Factors influencing adherence to cancer treatment in older adults with cancer: a systematic review

BACKGROUND

Cancer is a disease that mostly affects older adults. Treatment adherence is crucial to obtain optimal outcomes such as cure or improvement in quality of life. Older adults have numerous comorbidites as well as cognitive and sensory impairments that may affect adherence. The aim of this systematic review was to examine factors that influence adherence to cancer treatment in older adults with cancer.

PATIENTS AND METHODS

Systematic review of the literature published between inception of the databases and February 2013. English, Dutch, French and German-language articles reporting cross-sectional or longitudinal, intervention or observational studies of cancer treatment adherence were included. Data sources included MEDLINE, EMBASE, PsychINFO, Cumulative Index to Nursing and Allied Health (CINAHL), Web of Science, ASSIA, Ageline, Allied and Complementary Medicine (AMED), SocAbstracts and the Cochrane Library. Two reviewers reviewed abstracts and abstracted data using standardized forms. Study quality was assessed using the Mixed Methods Appraisal Tool 2011.

RESULTS

Twenty-two manuscripts were identified reporting on 18 unique studies. The quality of most studies was good. Most studies focused on women with breast cancer and adherence to adjuvant hormonal therapy. More than half of the studies used data from administrative or clinical databases or chart reviews. The adherence rate varied from 52% to 100%. Only one qualitative study asked older adults about reasons for non-adherence. Factors associated with non-adherence varied widely across studies.

CONCLUSION

Non-adherence was common across studies but little is known about the factors influencing non-adherence. More research is needed to investigate why older adults choose to adhere or not adhere to their treatment regimens taking into account their multimorbidity.

A decentralized admission screening protocol for a geriatric rehabilitation program: does it make a difference?

The purpose of this retrospective evaluation study was to compare outcomes related to two distinct processes for screening people referred for admission to a geriatric rehabilitation program at a chronic care hospital in southern Ontario. Data were collected through chart review and focus group methods. The results were unexpected in that the projected outcomes associated with the newer referral screening process did not materialize. For both referral screening processes, findings are discussed in terms of the percentage of achieved patient rehabilitation goals. The average lengths of patient stay associated with both screening processes were also compared. No statistically significant differences between the two processes were found in terms of either the percentage of goals achieved or the length of patient stay. Focus group sessions were held to elicit team members' perceptions of the effectiveness of each of the referral processes. Participants in the focus groups were supportive of the newer referral screening and admission process although the evidence gathered from the chart review did not demonstrate improvements in patients' length of stay or an increase in the percentage of rehabilitation goals achieved.

Intravenous therapy for women in labor: implementation of a practice change

BACKGROUND

Intravenous therapy for women in labor has been routinely administered in many North American hospitals since the 1950s. The purpose of this study was to evaluate a change in intravenous therapy practice.

METHODS

The evaluation study, using a posttest, quasi-experimental design, examined the responses of women in labor and nurses to a questionnaire. Proxy prestudy cohort data were used for comparison of some patient outcomes. The convenience sample comprised 219 women admitted to the labor and delivery unit of a community hospital in Toronto, Ontario, between August and October 1997.

RESULTS

Under the new intravenous therapy protocol, 26 percent of the women in labor did not receive intravenous therapy compared with 100 percent under the old protocol. The primary reasons for therapy were to enable administration of prescribed medication and bolus intravenous administration associated with epidural anesthesia. At the first after-delivery void, 61 percent of study women-65 percent of those who received intravenous therapy and 50 percent of those who received no intravenous therapy-tested negative for ketonuria. All 119 comments from nurses indicated comfort with their judgments related to the initiation of intravenous therapy.

CONCLUSIONS

The change in the intravenous therapy protocol was supported by the study findings. Nurses should increase patient education about drinking and eating adequately throughout labor if appropriate, and resuming adequate fluid and food intake as quickly as possible after childbirth.

Tap in on ear thermometry

In February 1992, nursing departments at The Mississauga Hospital, a 530-bed community hospital in Southern Ontario, purchased First Temp Genius ear thermometers to replace the electronic predictive thermometers then in use. Ear thermometers collect infrared heat radiation from the ear canal with a probe, then convert the radiation to a temperature reading. Although quick and easy to use with patients of all ages, there are nonetheless some issues concerning their use that still must be addressed.