Motivational Interviewing & Cognitive Behavioral Therapy To Promote Adherence In Cancer Patients Taking Oral Agent Medications: An Integrative Review Sandra.

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Motivational Interviewing & Cognitive Behavioral Therapy To Promote Adherence In Cancer Patients Taking Oral Agent Medications: An Integrative Review Sandra Spoelstra, PhD, RN 1 ; Ruth McCorkle, PhD, RN, FAAN 2 ; Kimberly Ridenour, Nurse Scholar 1 ; Melissa Hilton, RN 1 ; and Monica Schueller, BA 1 Search Strategy Whittemore and Knafl’s review method was used to conduct the literature synthesis. The literature search was conducted using the Cumulative Index to Nursing & Allied Health Literature and PubMed; and reviewing of references. Key search terms used included: “Motivational Interviewing”; “Cognitive Behavioral Therapy”; “Adherence”, and “Intervention” from College of Nursing, Michigan State University, East Lansing, MI; 2 College of Nursing, Yale University, New Haven, CT; 3 Family Medicine, Michigan State University, East Lansing, MI Problem & Purpose Patients must self-manage their cancer treatment at home. This shift in treatment places responsibility on the patients. Patients with cancer miss as much as one-third of the prescribed doses of oral anti-cancer agents required for treatment of their disease. A recent Cochrane review on medication adherence found an 11% improvement using motivational interviewing (MI) and a 23% improvement with cognitive behavioral therapy (CBT). This review examined the evidence on combined MI and CBT interventions that improved adherence to a treatment regimen. Implications for Practice MI/CBT interventions improved regimen adherence in challenging clinical problems that require behavior change, and MI/CBT interventions may help similar conditions such as cancer patients who are prescribed an oral agent for treatment. Combining MI and CBT in an intervention may yield higher adherence rates to oral agents in cancer patients. Results 2822 articles were retrieved on Motivational Interviewing articles were retrieved on Cognitive Behavioral Therapy. When the 2 terms (MI & CBT) were combined, there were a total of 206 articles. 100 of those articles examined adherence; and 12 were interventions. In total, 8 articles fit the inclusion criteria: peer reviewed articles published in English containing MI & CBT interventions to promote adherence to a treatment regimen. Total sample size was N=1129; with 3 RCTs, 4 clinical trials, and 1 case study. Five were on medication adherence and three were on challenging health conditions. Synthesis of Evidence Five articles focused on medication adherence (Effect Size.19 to.67) in HIV, osteoarthritis, ulcerative colitis, mental health disorders, and Fanconi anemia. Other articles focused on glycemic control in Type 1-diabetes (p=0.008), anxiety post-TBI (p<0.1), and weight loss post-bariatric surgery (4 pounds. Interventions included: phone calls (3 to 5 calls, 7 to 11 minutes) and face-to-face or group setting interactions (1 to 28 sessions, 60 to 90 minutes) by RNs, PTs, OTs, and psychologists; and written materials. One study compared MI/CBT versus CBT alone and found MI/CBT was more effective at improving adherence in glycemic control in Type-1 diabetes.