Teynor A. The SMILe integrated care model in allogeneic SteM cell TransplantatIon faciLitated by eHealth: a protocol for a hybrid effectiveness-implementation randomised controlled trial. BMC Health Serv Res 2022; 22:1067. [PMID: 35987671 PMCID: PMC9392360 DOI: 10.1186/s12913-022-08293-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/05/2022] [Indexed: 02/06/2023] Open
Abstract
Background While effectiveness outcomes of eHealth-facilitated integrated care models (eICMs) in transplant and oncological populations are promising, implementing and sustaining them in real-world settings remain challenging. Allogeneic stem cell transplant (alloSCT) patients could benefit from an eICM to enhance health outcomes. To combat health deterioration, integrating chronic illness management, including continuous symptom and health behaviour monitoring, can shorten reaction times. We will test the 1st-year post-alloSCT effectiveness and evaluate bundled implementation strategies to support the implementation of a newly developed and adapted eICM in allogeneic stem cell transplantation facilitated by eHealth (SMILe–ICM). SMILe-ICM has been designed by combining implementation, behavioural, and computer science methods. Adaptions were guided by FRAME and FRAME-IS. It consists of four modules: 1) monitoring & follow-up; 2) infection prevention; 3) physical activity; and 4) medication adherence, delivered via eHealth and a care coordinator (an Advanced Practice Nurse). The implementation was supported by contextually adapted implementation strategies (e.g., creating new clinical teams, informing local opinion leaders). Methods Using a hybrid effectiveness-implementation randomised controlled trial, we will include a consecutive sample of 80 adult alloSCT patients who were transplanted and followed by University Hospital Basel (Switzerland). Inclusion criteria are basic German proficiency; elementary computer literacy; internet access; and written informed consent. Patients will be excluded if their condition prevents the use of technology, or if they are followed up only at external centres. Patient-level (1:1) stratified randomisation into a usual care group and a SMILe-ICM group will take place 10 days pre-transplantation. To gauge the SMILe–ICM’s effectiveness primary outcome (re-hospitalisation rate), secondary outcomes (healthcare utilization costs; length of inpatient re-hospitalizations, medication adherence; treatment and self-management burden; HRQoL; Graft-versus-Host Disease rate; survival; overall survival rate) and implementation outcomes (acceptability, appropriateness, feasibility, fidelity), we will use multi-method, multi-informant assessment (via questionnaires, interviews, electronic health record data, cost capture methods). Discussion The SMILe–ICM has major innovative potential for reengineering alloSCT follow-up care, particularly regarding short- and medium-term outcomes. Our dual focus on implementation and effectiveness will both inform optimization of the SMILe-ICM and provide insights regarding implementation strategies and pathway, understudied in eHealth-facilitated ICMs in chronically ill populations. Trial registration ClinicalTrials.gov. Identifier: NCT04789863. Registered April 01, 2021.
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Rates and Predictors of Nonadherence to the Post-Allogeneic Hematopoietic Cell Transplantation Medical Regimen in Patients and Caregivers. Transplant Cell Ther 2022; 28:165.e1-165.e9. [PMID: 34875403 PMCID: PMC9004486 DOI: 10.1016/j.jtct.2021.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/18/2021] [Accepted: 11/28/2021] [Indexed: 11/20/2022]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) requires a complex, multicomponent medical regimen after hospital discharge. Patients must manage multiple medications; care for their catheter; minimize exposure to sources of potential infection; follow diet, exercise, and self-care guidelines; and attend frequent follow-up medical appointments. Their caregivers are tasked with helping them manage the regimen. Despite the importance of this management in preventing adverse clinical outcomes, there has been little study of regimen nonadherence and its predictors. We sought to prospectively determine rates and predictors of nonadherence to components of the post-HCT medical regimen during the first 8 weeks after hospital discharge. Patients (n = 92) and their caregivers (n = 91) (total n = 183) completed interview assessments pre-HCT, and at 4 weeks and 8 weeks after hospital discharge post-HCT. Sociodemographic factors (eg, age, sex), patient clinical status (eg, disease type, donor type), patient and caregiver self-reported health-related factors (eg, medical comorbidities), and patient and caregiver psychosocial factors (eg, anxiety, depression, HCT task-specific and general self-efficacy, relationship quality) were assessed pre-HCT. Nonadherence to each of 17 regimen tasks was assessed at 4 and 8 weeks after hospital discharge via self and caregiver collateral reports. Nonadherence rates varied among tasks, with 11.2% to 15.7% of the sample reporting nonadherence to immunosuppressant medication, 34.8% to 38.6% to other types of medications, 14.6% to 67.4% to required infection precautions, and 27.0% to 68.5% to lifestyle-related behaviors (eg, diet/exercise). Nonadherence rates were generally stable but worsened over time for lifestyle-related behaviors. The most consistent nonadherence predictors were patient and caregiver pre-HCT perceptions of lower HCT task efficacy. Higher caregiver depression, caregiver perceptions of poorer relationship with the patient, having a nonspousal caregiver, and having diseases other than acute myelogenous leukemia also predicted greater nonadherence in 1 or more areas. Rates of nonadherence varied across tasks, and both patient and caregiver factors, particularly self-efficacy, predicted nonadherence. The findings highlight the importance of considering not only patient factors, but also caregiver factors, in post-HCT regimen nonadherence.
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Sun D, Heimall JR, Greenhawt MJ, Bunin NJ, Shaker MS, Romberg N. Cost Utility of Lifelong Immunoglobulin Replacement Therapy vs Hematopoietic Stem Cell Transplant to Treat Agammaglobulinemia. JAMA Pediatr 2022; 176:176-184. [PMID: 34779842 PMCID: PMC8593831 DOI: 10.1001/jamapediatrics.2021.4583] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Lifelong immunoglobulin replacement therapy (IRT) is standard-of-care treatment for congenital agammaglobulinemia but accrues high annual costs ($30 000-$90 000 per year) and decrements to quality of life over patients' life spans. Hematopoietic stem cell transplant (HSCT) offers an alternative 1-time therapy, but has high morbidity and mortality. OBJECTIVE To evaluate the cost utility of IRT vs matched sibling donor (MSD) and matched unrelated donor (MUD) HSCT to treat patients with agammaglobulinemia in the US. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation used Markov analysis to model the base-case scenario of a patient aged 12 months with congenital agammaglobulinemia receiving lifelong IRT vs MSD or MUD HSCT. Costs, probabilities, and quality-of-life measures were derived from the literature. Microsimulations estimated premature deaths for each strategy in a virtual cohort. One-way sensitivity and probabilistic sensitivity analyses evaluated uncertainty around parameter estimates performed from a societal perspective over a 100-year time horizon. The threshold for cost-effective care was set at $100 000 per quality-adjusted life-year (QALY). This study was conducted from 2020 across a 100-year time horizon. EXPOSURES Immunoglobulin replacement therapy vs MSD or MUD HSCT for treatment of congenital agammaglobulinemia. MAIN OUTCOMES AND MEASURES The primary outcomes were incremental cost-effectiveness ratio (ICER) expressed in 2020 US dollars per QALY gained and premature deaths associated with each strategy. RESULTS In this economic evaluation of patients with congenital agammaglobulinemia, lifelong IRT cost more than HSCT ($1 512 946 compared with $563 776 [MSD] and $637 036 [MUD]) and generated similar QALYs (20.61 vs 17.25 [MSD] and 17.18 [MUD]). Choosing IRT over MSD or MUD HSCT yielded ICERs of $282 166 per QALY gained over MSD and $255 633 per QALY gained over MUD HSCT, exceeding the US willingness-to-pay threshold of $100 000/QALY. However, IRT prevented at least 2488 premature deaths per 10 000 microsimulations compared with HSCT. When annual IRT price was reduced from $60 145 to below $29 469, IRT became the cost-effective strategy. Findings remained robust in sensitivity and probabilistic sensitivity analyses. CONCLUSIONS AND RELEVANCE In the US, IRT is more expensive than HSCT for agammaglobulinemia treatment. The findings of this study suggest that IRT prevents more premature deaths but does not substantially increase quality of life relative to HSCT. Reducing US IRT cost by 51% to a value similar to IRT prices in countries implementing value-based pricing may render it the more cost-effective strategy.
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Affiliation(s)
- Di Sun
- Department of Pediatrics, Division of Allergy and Immunology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jennifer R. Heimall
- Department of Pediatrics, Division of Allergy and Immunology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Matthew J. Greenhawt
- Children's Hospital Colorado, Section of Allergy and Immunology, Food Challenge and Research Unit, Aurora,Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Nancy J. Bunin
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Department of Pediatrics, Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Marcus S. Shaker
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, New Hampshire
| | - Neil Romberg
- Department of Pediatrics, Division of Allergy and Immunology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Ribaut J, De Geest S, Leppla L, Gerull S, Teynor A, Valenta S. Exploring Stem Cell Transplanted Patients' Perspectives on Medication Self-Management and Electronic Monitoring Devices Measuring Medication Adherence: A Qualitative Sub-Study of the Swiss SMILe Implementation Science Project. Patient Prefer Adherence 2022; 16:11-22. [PMID: 35023905 PMCID: PMC8747798 DOI: 10.2147/ppa.s337117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/22/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Little is known about allogeneic stem cell transplant (alloSCT) patients' medication adherence strategies. Acceptability and preferences regarding electronic monitoring (EM) systems to assess all three phases of medication adherence (ie, initiation, implementation, persistence) are crucial to allow their successful implementation in clinical or research settings but have not yet been evaluated. We therefore aimed to explore: 1) alloSCT patients' medication adherence and self-management strategies; and 2) their acceptability and preferences of three different EM systems (MEMS Cap, Helping Hand, Button) as part of the Swiss SMILe study. PATIENTS AND METHODS Respecting anti-pandemic measures, we used a purposive sample of six adult alloSCT patients from the University Hospital Basel, Switzerland (USB)-6 weeks to 2 years post-alloSCT-to conduct three focus group sessions with two patients each. Using a semi-structured outline, we explored 1) patients' medication adherence strategies and medication self-management; and 2) their acceptance and preferences regarding EM use. The three tested EM systems were available for testing during each session. Discussions were audio-recorded, visualized using mind-mapping and analyzed using Mayring's qualitative content analysis. RESULTS Patients (33% females; mean age 54.6±16.3 years; 10.4±8.4 months post-alloSCT) used medication adherence enhancing strategies (eg, preparing pillbox, linking intake to a habit). Still, they indicated that post-alloSCT medication management was challenging (eg, frequent schedule changes). All participants preferred the MEMS Button. Participants said its small size and the possibility to combine it with existing pillboxes (eg, putting it into/next to them) made them more confident about implementing it in their daily lives. CONCLUSION Regarding EM systems for medication adherence, end-user preferences and acceptability influence adoption and fidelity. Of the three systems tested, our sample found the MEMS Button most acceptable and most preferable. Therefore, we will use it for our USB SMILe study.
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Affiliation(s)
- Janette Ribaut
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Theragnostic, Hematology, University Hospital of Basel, Basel, Switzerland
| | - Sabina De Geest
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Lynn Leppla
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- Departments of Hematology, Oncology and Stem Cell Transplantation, Medical Center University of Freiburg, Freiburg, Germany
| | - Sabine Gerull
- Department of Theragnostic, Hematology, University Hospital of Basel, Basel, Switzerland
- Department of Hematology, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Alexandra Teynor
- Department of Computer Science, University of Applied Sciences, Augsburg, Germany
| | - Sabine Valenta
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Theragnostic, Hematology, University Hospital of Basel, Basel, Switzerland
- Correspondence: Sabine Valenta Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Bernoullistrasse 28, Basel, CH-4056, SwitzerlandTel +41 61 32 85275 Email
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Kostalova B, Ribaut J, Dobbels F, Gerull S, Mala-Ladova K, Zullig LL, De Geest S. Medication adherence interventions in transplantation lack information on how to implement findings from randomized controlled trials in real-world settings: A systematic review. Transplant Rev (Orlando) 2021; 36:100671. [PMID: 34773910 DOI: 10.1016/j.trre.2021.100671] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/19/2021] [Accepted: 09/19/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Growing numbers of randomized controlled trials (RCTs) are showing the effectiveness of interventions to improve medication adherence in transplantation recipients. However, real-world implementation is still a major challenge. This systematic review assesses the range of information available in RCTs supporting these interventions' clinical adoption in adult transplant populations. METHODS We included RCTs of interventions that a) targeted any phase of medication adherence in solid organ or allogeneic stem cell transplantation recipients and b) were published between January 2015 and November 2020. We excluded study protocols, conference abstracts and studies focusing only on pediatric populations. We identified relevant database and trial registries as well as traced references backward and citations forward. Implementation-relevant information was evaluated using adapted versions of Peters' ten criteria: 1. healthcare/organizational context; 2. social/economic/policy context; 3. patient involvement; 4. other stakeholder involvement; 5. sample representativeness; 6. trial conducted in a real-world-setting; 7. presence of feasibility study; 8. implementation strategy; 9. process evaluation; 10. implementation outcomes, using a stoplight color-rating system. RESULTS Screening 17'004 titles/abstracts resulted in 23 eligible RCTs, including 2'339 patients (n = 19-209/study). All included studies focused on the implementation phase of medication adherence. The best-reported criteria were feasibility study (43%), representative sample (17%) and conducted in a real-world-setting (17%). Least reported were context (9%), implementation strategies (4%), process evaluation (4%). CONCLUSIONS RCTs testing medication adherence interventions tend to report limited implementation-relevant information. This hinders their translation to real-world transplant settings. Integrating implementation science principles early in the conceptualization of RCTs would fuel real-world-translation, reducing research waste.
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Affiliation(s)
- Barbora Kostalova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Akademika Heyrovskeho 1203, 500 05 Hradec Kralove, Czech Republic.
| | - Janette Ribaut
- Institute of Nursing Science, Department of Public Health, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Department of Theragnostic, Hematology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Fabienne Dobbels
- Institute of Nursing Science, Department of Public Health, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35 blok d, box 7001, 3000 Leuven, Belgium.
| | - Sabine Gerull
- Department of Theragnostic, Hematology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland; Department of Hematology, Cantonal Hospital of Aarau, Tellstrasse 25, 5001 Aarau, Switzerland.
| | - Katerina Mala-Ladova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Akademika Heyrovskeho 1203, 500 05 Hradec Kralove, Czech Republic.
| | - Leah L Zullig
- Department of Population Health Science, Duke University, 215 Morris St, Durham, NC 27701, USA; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton St, Durham, NC 27705, USA.
| | - Sabina De Geest
- Institute of Nursing Science, Department of Public Health, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35 blok d, box 7001, 3000 Leuven, Belgium.
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Cazeau N. Mobile Health Interventions: Examining Medication Adherence Outcomes Among Patients With Cancer. Clin J Oncol Nurs 2021; 25:431-438. [PMID: 34269338 DOI: 10.1188/21.cjon.431-438] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Treatment for cancer is trending toward oral therapies, which patients can self-manage from home. Proper adherence to oral therapy is vital to safe and optimal care in this setting. Mobile health interventions (i.e., text message reminders, mobile applications, and automated calls) are an evolving strategy aimed at improving medication adherence for patients on long-term oral therapies. OBJECTIVES This review aims to provide an overview of research outcomes for the use of mobile health interventions among patients with cancer. METHODS A comprehensive review of CINAHL®, MEDLINE®, and PubMed® was completed. Eleven articles were eligible for inclusion in this review. FINDINGS Mobile health interventions are an acceptable approach among patients with cancer and may improve adherence outcomes for those at highest risk for suboptimal adherence.
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Leppla L, Schmid A, Valenta S, Mielke J, Beckmann S, Ribaut J, Teynor A, Dobbels F, Duerinckx N, Zeiser R, Engelhardt M, Gerull S, De Geest S. Development of an integrated model of care for allogeneic stem cell transplantation facilitated by eHealth-the SMILe study. Support Care Cancer 2021; 29:8045-8057. [PMID: 34224016 PMCID: PMC8550349 DOI: 10.1007/s00520-021-06328-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 05/30/2021] [Indexed: 11/29/2022]
Abstract
Purpose Allogeneic stem cell transplantation would benefit from re-engineering care towards an integrated eHealth-facilitated care model. With this paper we aim to: (1) describe the development of an integrated care model (ICM) in allogeneic SteM-cell-transplantatIon faciLitated by eHealth (SMILe) by combining implementation, behavioral, and computer science methods (e.g., contextual analysis, Behavior Change Wheel, and user-centered design combined with agile software development); and (2) describe that model’s characteristics and its application in clinical practice. Methods The SMILe intervention’s development consisted of four steps, with implementation science methods informing each: (1) planning its set-up within a theoretical foundation; (2) using behavioral science methods to develop the content; (3) choosing and developing its delivery method (human/technology) using behavioral and computer science methods; and (4) describing its characteristics and application in clinical practice. Results The SMILe intervention is embedded within the eHealth enhanced Chronic Care Model, entailing four self-management intervention modules, targeting monitoring and follow-up of important medical and symptom-related parameters, infection prevention, medication adherence, and physical activity. Interventions are delivered partly face-to-face by a care coordinator embedded within the transplant team, and partly via the SMILeApp that connects patients to the transplant team, who can monitor and rapidly respond to any relevant changes within 1 year post-transplant. Conclusion This paper provides stepwise guidance on how implementation, behavioral, and computer science methods can be used to develop interventions aiming to improve care for stem cell transplant patients in real-world clinical settings. This new care model is currently being tested in a hybrid I effectiveness-implementation trial. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06328-0.
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Affiliation(s)
- Lynn Leppla
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
- Department of Medicine I, Faculty of Medicine, Medical Center University of Freiburg, Freiburg im Breisgau, Germany
| | - Anja Schmid
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
- Department of Medicine I, Faculty of Medicine, Medical Center University of Freiburg, Freiburg im Breisgau, Germany
| | - Sabine Valenta
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Juliane Mielke
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
| | - Sonja Beckmann
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
- Center of Clinical Nursing Science, University Hospital Zurich, Zürich, Switzerland
| | - Janette Ribaut
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Alexandra Teynor
- Faculty of Computer Science, University of Applied Sciences Augsburg, Augsburg, Germany
| | - Fabienne Dobbels
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Nathalie Duerinckx
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Robert Zeiser
- Department of Medicine I, Faculty of Medicine, Medical Center University of Freiburg, Freiburg im Breisgau, Germany
| | - Monika Engelhardt
- Department of Medicine I, Faculty of Medicine, Medical Center University of Freiburg, Freiburg im Breisgau, Germany
| | - Sabine Gerull
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Sabina De Geest
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland.
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056, Basel, Switzerland.
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Charra F, Philippe M, Herledan C, Caffin AG, Larbre V, Baudouin A, Schwiertz V, Vantard N, Labussiere-Wallet H, Ducastelle-Leprêtre S, Barraco F, Balsat M, Larcher MV, Salles G, Rioufol C, Ranchon F. Immunosuppression medication adherence after allogeneic hematopoietic stem cell transplant: Impact of a specialized clinical pharmacy program. J Oncol Pharm Pract 2021:10781552211000115. [PMID: 33683151 DOI: 10.1177/10781552211000115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aims to evaluate the impact of implementing a specialized clinical pharmacy program in patients with allogeneic hematopoietic stem cell transplant (HSCT) on their adherence to the immunosuppression treatment after discharge. A prospective open interventional design using a retrospective control group was used. The intervention was based on pharmaceutical consultations: the first was performed the day before discharge of HSCT unit and the next consultations during day-care follow-up (weeks 2 and 4 after discharge). Proactive medication reconciliation was implemented with a complete list of medications before the discharge prescription. The discharge prescription summarized on a personalized drug schedule was explained to the patient. The importance of optimal adherence and the potential problems related to self-medication were explained to the patient. Immunosuppression drug adherence was assessed by a direct method using serum levels of calcineurin inhibitors. The potential impact on acute GvHD, and infection was investigated. Twenty-six patients were included in the specialized clinical pharmacy program and 35 patients were in the control group. Seventy-nine pharmaceutical consultations were conducted in the intervention group, lasting a mean 25 min and 16 min for the first and following consultations, respectively. Serum levels in the therapeutic target range were higher in the intervention group (61.5% versus 53.0%, p = 0.07), with greater intra-individual variation (p = 0.005). There was no significant intergroup difference in acute GvHD (53.8% versus 50.3%, p = 0.85) or infection (26.9 versus 22.8%, p = 0.72). The implementation of a specialized clinical pharmacy program for patients who have received allogeneic HSCT seems to be beneficial for immunosuppression drug adherence; this now needs to be confirmed in a multicenter study involving a larger number of patients.
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Affiliation(s)
- Florent Charra
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
| | - Michael Philippe
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
| | - Chloé Herledan
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
- University Lyon 1, EA CICLY Centre pour l'innovation en cancérologie, Lyon, France
| | - Anne-Gaëlle Caffin
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
| | - Virginie Larbre
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
- University Lyon 1, EA CICLY Centre pour l'innovation en cancérologie, Lyon, France
| | - Amandine Baudouin
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
| | - Vérane Schwiertz
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
| | - Nicolas Vantard
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
| | - Hélène Labussiere-Wallet
- Hospices Civils de Lyon, Hematology Department, Blood and Marrow Transplantation Unit, Pierre Bénite, France
| | - Sophie Ducastelle-Leprêtre
- Hospices Civils de Lyon, Hematology Department, Blood and Marrow Transplantation Unit, Pierre Bénite, France
| | - Fiorenza Barraco
- Hospices Civils de Lyon, Hematology Department, Blood and Marrow Transplantation Unit, Pierre Bénite, France
| | - Marie Balsat
- Hospices Civils de Lyon, Hematology Department, Blood and Marrow Transplantation Unit, Pierre Bénite, France
| | - Marie Virginie Larcher
- Hospices Civils de Lyon, Hematology Department, Blood and Marrow Transplantation Unit, Pierre Bénite, France
| | - Gilles Salles
- Hospices Civils de Lyon, Hematology Department, Blood and Marrow Transplantation Unit, Pierre Bénite, France
| | - Catherine Rioufol
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
- University Lyon 1, EA CICLY Centre pour l'innovation en cancérologie, Lyon, France
| | - Florence Ranchon
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
- University Lyon 1, EA CICLY Centre pour l'innovation en cancérologie, Lyon, France
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Zarif-Yeganeh M, Kargar M. Comparison of the effect of different methods of cyclosporine infusion on transplant-related outcomes in allogeneic transplant recipients. J Oncol Pharm Pract 2021; 27:778-779. [PMID: 33626988 DOI: 10.1177/1078155221996761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Morvarid Zarif-Yeganeh
- Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mona Kargar
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
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20
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Scherer S, Scheid C, von Bergwelt M, Hellmich M, Albus C, Vitinius F. Psychosocial Pre-Transplant Screening With the Transplant Evaluation Rating Scale Contributes to Prediction of Survival After Hematopoietic Stem Cell Transplantation. Front Psychiatry 2021; 12:741438. [PMID: 34690843 PMCID: PMC8533822 DOI: 10.3389/fpsyt.2021.741438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/07/2021] [Indexed: 11/13/2022] Open
Abstract
There is no standard in hematopoietic stem cell transplantations (HSCT) for pre-transplant screening of psychosocial risk factors, e.g., regarding immunosuppressant non-adherence. The aim of this prospective study is to explore the predictive value of the pretransplant psychosocial screening instrument Transplant Evaluation Rating Scale (TERS) for mortality in a 3-year follow-up. Between 2012 and 2017 61 patients were included and classified as low (TERS = 26.5-29) and increased-risk group (TERS = 29.5-79.5). Both groups were compared regarding mortality until 36 months after transplantation and secondary outcomes [Medication Experience Scale for Immunosuppressants (MESI); incidence/grade of GvHD]. The increased-risk group (n = 28) showed significantly worse cumulative survival in the outpatient setting (from 3 months to 3 years after HSCT) [Log Rank (Mantel Cox) P = 0.029] compared to low-risk group (n = 29) but there was no significant result for the interval immediately after HSCT until 3 years afterwards. Pre-transplant screening with TERS contributes to prediction of survival after HSCT. The reason remains unclear, since TERS did not correlate with GvHD or MESI. The negative result regarding the interval immediately after HSCT until 3 years could be caused by the intensive in-patient setting with mortality which is explained rather by biological reasons than by non-adherence.
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Affiliation(s)
- Simon Scherer
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, University Hospital Tuebingen, Tuebingen, Germany
| | - Christoph Scheid
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Michael von Bergwelt
- Department III of Internal Medicine, Ludwig Maximilian University of Munich, Munich, Germany
| | - Martin Hellmich
- Faculty of Medicine and University Hospital Cologne, Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Frank Vitinius
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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21
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Ribaut J, Leppla L, Teynor A, Valenta S, Dobbels F, Zullig LL, De Geest S. Theory-driven development of a medication adherence intervention delivered by eHealth and transplant team in allogeneic stem cell transplantation: the SMILe implementation science project. BMC Health Serv Res 2020; 20:827. [PMID: 32878623 PMCID: PMC7465386 DOI: 10.1186/s12913-020-05636-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 08/09/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Medication adherence to immunosuppressants in allogeneic stem cell transplantation (alloSCT) is essential to achieve favorable clinical outcomes (e.g. control of Graft-versus-Host Disease). Over 600 apps supporting medication adherence exist, yet they lack successful implementation and sustainable use likely because of lack of end-user involvement and theoretical underpinnings in their development and insufficient attention to implementation methods to support their use in real-life settings. Medication adherence has three phases: initiation, implementation and persistence. We report the theory-driven development of an intervention module to support medication adherence (implementation and persistence phase) in alloSCT outpatients as a first step for future digitization and implementation in clinical setting within the SMILe project (Development, implementation and testing of an integrated care model in allogeneic SteM cell transplantatIon faciLitated by eHealth). METHODS We applied Michie's Behavior Change Wheel (BCW) and the Capability-Opportunity-Motivation and Behavior (COM-B) model using three suggested stages followed by one stage added by our team regarding preparation for digitization of the intervention: (I) Defining the problem in behavioral terms; (II) Identifying intervention options; (III) Identifying content and implementation options; (IV) SMILe Care Model Prototype Development. Scientific evidence, data from a contextual analysis and patients'/caregivers' and clinical experts' inputs were compiled to work through these steps. RESULTS (I) Correct immunosuppressant taking and timing were defined as target behaviors. The intervention's focus was determined within the COM-B dimensions Capability (lack of knowledge, lack of routine), Opportunity (lack of cues, interruptions in daily routine) and Motivation (lack of problem solving, trivialization). (II) Five intervention functions were chosen, i.e. education, training, modelling, persuasion and enablement. (III) Twenty-four behavior change techniques were selected, e.g., goal setting, action planning and problem solving. (IV) Finally, seventeen user stories were developed to guide the SMILeApp's software development process. CONCLUSION Our example on the theory-driven development of an intervention module in alloSCT delivered by eHealth and transplant team using a rigorous 3 + 1-stage approach based on BCW, COM-B and agile software development techniques, can be used as methodological guidance for other eHealth intervention developers. Our approach has the potential to enhance successful implementation and sustained use of eHealth solutions in real-life settings.
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Affiliation(s)
- Janette Ribaut
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.,Department of Hematology, University Hospital of Basel, 4031, Basel, Switzerland
| | - Lynn Leppla
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.,Departments of Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, 79110, Freiburg im Breisgau, Germany
| | - Alexandra Teynor
- Department of Computer Science, University of Applied Sciences, Augsburg, Germany
| | - Sabine Valenta
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.,Department of Hematology, University Hospital of Basel, 4031, Basel, Switzerland
| | - Fabienne Dobbels
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.,Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, University of Leuven, 3000, Leuven, Belgium
| | - Leah L Zullig
- Department of Population Health Science, Duke University, Durham, NC, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Sabina De Geest
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland. .,Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, University of Leuven, 3000, Leuven, Belgium.
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22
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Belaiche S, Décaudin B, Caron A, Depas N, Vignaux C, Vigouroux S, Coiteux V, Magro L, Sirvent A, Huynh A, Turlure P, Farge D, Lioure B, Bruno B, De Berranger E, Maillard N, Bourhis JH, Bay JO, Bulabois CE, Ceballos P, Fegueux N, Hicheri Y, Vincent L, Rialland F, Gandemer V, Taque S, Cornillon J, Contentin N, Galambrun C, Plantaz D, Odou P, Yakoub-Agha I. Medication non-adherence after allogeneic hematopoietic cell transplantation in adult and pediatric recipients: a cross sectional study conducted by the Francophone Society of Bone Marrow Transplantation and Cellular Therapy. Fundam Clin Pharmacol 2020; 35:435-445. [PMID: 32740936 DOI: 10.1111/fcp.12593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 06/09/2020] [Accepted: 07/27/2020] [Indexed: 12/14/2022]
Abstract
Medication non-adherence (NA) after allogeneic hematopoietic cell transplantation (allo-HCT) can lead to serious complications. This study assesses NA in French adult and pediatric recipients and identifies factors associated with NA. In accordance with the EMERGE and STROBE guidelines, a cross sectional multicentric survey was conducted. We used a self-reported questionnaire that was adapted to adults and pediatrics and that could provide a picture of all three phases of medication adherence: initiation, implementation, persistence. We enrolled 242 patients, 203 adults (mean age: 51 years old, 50.7% male) and 39 children (mean age: 9 years old, 56.4% female). Reported NA was estimated at about 75% in both populations, adults and pediatrics. In adults, the univariate analysis showed that patients less than 50 years old (P = 0.041), (i) treated with cyclosporine (P = 0.02), (ii) treated with valacyclovir/acyclovir (P = 0.016), and (iii) experiencing side effects (P = 0.009), were significantly more non-adherent. In multivariate analysis, only recipient age was significantly associated to NA (P = 0.05). The limited size of the pediatric population did not allow us to draw any statistical conclusion about this population. To the best of our knowledge, this is the first study in France on NA in allo-HCT recipients. Our results highlight the age factor as the only factor related to NA. Further studies are needed to confirm our observations and refine results in pediatric populations, currently most at risk of medication NA.
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Affiliation(s)
| | | | - Alexandre Caron
- EA 2694 - Santé publique: épidémiologie et qualité des soins, CHU Lille, Univ. Lille, Lille, F-59000, France
| | - Nicolas Depas
- EA 2694 - Santé publique: épidémiologie et qualité des soins, CHU Lille, Univ. Lille, Lille, F-59000, France
| | - Claire Vignaux
- Service Hématologie Adulte, CHU Bordeaux, Bordeaux Cedex, F-33076, France
| | - Stephane Vigouroux
- Service Hématologie Adulte, CHU Bordeaux, Bordeaux Cedex, F-33076, France
| | | | | | - Anne Sirvent
- Service Hématologie Pédiatrique, CHU Montpellier, Montpellier, F-34090, France
| | - Anne Huynh
- Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse Cedex 9, F-31059, France
| | - Pascal Turlure
- Service Hématologie Adulte, CHU Dupuytren, Limoges Cedex, F-87042, France
| | - Dominique Farge
- Service Hématologie Adulte, APHP- Hopital Saint Louis, Paris, F-75010, France
| | - Bruno Lioure
- Service Hématologie Adulte, Hopital de Hautepierre, CHU de Strasbourg, Strasbourg, F-67200, France
| | - Bénédicte Bruno
- Service Hématologie Pédiatrique, CHU Lille, Lille, F-59000, France
| | - Eva De Berranger
- Service Hématologie Pédiatrique, CHU Lille, Lille, F-59000, France
| | - Natacha Maillard
- Service Hématologie Adulte, CHU Poitier, Poitier, F-86000, France
| | - Jean-Henri Bourhis
- Service Hématologie Adulte, Institut Gustave Roussy, Villejuif Cedex, F-94805, France
| | | | | | - Patrice Ceballos
- Service Hématologie Adulte, CHU Montpellier, Montpellier, F-34090, France
| | - Nathalie Fegueux
- Service Hématologie Adulte, CHU Montpellier, Montpellier, F-34090, France
| | - Yosr Hicheri
- Service Hématologie Adulte, CHU Montpellier, Montpellier, F-34090, France
| | - Laure Vincent
- Service Hématologie Adulte, CHU Montpellier, Montpellier, F-34090, France
| | - Fanny Rialland
- Service Hématologie Pédiatrique, CHU Nantes, Nantes, F-44000, France
| | - Virginie Gandemer
- Service Hématologie Pédiatrique, CHU Rennes, Rennes Cedex 9, F-35033, France
| | - Sophie Taque
- Service Hématologie Pédiatrique, CHU Rennes, Rennes Cedex 9, F-35033, France
| | - Jérôme Cornillon
- Service Hématologie Adulte, Institut de Cancérologie Lucien Neuwirth, Saint Etienne, F-42000, France
| | - Nathalie Contentin
- Service Hématologie Adulte, Centre Henri Becquerel, Rouen Cedex, F 76038, France
| | - Claire Galambrun
- Service Hématologie Pédiatrique, APHM Hopital La Timone, Marseille, F-13005, France
| | - Dominique Plantaz
- Service Hématologie Pédiatrique, CHU Grenoble, La Tronche, F-38700, France
| | - Pascal Odou
- Institut de Pharmacie, CHU Lille, Lille, F-59000, France
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23
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Ice LL, Bartoo GT, McCullough KB, Wolf RC, Dierkhising RA, Mara KC, Jowsey-Gregoire SG, Damlaj M, Litzow MR, Merten JA. A Prospective Survey of Outpatient Medication Adherence in Adult Allogeneic Hematopoietic Stem Cell Transplantation Patients. Biol Blood Marrow Transplant 2020; 26:1627-1634. [PMID: 32505809 DOI: 10.1016/j.bbmt.2020.05.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 11/28/2022]
Abstract
Limited data exist regarding the prevalence and outcome of medication nonadherence in the adult allogeneic hematopoietic stem cell transplantation (allo-HSCT) population. The objective of this cross-sectional survey study is to determine the prevalence of medication nonadherence to immunosuppressant and nonimmunosuppressant medications in adult recipients of allo-HSCT. An electronic survey using previously validated medication adherence scales was distributed between December 2014 and April 2015 to 200 adult patients with at least 3 months of follow-up after allo-HSCT. Immunosuppressant serum drug levels and prescription refill records were retrospectively collected to assess correlation with survey responses. In the entire cohort, 51% of subjects (n = 102) reported nonadherence to nonimmunosuppressant medications (95% confidence interval [CI], 44.07% to 57.93%) on the Morisky Medication Adherence Scale. Of the 153 patients taking oral immunosuppressant medications at the time of the survey, 58 (37.9%) reported nonadherence to immunosuppressant therapy (95% CI, 30.22% to 45.6%), as measured by the Immunosuppressant Therapy Adherence Scale. Younger age and distress were associated with medication nonadherence. Nonadherence to immunosuppressant therapy was associated with mild chronic graft-vs-host disease (cGVHD), and a similar trend was observed for moderate cGVHD. Medication nonadherence was found to be highly prevalent for both immunosuppressant and nonimmunosuppressant medications in adult allo-HSCT recipient, and further study to identify interventions to improve adherence in these patients is warranted.
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Affiliation(s)
- Lauren L Ice
- Department of Pharmacy Services, Mayo Clinic Hospital, Rochester, Minnesota
| | - Gabriel T Bartoo
- Department of Pharmacy Services, Mayo Clinic Hospital, Rochester, Minnesota
| | | | - Robert C Wolf
- Department of Pharmacy Services, Mayo Clinic Hospital, Rochester, Minnesota
| | - Ross A Dierkhising
- Division of Biomedical Statistics and Informatics, Mayo Clinic Hospital, Rochester, Minnesota
| | - Kristin C Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic Hospital, Rochester, Minnesota
| | | | - Moussab Damlaj
- Division of Hematology, Mayo Clinic Hospital, Rochester, Minnesota
| | - Mark R Litzow
- Division of Hematology, Division of Palliative Medicine, Mayo Clinic Hospital, Rochester, Minnesota
| | - Julianna A Merten
- Department of Pharmacy Services, Mayo Clinic Hospital, Rochester, Minnesota.
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24
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Hui L, Qi L, Guoyu H, Xuliang S, Meiao T. Ruxolitinib for treatment of steroid-refractory graft-versus-host disease in adults: a systematic review and meta-analysis. Expert Rev Hematol 2020; 13:565-575. [PMID: 32178541 DOI: 10.1080/17474086.2020.1738214] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Objectives: Authors assessed the impact of ruxolitinib (RUX) on steroid-refractory graft-versus-host disease (SR-GVHD) patients.Methods: Studies published before January 2019 were identified by electronic search of MEDLINE, EMBASE, Cochrane Library, Clinical Trials.Gov and Web of Science databases.Results: Sixteen cohort studies (414 adults) were included whose methodological quality ranged from poor to good. Pooled outcomes such as the response rates, steroid dose reduction, 1-year overall survival, overall infection, and grade 3 to 4 cytopenia were calculated separately for adults with steroid-refractory acute GVHD (aGVHD) and chronic GVHD (cGVHD). Further, the overall response rates were analyzed according to the affected organ. Adults with aGVHD as well as cGVHD showed high response with RUX, and steroid dose reduction was observed in both cases. Infection rates and cytopenia were important safety concerns for both aGVHD and cGVHD.Conclusion: Notwithstanding the need of randomized controlled trials to confirm the effect of RUX on SR-GVHD, response rates among adults with aGVHD and cGVHD seem to be high with the use of RUX as a salvage treatment, particularly in cases with gastrointestinal and cutaneous involvement. However, high rates of myelosuppression and infection remain a cause for concern regardless of aGVHD or cGVHD.
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Affiliation(s)
- Li Hui
- Department of Hematology, Zhuzhou Central Hospital, The Affiliated Zhuzhou Hospital of Xiangya Medical College of Central South University, Zhuzhou, Hunan, China
| | - Li Qi
- Department of Gastroenterology, Shaoyang Hospital of TCM, Shaoyang, Hunan, China
| | - Hu Guoyu
- Department of Hematology, Zhuzhou Central Hospital, The Affiliated Zhuzhou Hospital of Xiangya Medical College of Central South University, Zhuzhou, Hunan, China
| | - Shen Xuliang
- Graduate School, Changzhi Medical College, Changzhi, Shanxi, China.,Department of Hematology, Heping Hospital of Changzhi Medical College, Changzhi, Shanxi, China
| | - Tan Meiao
- Graduate School, First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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25
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Leppla L, Mielke J, Kunze M, Mauthner O, Teynor A, Valenta S, Vanhoof J, Dobbels F, Berben L, Zeiser R, Engelhardt M, De Geest S. Clinicians and patients perspectives on follow-up care and eHealth support after allogeneic hematopoietic stem cell transplantation: A mixed-methods contextual analysis as part of the SMILe study. Eur J Oncol Nurs 2020; 45:101723. [PMID: 32062362 DOI: 10.1016/j.ejon.2020.101723] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 01/20/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE We report on our contextual analysis's methodology, as a first step of an implementation science project aiming to develop, implement, and test the effectiveness of an integrated model of care in SteM-cell transplantatIon faciLitated by eHealth (SMILe). METHODS We applied an explanatory sequential mixed-methods design including clinicians and patients of the University Hospital Freiburg, Germany. Data were collected from 3/2017 to 1/2018 via surveys in 5 clinicians and 60 adult allogeneic stem-cell transplantation patients. Subsequently, we conducted 3 clinician focus groups and 10 patient interviews. Data analysis followed a 3-step process: (1) creating narrative descriptions, tables, and maps; (2) mapping key observational findings per dimension of the eHealth-enhanced Chronic-Care Model; (3) reflecting on how findings affect our choice of implementation strategies. RESULTS Current clinical practice is mostly acute care driven, with no interdisciplinarity and weak chronic illness management. Gaps were apparent in the dimensions of self-management support and delivery-system design. Health behaviors that would profit from support include medication adherence, physical activity and infection prevention. The theme "being alone and becoming an expert" underpinned patients need to increase support in hospital-to-home transitions. Patients reported insecurity about recognizing, judging and acting upon symptoms. The theme "eHealth as connection not replacement" underscores the importance of eHealth augmenting, not supplanting human contact. Synthesis of our key observational findings informed eight implementation strategies. CONCLUSION Stakeholders are willing towards a chronic care-focused approach and open for eHealth support. The contextual information provides a basis for the SMILe model's development and implementation.
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Affiliation(s)
- Lynn Leppla
- Institute of Nursing Science, Department Public Health, University of Basel, Switzerland; Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Juliane Mielke
- Institute of Nursing Science, Department Public Health, University of Basel, Switzerland
| | - Maria Kunze
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; Department of Psychiatry and Psychotherapy, University of Freiburg, Germany
| | - Oliver Mauthner
- Institute of Nursing Science, Department Public Health, University of Basel, Switzerland
| | - Alexandra Teynor
- University of Applied Sciences Augsburg, Faculty of Computer Science, Germany
| | - Sabine Valenta
- Institute of Nursing Science, Department Public Health, University of Basel, Switzerland; Department of Hematology, University Hospital Basel, Switzerland
| | - Jasper Vanhoof
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium; Nursing Center of Excellence, University Psychiatric Center, KU Leuven, Belgium
| | - Fabienne Dobbels
- Institute of Nursing Science, Department Public Health, University of Basel, Switzerland; Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Lut Berben
- Institute of Nursing Science, Department Public Health, University of Basel, Switzerland
| | - Robert Zeiser
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Monika Engelhardt
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Sabina De Geest
- Institute of Nursing Science, Department Public Health, University of Basel, Switzerland; Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium.
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26
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Psychosocial Assessment of Candidates for Transplantation scale (PACT) and survival after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2018; 54:1013-1021. [PMID: 30353064 DOI: 10.1038/s41409-018-0371-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/18/2018] [Accepted: 10/08/2018] [Indexed: 12/26/2022]
Abstract
Recent findings suggest that patient pre-transplant psychosocial risk factors predict survival after hematopoietic stem cell transplant (HSCT) and importance of comprehensive psychosocial assessment during pre-transplant period is increasingly acknowledged. Psychosocial screening process, however, has not been standardized across transplant centers and its predictive value has not yet been confirmed. An observational cohort study was conducted to explore the relationships between psychosocial variables, assessed with the Psychosocial Assessment of Candidates for Transplantation (PACT) scale, and post-transplant overall survival (OS) of patients with hematologic malignancies who received allogeneic HSCT as treatment. Overall, 119 patient medical records were reviewed to determine the PACT score. After controlling for clinical and demographic covariates, lower PACT scores in the domain of compliance with medications and medical advice were significantly associated with poorer OS (HR = 1.75, P = 0.03). Lower PACT ratings in the subscales of personality and psychopathology (HR = 1.35, P = 0.08), lifestyle factors (HR = 1.43, P = 0.08), and relevant disease knowledge and receptiveness to education (HR = 1.32, P = 0.08) tended to be associated with shorter OS. These findings suggested the association between pre-transplant psychosocial factors using PACT and post-transplant OS in patients receiving allogeneic HSCT.
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