Patient Symptoms >=4

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Presentation transcript:

Patient Symptoms >=4 A Pilot Study of an Automated Voice Response System and Nursing Intervention to Monitor Adherence to Oral Chemotherapy Agents Sandra Spoelstra, MSN, RN; Charles Given, PhD; Emily Miezio, MSN, RN; Renee Bremer, MS; Mei You, MS; Veronica Decker, MS, RN; Barbara Given, PhD, RN, FAAN. Affiliations: Michigan State University College of Nursing Sociodemographic Introduction Increasing use of oral agents creates a new paradigm in cancer care. Patients fill prescriptions, implement complex dosing regimens, and self monitoring symptoms, side effects and adverse events. The more adherent to oral chemotherapy agents, the more symptoms experienced. Patients self-titrate does to manage symptoms, not adhering to prescribed regimens. A disconnect between chemo received and clinicians assumptions. Failure to achieve therapeutic dose. - 7 out of 30 (23%) non-adherence - 5 of 7 “forgot” to take the pills No significance: type of cancer, demographics, symptom severity, out-of-pocket costs, depression, functional status, belief about medications, or services utilization. Results Setting and Sample National Cancer Institute Community Clinical Oncology Program site. University Cancer Center. Non-hormonal oral chemotherapeutic agents. N=30 # Patients Measures Intake and 10-week Exit Interview: Symptom Experience Inventory: prevalence 15 symptoms past 7 days, severity 0-10 point scale, and interference with daily activities. Adherence : to prescribed oral chemo on each call. Depression: CESD 20 and Functional Status: SF-12 Utilization of ER, Hospital, and Physician services Beliefs about Medicines Questionnaire and Out of Pocket Costs Weekly AVR Calls for 8 weeks: Symptom Experience Inventory and Adherence with oral chemo Medical Record Audit: Enrollment: Cancer site, stage, oral therapy, number of pills prescribed per day, times per day, number of pills per time, interval between doses. Exit: Change in dose, pills per day, dose delays, and stoppage. Satisfaction Survey: with AVR and Nursing Interventions. Patient Symptoms >=4 Design and Conceptual Framework Exploratory, longitudinal study. Modified health belief model that builds on Cognitive Behavioral Intervention framework for symptom management. Conclusion Patients are assumed to be motivated to take their oral chemotherapy, however, adherence should never be assumed. Pilot study demonstrated feasibility of accruing patients undergoing non-hormonal oral chemotherapy to develop and test an AVR system, complemented by a Symptom Management Toolkit and nursing intervention to improve adherence to the oral chemo protocol and symptom management. Research Questions Can adherence be defined and measured? What is symptom severity at intake, 4-, 6-, 8- weeks, and exit. Comparison of adherent with non-adherent patients. Funding Source: Michigan State University College of Nursing Acknowledgement: Pilot study was conducted in affiliation with the Walther Cancer Institute, located in Indianapolis, Indiana.