Patients and family care givers' experiences around highly active antiretroviral therapy (HAART)

Development and Validation of the Revised Patients' Attitudes Towards Deprescribing (rPATD) Questionnaire: Versions for Older Adults and Caregivers

BACKGROUND

Knowledge of consumer (patient and caregiver) attitudes is essential for conducting medication optimization in practice.

OBJECTIVES

The aim of this study was to develop and validate a questionnaire to capture older adults' and caregivers' beliefs and attitudes towards deprescribing.

METHODS

The previously validated Patients' Attitudes Towards Deprescribing (PATD) questionnaire was expanded based on literature review, expert opinion and focus groups, and a caregivers' version was developed. The revised questionnaire was piloted and then distributed for self-completion to older adults (≥65 years of age), taking at least one regular medication and caregivers of older adults. Psychometric validity and reliability were examined. Responses to questions that were identified to group into a specific factor were combined to produce a score.

RESULTS

A total of 383 consumer questionnaires and 200 caregiver questionnaires were completed and included in analysis. Exploratory factor analysis revealed four factors in both versions of the questionnaire (with four to five questions retained in each factor). The factors relate to the perceived burden of medication taking, belief in appropriateness of medication use (harms and benefits), concerns about stopping the medication, and level of involvement/knowledge of medications. Internal consistency of all factors was acceptable with Cronbach's alpha >0.6. In both the older adults' and caregivers' versions, the burden score was inversely associated with the appropriateness score (p < 0.001 both versions). Factor scores between administration times (test-retest reliability) were statistically significantly correlated (p = 0.000), with gamma values ranging between 0.57 and 0.89.

CONCLUSION

The revised PATD questionnaire had acceptable validity and reliability. This newly validated questionnaire may provide insight into individuals' willingness for/barriers to deprescribing, with applications in practice and research.

It's Not Just the Pills: A Qualitative Meta-Synthesis of HIV Antiretroviral Adherence Research

Antiretroviral therapy (ART) improves the health and longevity of people living with HIV infection (PLWH) and also prevents transmission of the virus. Yet, lack of adherence to ART regimens has been a persistent problem, even with simpler regimens. Guidelines that deal with ART adherence are based almost solely on quantitative studies; this focus ignores the context and complexity of patients' lives. Guidelines are also focused on the individual. We argue that the solution is to include the broader communities in which patients live, and to deal with systemic disparities that persist worldwide; this can be done in part through demedicalizing HIV care for healthy PLWH. We present findings from a qualitative meta-synthesis of 127 studies conducted around the world on the last two pillars of the HIV treatment cascade: starting and remaining on ART until optimal viral suppression is achieved. We use Maslow's hierarchy of needs to frame our findings.

Palliative care needs in Malawi: Care received by people living with HIV

Background

Infection with human immunodeficiency virus (HIV) has changed from an acute to a chronic illness in the past decade, because of highly active antiretroviral therapy (ART). Malawi’s response to the HIV challenge included provision of ART for people living with HIV or AIDS (PLWHA), which significantly reduced HIV- and AIDS-related mortality. In addition, palliative care for PLWHA was introduced as a strategy that improves the success of ART.

Objective

The purpose of the study was to explore the needs of PLWHA concerning care received from primary caregivers and palliative care nurses in Malawi.

Methods

A qualitative, explorative design was used and 18 participants were selected purposefully and interviewed individually using a semi-structured interview guide. Data were analysed using NVivo software package version 10.

Results

Results revealed that PLWHA needed physical care from the primary caregivers due to severity of illness, integration of healthcare services, and continuity of care and proper care from nurses. They also needed knowledge from nurses in several areas which affected decision-making and needed financial and nutritional support.

Conclusion

More could be done in meeting needs of PLWHA to improve their health and survival and assist them to achieve a better quality of life.

FAmily CEntered (FACE) advance care planning: Study design and methods for a patient-centered communication and decision-making intervention for patients with HIV/AIDS and their surrogate decision-makers

Although the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has become a chronic illness, disease-specific advance care planning has not yet been evaluated for the palliative care needs of adults with HIV/AIDS. This prospective, longitudinal, randomized, two-arm controlled clinical trial aims to test the efficacy of FAmily CEntered advance care planning among adults living with AIDS and/or HIV with co-morbidities on congruence in treatment preferences, healthcare utilization, and quality of life. The FAmily CEntered intervention arm is two face-to-face sessions with a trained, certified facilitator: Session 1) Disease-Specific Advance Care Planning Respecting Choices Interview; Session 2) Completion of advance directive. The Healthy Living Control arm is: Session 1) Developmental/Relationship History; Session 2) Nutrition. Follow-up data will be collected at 3, 6, 12, and 18 months post-intervention. A total of 288 patient/surrogate dyads will be enrolled from five hospital-based, out-patient clinics in Washington, District of Columbia. Participants will be HIV positive and ≥ 21 years of age; surrogates will be ≥ 18 years of age. Exclusion criteria are homicidality, suicidality, psychosis, and impaired cognitive functioning. We hypothesize that this intervention will enhance patient-centered communication with a surrogate decision-maker about end of life treatment preferences over time, enhance patient quality of life and decrease health care utilization. We further hypothesize that this intervention will decrease health disparities for Blacks in completion of advance directives. If proposed aims are achieved, the benefits of palliative care, particularly increased treatment preferences about end-of-life care and enhanced quality of life, will be extended to people living with AIDS.

Knowledge, attitudes and beliefs of patients and carers regarding medication adherence: a review of qualitative literature

PURPOSE

The aim of this review is to cohere evidence on the knowledge, attitudes and beliefs of patients and carers regarding medication adherence. Medication adherence refers to "the extent to which the patient's action matches the agreed recommendations". Medication adherence is vital in preventing, managing and curing illnesses and, hence, is linked with positive health outcomes.

METHODS

A search was conducted using the following databases: CINAHL, Embase, PubMed and Web of Knowledge from inception to November 2013. Titles and abstracts were screened for inclusion in the review according to pre-defined inclusion and exclusion criteria. Studies were assessed for quality, and data were extracted into a data extraction form. Results were analysed thematically.

RESULTS

The final results included 34 articles. Eight analytical themes were identified: (i) beliefs and experiences of medicines, (ii) family support and culture, (iii) role of and relationship with health-care practitioners, (iv) factors related to the disease, (v) self-regulation, (vi) communication, (vii) cost and (viii) access. The theme, "beliefs and experiences of medicines", was present in 33 studies, with many discussing the influence that side effects have on medication adherence.

CONCLUSIONS

There are a number of variables that impact upon the knowledge, attitudes and beliefs of patients and carers regarding medication adherence. This review presents an overview of the analytical themes which offers the opportunity to examine interventions and their relative efficacies to increase medication adherence.

Emotional bonds and social support exchange between men living with HIV infection and their mothers

Men infected with HIV are often faced with caregiving responsibilities of aging, ill parents, while simultaneously looking for support from their parents in dealing with their own health problems. Unfortunately, the reciprocal roles of HIV-positive adult sons and aging mothers as caregivers have not been examined. To address this gap in the literature, HIV-positive men (n = 118) answered open-ended questions about the support they exchanged with their mothers, completed the Depth of Relationships Inventory, and rated the importance of health-related assistance between themselves and their mothers. The men viewed themselves as important providers of both instrumental and emotional support to their mothers. Men perceived their mothers to be significant providers of emotional support but only moderately important in providing instrumental support. About a third of the men responded that the help they provided and received from the mothers in managing each other's health and staying healthy was extremely important. Men regarded their relationships with their mothers as one of their most important social relationships. Non-White men rated the quality of their mother-son relationships more highly, exchanged more instrumental support, and provided more emotional support to their mothers than White men. Men who disclosed their HIV-positive status to their mothers rated the importance of the help they received from their mothers in managing their illnesses higher than men who had not disclosed.

Adjuvant endocrine therapy with tamoxifen in young women with breast cancer: determinants of interruptions vary over time

BACKGROUND

In premenopausal women with hormone receptor-positive breast cancer (BC), 5 years of tamoxifen is recommended. Little is known about reasons for interruption in this population. The aim was to estimate the incidence of tamoxifen interruption and its correlates among younger women.

PATIENTS AND METHODS

Using a prospective cohort Elippse 40 of women with BC aged ≤ 40 diagnosed between 2005 and 2008, we studied 196 women. Tamoxifen interruption was defined as two or more consecutive months without dispensed prescription of tamoxifen, based on pharmacy refill database. Two periods were studied: between tamoxifen initiation and 16 months after BC diagnosis, and between 16 and 28 months.

RESULTS

Among women treated with tamoxifen, 42% interrupted within the first 2 years of treatment. During the first period, treatment interruptions were associated with a lack of understandable information about endocrine treatment and insufficient social support. During the second period, another set of factors were associated with interruption: treatment side-effects, no longer fearing cancer relapse, lack of social support, no opportunity to ask questions at the time of diagnosis, and fewer treatment modalities.

CONCLUSIONS

Improving information and patient-provider relationship might prevent interruption. Particular attention should be paid to women with little social support.