Impact of Oral Anticancer Medication From a Family Caregiver Perspective

Co-designing a motivational interviewing training platform to enhance oncology healthcare professional communication

Background

Oncology healthcare professionals (HCPs) using motivational interviewing may motivate and support patients with chronic illness to adhere to medications. Research of online motivational interviewing training focusing on medication adherence in cancer is limited.

Objective

Co-design, develop, and preliminarily evaluate a motivational interviewing training platform (MITP) for oncology HCPs focused on medication adherence.

Methods

We used co-design and design science research methodology to develop and test the MITP in two phases: 1) program co-design and development and 2) interactive platform design and development.

Results

HCPs expressed a high demand for a practical and tailored motivational interviewing training. MITP is an online three-hour training comprising education, roleplay videos, and formative assessments. MITP was reported to be acceptable, usable, and useful by users.

Innovation

This study used a novel approach combining co-design and design science research methodology, and digital media to develop a flexible and acceptable online motivational interviewing training focused on medication adherence in cancer.

Discussion and conclusion

Applied rigorous methodology ensured the MITP was developed to address knowledge gaps and the needs of oncology HCPs for supporting patient adherence, and to be usable and useful. Study findings may inform future research on online motivational interviewing training and its potential impact on medication adherence.

Parents' experiences on handling paediatric anticancer drugs at home after an educational intervention

BACKGROUND

The shift of treatment of paediatric cancer patients to include more care at home puts a lot of pressure on health care professionals (HCPs) to prepare and train parents on safe and correct drug handling at home. Parents must take in and understand the information presented to them while coping with their own fear related to their child's cancer diagnosis. In Sweden, parents are expected to handle and manipulate oral anticancer drugs (OADs) in the home setting. There is however a lack of a standardized method to inform and educate parents on how to handle OADs in a correct way at home.

AIM

To describe parents' experiences of handling OADs at home after participating in an educational intervention.

METHOD

Educational intervention in the present study aimed to improve parents' knowledge in key concepts that is, handling OADs at home by using information presented in different forms. Fifteen parents to 12 children with cancer were recruited from a paediatric oncology ward in Sweden to participate in an interview. The interviews were transcribed verbatim and subjected to qualitative content analysis.

RESULTS

Parents' experiences are presented in categories: Relieved stress, Awareness of own exposure, Facilitated my everyday life, Parents need continued support individually. The educational intervention resulted in both positive and negative feelings, increased awareness of drug exposure and correct drug handling at home. Practical training and information presented in different ways facilitated the process of drug handling. To handle the drug correctly at home parents requested to be trained and informed in the beginning of their child's oral drug treatment. In addition, parents requested to be individually approached by HCP to get answers to questions and concerns.

CONCLUSIONS

This educational intervention study shows promising results for the method used by HCPs to inform and educate parents on complicated topics such as handling OADs at home.

The role of the caregiver in older patients with advanced prostate cancer: results from the ADHERE Prospective Study of the Meet-URO network

PURPOSE

To assess caregivers' characteristics and influence of the presence or absence of the caregiver on clinical outcomes of older (≥70 years) metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone (ABI) or enzalutamide (ENZ).

METHODS

Patients from the Meet-URO 5 ADHERE study were assessed with a 5-item caregiver evaluation questionnaire focusing on the presence, age, degree of kinship, working status and qualification of the caregiver. We investigated the association between the presence of a caregiver and the clinical characteristics and outcomes of enrolled patients.

RESULTS

No differences were found in the main clinical characteristics between patients with or without a caregiver, except for a lower median G8 score (p = 0.0453) in the caregiver group. A longer radiographic PFS (rPFS) was observed in the group without a caregiver, with a trend towards more prolonged overall survival (OS) in the same group.

CONCLUSION

Our work suggests a detrimental effect of caregivers in managing older mCRPC patients treated with ABI or ENZ, especially those identified as frail by the geriatric G8 screening score. Further work is needed to identify and address patients' vulnerability areas, which could have a detrimental effect on prognosis.

Patients' knowledge and awareness of safe handling of oral anticancer agents at Sultan Qaboos University Hospital in Oman

BACKGROUND

Safe handling of oral anticancer agents is of great concern. There is a lack of clear, national guidelines on how patients can safely handle and dispose of unwanted medications. We aimed to evaluate the safe handling, storage, and disposal of oral anticancer drugs among cancer patients and caregivers at home.

METHOD

This cross-sectional survey of adult cancer patients (or their adult caregivers) used a closed-ended questionnaire from May 2019 to March 2020.

RESULTS

A total of 257 patients (50 ± 15 years; range: 18-93 years) were enrolled; however, only 91% (233/257) reported self-administering oral anticancer medications. Caregivers were more likely to administer oral anticancer agents for patients ≥60 years than those <40 years old (63% vs. 8%; P = 0.001). Most patients (52%; 133/257) did not wash their hands after administering the drug; 74% (164/222) of the respondents reported that their medications were kept in a bedroom cabinet, while 18% (40/222) stored their medications in a refrigerator, and 5% (12/222) in a kitchen cabinet. A total of 55% (68/124) of patients returned their excess oral chemotherapy medications to the hospitals; however, 36% (45/124) disposed of their unused oral chemotherapy drugs in a household garbage container.

CONCLUSION

While two-thirds of patients stored their oral anticancer medications properly, more than half used inappropriate handling procedures. Disposal practices were inconsistent and did not adhere to the reported international guidelines.

Family caregivers of those with cancer: quality of life outcomes from a sequential multiple assignment randomized trial

PURPOSE

To conduct a secondary analysis focused on health-related quality of life (HRQOL) among caregivers engaged in a 12-week complementary therapy sequential multiple assignment randomized trial (SMART) of reflexology and/or meditative practices (MP), to manage cancer patients' symptoms.

METHODS

In this SMART, patient-caregiver dyads were initially randomized to 4 weeks of caregiver-delivered reflexology for the patient (N = 150), MP with the patient (N = 150), or control (N = 47). After 4 weeks, dyads with patients not improving on fatigue (non-responders, n = 69 to reflexology and n = 57 to MP) were re-randomized to continue the same therapy or add the other therapy for an additional 4 weeks. Week-12 caregiver HRQOL was measured using the Patient Reported Outcomes Measurement Information System (PROMIS) Profile-29 and the Caregiver Reaction Assessment Tool (CRAT) for caregiver burden; scores were analyzed using general linear models.

RESULTS

In the comparison of 4 adaptive intervention sequences: reflexology for 8 weeks, reflexology for 4 weeks followed by MP for 4 weeks if no response to reflexology, MP for 8 weeks, and MP for 4 weeks followed by reflexology for 4 weeks if no response to MP, there were no differences in PROMIS-29 scores. However, CRAT domains of impact on schedule, family support, and finances worsened when adding reflexology after the first 4 weeks of MP. The CRAT domain of health worsened by adding either intervention compared to continuing the same one.

CONCLUSIONS

Clinicians should be aware that caregiver engagement in more than one complementary therapy may increase caregiver burden in some domains but not affect other HRQOL domains.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02759146.

The Effect of Educational Follow-Up with the Motivational Interview Technique on Self-Efficacy and Drug Adherence in Cancer Patients Using Oral Chemotherapy Treatment: A Randomized Controlled Trial

OBJECTIVES

This study aimed to determine the effect of educational follow-up with the motivational interview technique on drug adherence and self-efficacy in patients with cancer using at least one oral chemotherapy drug.

DATA SOURCES

A total of 80 patients with cancer were randomly allocated to the intervention group or the control group. Educational follow-up with the motivational interview technique was applied to the patients with phone calls during weeks 1, 3, 6, and 9. Patients in the intervention and control groups were evaluated during both the first interview and at week 12 using a questionnaire, the medication adherence self-efficacy scale (MASES), and oral chemotherapy adherence scale (OCAS).

CONCLUSION

At the end of the study, the level of drug adherence and self-efficacy of patients who received educational follow-up with the motivational interview technique by phone call increased significantly (P < .001). Additionally, the level of drug self-efficacy of patients increased (P < .001).

IMPLICATIONS FOR NURSING PRACTICE

This study emphasizes treatment compliance problems of patients with cancer using oral chemotherapy. Designed with communication techniques that will be added to our counseling process, interventions can allow nurses to use their time effectively.

Informal caregiver burden for solid tumour cancer patients: a review and future directions

OBJECTIVE

Recent shifts in healthcare delivery and treatment for solid tumour cancer patients have modified the responsibilities of informal caregivers. The objective of this study was to: review informal caregiver burden factors and determine areas where future research is needed.

METHODS

The Arksey and O'Malley's framework and a modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in conducting this review. Research literature was systematically searched using five-electronic databases, including PubMed, PsycINFO, Cochrane, CINAHL, and SCOPUS, and reference lists from included studies to identify publications since 2010. Inclusion criterion was caregivers providing home-based care to a cancer patient.

RESULTS

The search yielded 43 eligible papers of 2119 reviewed, including articles from over 17 countries. Caregiver physical and psychological health, financial strain, and social isolation, as well as limited family and social support continued to be important factors contributing to high levels of caregiver burden. Less recognised factors affecting higher burden included caregivers' self-esteem, male gender, and the dynamic nature of cancer treatment.

CONCLUSIONS

This review updates the state of the science on informal caregiver burden when caring for patients with solid tumour cancers and informs future interventions on how to reduce this burden.

Satisfaction With an Interactive Voice Response System and Symptom Management Toolkit Intervention to Improve Adherence in Patients Prescribed an Oral Anticancer Agent

OBJECTIVES

To describe patient satisfaction with an interactive voice response (IVR) system to assess adherence and symptom management in patients newly prescribed an oral anticancer agent (OAA).

SAMPLE & SETTING

Patients prescribed a new OAA were recruited from six comprehensive cancer centers in the United States.

METHODS & VARIABLES

Cross-sectional analysis and descriptive statistics were used to summarize patient demographics and satisfaction with the IVR system and symptom management toolkit.

RESULTS

Participants had a mean age of 61.82 years, and gastrointestinal cancer was most prevalent. Participants were either "very" or "highly" satisfied with the IVR weekly calling system to assess symptoms, the IVR system daily OAA adherence reminders, and the symptom management toolkit.

IMPLICATIONS FOR NURSING

Nurses often triage patient-reported issues with OAAs. Nurses are well positioned to lead IVR system symptom management interventions and to be actively involved in the development, implementation, and dissemination of IVR technologies through research and practice.

From theory to practice: implementing a standardized, interactive education session on oral anticancer medication (OAM) for patients and their caregivers

PURPOSE

Self-administration at home and decreased visits to see health care professionals bring patients on oral anticancer medication (OAM) and their caregivers to become experts in handling medication, managing adverse events, and making sure that they adhere to treatment. This project aimed to implement a standardized education group session for patients starting an OAM regimen and their caregivers that would build new knowledge, validate comprehension of information, increase satisfaction, and empower participants in self-management.

MATERIALS AND METHODS

A group session led by an oncology nurse was developed. The theoretical section consisted of short videos that include both verbal and visual explanations. The practical component consisted of quizzes with electronic recordings and instant answers. Turning Point technology was used to compile and analyze the data.

RESULTS

Over a 2-year period, 124 patients and 79 caregivers participated in the group sessions. More than 111 h were saved by giving standardized group sessions instead of individual teachings. The participants' level of confidence regarding the essential concepts to master significantly increased following the group sessions. The results ranged from 18% of participants who answered 4 or 5 on a five-point Likert-type scale before the session to 100% who answered 4 or 5 after the group session. 94% of participants responded with a rating of 4 or 5 when asked if they were satisfied with the overall interactive group session.

CONCLUSION

It is crucial that caregivers participate in the initial OAM teaching. The involvement of the interdisciplinary team was crucial in meeting the informational needs of patients. A standardized group session accessible for viewing and use by all health care professionals and patients simplifies the process of sharing high-quality learning materials in a technological society.

Challenges of Caregivers of Cancer Patients who are on Oral Oncolytic Therapy

OBJECTIVE

To describe the major challenges faced by caregivers of patients receiving oral oncolytic therapy (OOT).

DATA SOURCES

Published literature, national clinical practice guidelines, standards of care.

CONCLUSION

Caregivers of patients receiving OOT have unmet needs. Caregivers need standardized OOT education and coping support to improve patient outcomes through enhanced drug safety practices, better management of complex treatment regimens and adherence, patient symptoms, treatment side effects, care decision-making, and financial assistance for costly OOT.

IMPLICATIONS FOR NURSING PRACTICE

Nurses are well-positioned to take leadership roles in facilitating optimal utilization of multidisciplinary health care resources necessary to support caregivers and improve outcomes in patients receiving OOT.