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Wang Y, Hu C, Hu J, Liang Y, Zhao Y, Yao Y, Meng X, Xing J, Wang L, Jiang Y, Xiao X. Investigating the risk factors for nonadherence to analgesic medications in cancer patients: Establishing a nomogram model. Heliyon 2024; 10:e28489. [PMID: 38560243 PMCID: PMC10981129 DOI: 10.1016/j.heliyon.2024.e28489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 03/12/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
Objective The substantial prevalence of nonadherence to analgesic medication among individuals diagnosed with cancer imposes a significant strain on both patients and healthcare resources. The objective of this study is to develop and authenticate a nomogram model for assessing nonadherence to analgesic medication in cancer patients. Methods Clinical information, demographic data, and medication adherence records of cancer pain patients were gathered from the Affiliated Hospital of Chengde Medical University between April 2020 and March 2023. The risk factors associated with analgesic medication nonadherence in cancer patients were analyzed using the least absolute selection operator (LASSO) regression model and multivariate logistic regression. Additionally, a nomogram model was developed. The bootstrap method was employed to internally verify the model. Discrimination and accuracy of the nomogram model were evaluated using the Concordance index (C-index), area under the receiver Operating characteristic (ROC) curve (AUC), and calibration curve. The potential clinical value of the nomogram model was established through decision curve analysis (DCA) and clinical impact curve. Results The study included a total of 450 patients, with a nonadherence rate of 43.33%. The model incorporated seven factors: age, address, smoking history, number of comorbidities, use of nonsteroidal antiinflammatory drugs (NSAIDs), use of opioids, and PHQ-8. The C-index of the model was found to be 0.93 (95% CI: 0.907-0.953), and the ROC curve demonstrated an AUC of 0.929. Furthermore, the DCA and clinical impact curves indicate that the built model can accurately predict cancer pain patients' medication adherence performance. Conclusions A nomogram model based on 7 risk factors has been successfully developed and validated for long-term analgesic management of cancer patients.
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Affiliation(s)
- Ying Wang
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - ChanChan Hu
- Department of Oncology, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Junhui Hu
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Yunwei Liang
- Department of Oncology, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Yanwu Zhao
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Yinhui Yao
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Xin Meng
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Jing Xing
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Lingdi Wang
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Yanping Jiang
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Xu Xiao
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
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Zhao X, Xu R, Wang Y, Zhou Y, Lu J, Zhu W, Qiu Y, Yang Q, Shen Z, Guo C, Zhang J. Adherence to Analgesic Drugs and its Associated Factors among Patients with Cancer Pain: A Crosssectional Study in China. Am J Health Behav 2023; 47:30-39. [PMID: 36945089 DOI: 10.5993/ajhb.47.1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Objectives: Pain is one of the most common and distressing symptoms co-occurring with cancer progression and treatment, and medication adherence plays an important role in achieving good pain control. However, research on medication adherence and influential factors among individuals with cancer pain (CP) is limited in China. The present study aimed to investigate the adherence to analgesics in patients with CP in China and to identify factors that may influence adherence. Methods: A cross-sectional study was conducted from June 2020 to February 2021. Study instruments consisted of a set of validated questionnaires, 5 measurement instruments including the numerical rating scale (NRS), ID-Pain, Morisky Medication Adherence Scale-Chinese validated version (MMAS-C), Beliefs about Medicines Questionnaire (BMQ) - Specific, and the Hospital Anxiety and Depression Scale (HADS). Results: A total of 141 participants with CP including 71 males (50.4%), aged 54.5±15.5 years were surveyed in this study. Overall, 83 patients (58.9%) showed adherence, but 58 patients (41.1%) showed non-adherence to analgesics. The univariate analysis showed that analgesic adherence was associated with pain duration of>3 months, outbreaks of pain in the last 24 hours, presence of side effects, getting analgesics in time, presence of neuropathic pain, stopping analgesics or adjusting dosage by themselves, presence of anxiety and depression, and beliefs about medicines. Moreover, the multivariate logistic regression showed that getting analgesic drugs in time (odds ratio [OR]=5.218, 95% confidence interval [CI] 1.691-16.100) and high BMQ-Necessity (OR=1.907, 95% CI 1.418-2.565) were associated with high adherence, stopping analgesics or adjusting dosage by themselves (OR=7.958, 95% CI 2.443-25.926) and high BMQ-Concern (OR=0.760, 95% CI 0.600-0.964) were more likely to be associated with non-adherence. Conclusion: In view of our findings, it may be critical for individuals to have a better understanding and strong beliefs about their prescribed analgesic drugs. Pain education, counseling and follow-up of patients and their caregivers, and removal of barriers to accessing analgesic drugs could be considered in further intervention strategies.
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Affiliation(s)
- Xincai Zhao
- Department of Pharmacy, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Xu
- Department of Pharmacy, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yonggang Wang
- Department of Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Zhou
- Department of Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jin Lu
- Department of Pharmacy, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wanhu Zhu
- Department of Pharmacy, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yao Qiu
- Department of Pharmacy, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Quanjun Yang
- Department of Pharmacy, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zan Shen
- Department of Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cheng Guo
- Department of Pharmacy, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China;,
| | - Jianping Zhang
- Department of Pharmacy, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China;,
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Zheng X, Ding H, Xu S, Xie R, Liu Y, Zhai Q, Fang L, Tong Y, Sun J, Xin W, Wu N, Chen J, Shi W, Yang L, Li H, Shao J, Wang Y, Yu H, Zhang B, Du Q, Yang Y, Zhang X, Duan C, Zhao Q, Shi J, Huang J, Fan Q, Cheng H, Chen L, Kong S, Zhang H, Gong L, Zhang Y, Song Z, Yang Y, Zhou S, Huang C, Lin J, Wang C, Huang X, Wei Q, Sun Y, Huang P. Pharmacist-Led Management Improves Treatment Adherence and Quality of Life in Opioid-Tolerant Patients With Cancer Pain: A Randomized Controlled Trial. Pain Ther 2022; 11:241-252. [PMID: 35092599 PMCID: PMC8861211 DOI: 10.1007/s40122-021-00342-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Opioid-tolerant patients are more likely to deviate from recommended treatments and to experience inadequate analgesia than opioid-naive ones. The aim of this study was to examine whether pharmacist-led management could help improve treatment adherence and quality of life. Methods Eligible patients were randomized in a 1:1 ratio to control group and intervention group. The control group received routine education and support, while the intervention group received additional individualized pharmacist-led care. The primary endpoint was treatment adherence in the per-protocol analysis, as evaluated by blinded assessors. An interim analysis was planned when 30% patients completed the study. Alpha was divided into the interim analysis (0.015) and the final analysis (0.035). Results In the interim analysis (97 and 87 patients in the control and intervention groups, respectively), the primary endpoint was met. Pharmacist-led intervention significantly increased treatment adherence (93.3 vs. 79.8%; OR: 2.25; 95% CI 1.02, 4.94; P = 0.013), quality of life (0.81 ± 0.17 vs. 0.72 ± 0.25; P = 0.008), and reporting of adverse events (82.7 vs. 61.9%; OR: 1.88; 95% CI 1.16, 3.07; P = 0.004). The two groups did not differ in pain control rate (66.7 vs. 57.1%; OR: 1.25; 95% CI 0.87, 1.78; P = 0.218), breakthrough pain-free rate (66.7 vs. 61.9%; OR: 1.12; 95% CI 0.78, 1.59; P = 0.532) and pain score (1.97 ± 1.04 vs. 2.15 ± 1.24; P = 0.522). Conclusions Pharmacist-led management improved treatment adherence, quality of life, and the reporting of adverse events in opioid-tolerant patients with cancer pain. Trial Registration ClinicalTrials.gov, NCT03455023. Supplementary Information The online version contains supplementary material available at 10.1007/s40122-021-00342-0.
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Affiliation(s)
- Xiaowei Zheng
- Department of Pharmacy, Cancer Hospital of University of Chinese Academy of Sciences, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China.,Department of Pharmacy, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, China.,Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Hangzhou, China
| | - Haiying Ding
- Department of Pharmacy, Cancer Hospital of University of Chinese Academy of Sciences, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Silu Xu
- Department of Pharmacy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, 42 Baiziting Road, Nanjing, 210009, China
| | - Ruixiang Xie
- Department of Pharmacy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, China
| | - Yuguo Liu
- Department of Pharmacy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Qing Zhai
- Department of Pharmacy, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Luo Fang
- Department of Pharmacy, Cancer Hospital of University of Chinese Academy of Sciences, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Yinghui Tong
- Department of Pharmacy, Cancer Hospital of University of Chinese Academy of Sciences, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Jiao Sun
- Department of Pharmacy, Cancer Hospital of University of Chinese Academy of Sciences, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Wenxiu Xin
- Department of Pharmacy, Cancer Hospital of University of Chinese Academy of Sciences, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Nan Wu
- Department of Pharmacy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, 42 Baiziting Road, Nanjing, 210009, China
| | - Juan Chen
- Department of Pharmacy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, China
| | - Wenna Shi
- Department of Pharmacy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Ling Yang
- Department of Pharmacy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, China
| | - Hui Li
- Department of Pharmacy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Jingjing Shao
- Department of Pharmacy, Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230031, China
| | - Yangkui Wang
- Department of Pharmacy, Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230031, China
| | - Hui Yu
- Department of Pharmacy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, China
| | - Bo Zhang
- Department of Pharmacy, Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230031, China
| | - Qiong Du
- Department of Pharmacy, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yezi Yang
- Department of Pharmacy, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Xiaodan Zhang
- Department of Pharmacy, Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230031, China
| | - Cunxian Duan
- Department of Pharmacy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Qiulin Zhao
- Department of Pharmacy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, China
| | - Jing Shi
- Department of Pharmacy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Jing Huang
- Department of Pharmacy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, China
| | - Qing Fan
- Department of Pharmacy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Huawei Cheng
- Department of Pharmacy, Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230031, China
| | - Lingya Chen
- Department of Pharmacy, Cancer Hospital of University of Chinese Academy of Sciences, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Sisi Kong
- Department of Pharmacy, Cancer Hospital of University of Chinese Academy of Sciences, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Hui Zhang
- Department of Pharmacy, Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230031, China
| | - Liyan Gong
- Department of Rare Cancer and Head and Neck Medical Oncology, Cancer Hospital of University of Chinese Academy of Sciences, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Yiping Zhang
- Department of Thoracic Medical Oncology, Cancer Hospital of University of Chinese Academy of Sciences, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Zhengbo Song
- Department of Clinical Trial, Cancer Hospital of University of Chinese Academy of Sciences, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Yang Yang
- Department of Pain Management, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Shoubing Zhou
- Department of Medical Oncology, Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230031, China
| | - Chengsuo Huang
- Department of Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Jinyuan Lin
- Department of Abdominal Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, China
| | - Chenchen Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Xianhong Huang
- Department of Health Service Management, Medical College of Hangzhou Normal University, Hangzhou, 310022, China
| | - Qing Wei
- Department of Pharmacy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, 42 Baiziting Road, Nanjing, 210009, China.
| | - Yancai Sun
- Department of Pharmacy, Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230031, China.
| | - Ping Huang
- Department of Pharmacy, Cancer Hospital of University of Chinese Academy of Sciences, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China. .,Department of Pharmacy, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, China. .,Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Hangzhou, China.
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Aparna S, Gopichandran L, Garg R, Sinha AP. Impact of Standardized Educational Intervention on Improvement in Analgesic Knowledge and Its Compliance among Patients of Advanced Cancer Patients Attending Palliative Clinic: Prospective Randomized Study. J Pain Palliat Care Pharmacother 2021; 35:246-253. [PMID: 34344273 DOI: 10.1080/15360288.2021.1915442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Patient education is a low-cost intervention that can help in improving the knowledge and compliance regarding analgesics. This study aimed to assess the effectiveness of the standardized educational intervention on knowledge regarding analgesic, its compliance, and barriers to compliance among advanced cancer patients attending palliative care clinic.In this randomized control trial, 100 advanced cancer patients with pain were randomly allocated to two groups. A standardized educational intervention of 10-15 minutes on cancer pain management and analgesics was delivered at clinic visit to the patients in the intervention group at baseline and the control group received usual care. Analgesic knowledge, analgesic compliance, and barriers to compliance were measured for each patient at baseline, 2 and 4 weeks follow up visit. The data was analyzed and p < 0.05 was considered significant.Analgesic knowledge (p = 0.001) and compliance (p = 0.001) improved significantly in the experimental group at 2 weeks and 4 weeks as compared to the control group. There was also a statistically significant decrease in barriers to compliance in the experimental group as compared to the control group. A significant correlation between the knowledge and compliance score at 4 weeks in the experimental group was found with a Karl Pearson correlation coefficient, r = 0.628 (p = 0.001).The standardized educational intervention was found to be effective in improving the analgesic knowledge and analgesic compliance among cancer patients with pain at 2 and 4 weeks follow up as compared to the usual care.
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Zhang L, McLeod HL, Liu KK, Liu WH, Huang HX, Huang YM, Sun SS, Chen XP, Chen Y, Liu FZ, Jian X. Effect of Physician-Pharmacist Participation in the Management of Ambulatory Cancer Pain Through a Digital Health Platform: Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e24555. [PMID: 34398796 PMCID: PMC8406114 DOI: 10.2196/24555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 05/01/2021] [Accepted: 07/15/2021] [Indexed: 12/14/2022] Open
Abstract
Background Self-management of ambulatory cancer pain is full of challenges. Motivated by the need for better pain management, we developed a WeChat-supported platform, Medication Housekeeper (MediHK), to enhance communication, optimize outcomes, and promote self-management in the home setting. Objective We conducted a randomized controlled trial to assess whether the joint physician-pharmacist team through MediHK would provide better self-management of ambulatory patients with cancer pain. Methods Patients were randomly assigned to either an intervention group or control group. During the 4-week study period, the pharmacist would send 24-hour pain diaries daily, adverse drug reaction (ADR) forms every 3 days, and the Brief Pain Inventory form every 15 days to patients in the intervention group via MediHK. If a patient needed a change in drug/dosage or treatment of an ADR after the comprehensive review, the pharmacist would propose pharmacological interventions to the attending physician, who was then responsible for prescribing or adjusting pain medications. If no adjustments were needed, the pharmacist provided appropriate targeted education based on knowledge deficits. Patients in the control group received conventional care and did not receive reminders to fill out the forms. However, if the control group patients filled out a form via MediHK, the pain management team would review and respond in the same way as for the intervention group. The primary outcomes included pain intensity and pain interference in daily life. Secondary outcomes included patient-reported outcome measures, medication adherence, ADRs, and rehospitalization rates. Results A total of 100 patients were included, with 51 (51%) in the intervention group and 49 (49%) in the control group. The worst pain scores, least pain scores, and average pain scores in the intervention group and the control group were statistically different, with median values of 4 (IQR 3-7) vs 7 (IQR 6-8; P=.001), 1 (IQR 0-2) vs 2 (IQR 1-3; P=.02), and 2 (IQR 2-4) vs 4 (IQR 3-5; P=.001), respectively, at the end of the study. The pain interference on patients' general activity, mood, relationships with others, and interests was reduced, but the difference was not statistically significant compared with the control group (Ps=.10-.76). The medication adherence rate increased from 43% to 63% in the intervention group, compared with an increase of 33% to 51% in the control group (P<.001). The overall number of ADRs increased at 4 weeks, and more ADRs were monitored in the intervention group (P=.003). Rehospitalization rates were similar between the 2 groups. Conclusions The joint physician-pharmacist team operating through MediHK improved pain management. This study supports the feasibility of integrating the internet into the self-management of cancer pain. Trial Registration Chinese Clinical Trial Registry ChiCTR1900023075; https://www.chictr.org.cn/showproj.aspx?proj=36901
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Affiliation(s)
- Lu Zhang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Howard L McLeod
- Geriatric Oncology Consortium, Tampa, FL, United States.,Taneja College of Pharmacy, University of South Florida, Tampa, FL, United States.,Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Ke-Ke Liu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Wen-Hui Liu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hang-Xing Huang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ya-Min Huang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shu-Sen Sun
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,College of Pharmacy and Health Sciences, Western New England University, Boston, MA, United States
| | - Xiao-Ping Chen
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Yao Chen
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China
| | - Fang-Zhou Liu
- College of Information Science and Engineering, Hunan Normal University, Changsha, China
| | - Xiao Jian
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Huang HX, Liu KK, Zhang L, Huang YM, Liu WH, Xiao J. Influencing factors of end-of-dose failure in patients with cancer pain after oral oxycodone sustained-release tablets: a retrospective, case-control study. Jpn J Clin Oncol 2021; 51:932-941. [PMID: 33521814 DOI: 10.1093/jjco/hyab002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/04/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Comparing the characteristics of end-of-dose failure patients and non-end-of-dose failure patients in the Chinese population and exploring the factors that may affect the occurrence of end-of-dose failure in cancer pain patients. METHODS The outpatient with cancer pain from 2016 to 2019 were collected through hospital information system, and patients were included who met the following criteria: patients with the average numerical rating scale ≥4 points within 3 days after taking the oxycodone sustained-release preparation, titrated to an effective therapeutic dose suitable for patients, had at least two clinical visits information of the patient with a minimum of ≥3 days between visits, the average numerical rating scale of the next visit after the treatment of occasional pain is ≥4, and were divided into end-of-dose failure group and non-end-of-dose failure group. RESULTS Age (P < 0.05, odds ratio 0.933), diagnosis of nasopharyngeal carcinoma (P < 0.05, odds ratio 0.009), pain site is the head and neck (P < 0.05, odds ratio 0.005) and the abdomen (P < 0.01, odds ratio 0.021), and the metastatic site is the liver (P < 0.05, odds ratio 0.001) are related to the occurrence of end-of-dose failure. CONCLUSIONS Younger patients are more likely to develop end-of-dose failure. Patients diagnosed with nasopharyngeal cancer, with pain in the head and neck and abdomen, and with liver metastases have a lower incidence of end-of-dose failure.
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Affiliation(s)
- Hang-Xing Huang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ke-Ke Liu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lu Zhang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ya-Min Huang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Wen-Hui Liu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Jian Xiao
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Liu K, Huang H, Zhang L, Huang Y, Sun S, Chen X, Chen Y, Liu W, Xiao J. Effects of a physician- and pharmacist-managed clinic on pain management in cancer patients in China. Basic Clin Pharmacol Toxicol 2021; 129:36-43. [PMID: 33763950 DOI: 10.1111/bcpt.13583] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 03/19/2021] [Accepted: 03/19/2021] [Indexed: 01/15/2023]
Abstract
In China, pharmacists have started to manage cancer pain at outpatient clinics. This retrospective study performed at a tertiary teaching hospital was aimed to evaluate the effects of a physician-pharmacist joint clinic for cancer pain management. The study was performed between December 2016 and August 2019 and included 113 outpatients with moderate to severe cancer-related pain. Patients were divided into two groups according to the clinic each patient visited: the physician-pharmacist joint clinic (joint group, n = 59) or physician-only clinic (usual group, n = 54). Brief Pain Inventory (BPI) and Morisky Medication Adherence Measure (MMAM) were used to collect data on pain intensity, interference and medication adherence. Pain Management Index (PMI) was also calculated. BPI, MMAM and PMI were assessed at baseline (patients' first visit, week 0) and week 4 follow-up. The Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) was used to assess patients' health-related quality of life (HRQoL) at week 4. The primary outcomes were the improvement in pain intensity, adequacy of pain management and medication adherence. The secondary outcome was the improvement in HRQoL. At week 4, compared to the usual group, the BPI pain intensity categories except the pain right now were significantly lower in the joint group: worst pain, 4 (3-7) vs 6 (4-8), P = .020; least pain, 1 (0-2) vs 2 (1-3), P = .010; average pain, 3 (2-4) vs 4 (2-5), P = .023; pain right now, 2 (1-3) vs 2 (0-4), P = .796. For the seven pain interference categories, there were no significant improvements in the joint group (P > .05). Significantly more patients achieved adequate pain control in the joint group than the usual group ((P = .002). There was also a significant difference in medication adherence between the two groups (P = .001). There were no significant differences in HRQoL between the two groups. The study suggests that pharmacist participation in outpatient cancer pain management is associated with improvement of patients' pain control and medication adherence.
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Affiliation(s)
- Keke Liu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Department of Pharmacy, Huaihe Hospital of Henan University, Kaifeng, China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Hangxing Huang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lu Zhang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yamin Huang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shusen Sun
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,College of Pharmacy and Health Sciences, Western New England University, Springfield, MA, USA
| | - Xiaoping Chen
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Central South University, Changsha, China
| | - Yao Chen
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China
| | - Wenhui Liu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jian Xiao
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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8
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Meghani SH, Persico AL, Fudin J, Knafl GJ. Gaps in the Use of Long-Acting Opioids Within Intervals of Consecutive Days Among Cancer Outpatients Using Electronic Pill Caps. PAIN MEDICINE 2021; 22:687-693. [PMID: 32935134 DOI: 10.1093/pm/pnaa273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE This study describes individual cancer patients' nonuse of extended-release or long-acting (ER/LA) opioids, including periods of gap between opioid doses taken. DESIGN Secondary analysis of a three-month observational study of prescribed ER/LA opioids monitored using electronic pill caps. SETTING Two outpatient oncology clinics of a large health system in the Mid-Atlantic region. PARTICIPANTS Inclusion was based on self-identified African Americans and whites, at least 18 years old, diagnosed with solid tumors or multiple myeloma. For the current analysis, the additional inclusion criterion was prescription of an oral ER/LA opioid for cancer pain to be taken around the clock. METHODS The electronic monitoring period for each study participant was partitioned into intervals of days between days with one or more openings (using medication event monitoring systems) representing rates of ER/LA opioid nonuse over consecutive days and over time. RESULTS Of the sample (N = 109), two-thirds of the cancer patients had some nonuse of prescribed ER/LA opioids, with one in four having nonuse during 31.5-87.5% of their electronic-monitoring periods. Nonuse over periods of five or more, six or more, and seven or more consecutive days occurred for 37.6%, 34.9%, and 30.3% of the participants, respectively. CONCLUSIONS About one in three ambulatory cancer patients in this study had substantial gaps between days of ER/LA opioid use, potentially resulting in risk of overdose depending upon the prescribed ER/LA opioid type, dose, and length of the time the opioid was stopped and resumed at the previous dose. This phenomenon has received little to no attention in the opioid safety discourse.
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Affiliation(s)
- Salimah H Meghani
- Department of Biobehavioral Health Sciences; New Courtland Center for Transitions and Health; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Jeffrey Fudin
- Samuel S. Stratton Department of Veterans Affairs Medical Center, Albany, New York, USA.,Albany College of Pharmacy and Health Sciences, Albany, New York, USA.,Western New England University, Springfield, Massachusetts, USA.,Remitigate Therapeutics, Delmar, New York, USA
| | - George J Knafl
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Vanneste L, Lefebvre T, Tack L, Van Eygen K, Cool L, Schofield PA, Boterberg T, De Rijdt T, Verhaeghe A, Verhelle K, Debruyne PR. Pain medication adherence in patients with cancer: a pragmatic review. PAIN MEDICINE 2021; 23:782-798. [PMID: 33502510 DOI: 10.1093/pm/pnab010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Adherence to pain medication in patients with cancer is crucial for successful pain therapy. This review aimed to investigate: the rate of adherence, which factors influence adherence, whether adherence differs in diverse patient populations, whether there are methods to improve adherence, and the relationship between adherence and pain relief. METHODS This review was performed following the PRISMA guidelines. MEDLINE/Pubmed, Embase, Web Of Science, Cochrane and ClinicalTrials.gov were searched. All types of studies investigating adherence of patients with cancer, factors influencing adherence, and methods to improve adherence to pain medication were included. They were first screened on title and abstract and thereafter on full text. Selected articles were subjected to a quality assessment according to the PRISMA checklist. From included articles, study characteristics and outcomes were extracted. RESULTS Out of 795 articles, 18 were included. Different methods were used to measure adherence, which led to adherence rates ranging from 8.9% to 82.0%. White Americans and men were found to be more adherent than African Americans and women. Due to various barriers, adherence is often suboptimal. Fear of addiction, physiological and harmful effects, tolerance, and disease progression are common concerns. Interventions, such as pain education booklets, pain consults, and specialised nurses, may be beneficial to increase the adherence. Lower adherence rates were associated with lower pain relief. CONCLUSION Adherence of cancer patients to pain medication is suboptimal. Health care workers should focus on barriers to increase the adherence in order to obtain a better pain relief.
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Affiliation(s)
- Lorenz Vanneste
- Hospital Pharmacy, General Hospital Groeninge, Kortrijk, Belgium.,Department of Medical Oncology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium.,Faculty of Pharmaceutical Sciences, Catholic University Leuven, Leuven, Belgium
| | - Tessa Lefebvre
- Department of Medical Oncology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium.,Department of Radiotherapy and Experimental Cancer Research, Ghent University, Ghent, Belgium
| | - Laura Tack
- Department of Medical Oncology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium.,Department of Radiotherapy and Experimental Cancer Research, Ghent University, Ghent, Belgium
| | - Koen Van Eygen
- Department of Haematology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Lieselot Cool
- Department of Medical Oncology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | | | - Tom Boterberg
- Department of Radiotherapy and Experimental Cancer Research, Ghent University, Ghent, Belgium
| | - Thomas De Rijdt
- Hospital Pharmacy, University Hospitals Leuven, Leuven, Belgium.,Department of Pharmaceutical and Pharmacological Sciences, Catholic University Leuven, Leuven, Belgium
| | - Anne Verhaeghe
- Hospital Pharmacy, General Hospital Groeninge, Kortrijk, Belgium
| | - Katy Verhelle
- Hospital Pharmacy, General Hospital Groeninge, Kortrijk, Belgium
| | - Philip R Debruyne
- Department of Medical Oncology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium.,Positive Ageing Research Institute (PARI), Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK
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10
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Seangrung R, Ahuja M, Pasutharnchat K, Mahawan R. Factors influencing non-adherence to opioids in cancer patients: a mixed-methods cross-sectional study. F1000Res 2020; 9:1471. [PMID: 33815776 PMCID: PMC7984143 DOI: 10.12688/f1000research.27725.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 04/01/2024] Open
Abstract
Background: Strong opioids are mainly utilized to attenuate pain in cancer patients. Adherence to analgesic drugs significantly promotes adequate pain management and improves quality of life. We aimed to identify the factors influencing non-adherence to strong opioids in cancer patients. Methods: A descriptive, cross-sectional, two-phased, mixed methods design was conducted prospectively to evaluate a cohort of 101 cancer patients who are currently prescribed strong opioids from a pain clinic in Thailand between January and March 2018. Participants were asked to complete a questionnaire that included the following sections: general characteristics; the Medication Taking Behavior in Thai (MTB-Thai) for assessing adherence to medications; and factors influencing nonadherence, which were analyzed using multivariate logistic regression. In addition, face-to-face in depth interviews were conducted with patients showing non-adherence to strong opioids (MTB-Thai score ≤21) and analyzed using thematic content analysis. Results: Of 101 cancer pain patients that completed the questionnaire, 39.6% showed non-adherence to strong opioids. Illness understanding (P=0.047) and the use of more than three types of pain medication (P=0.032) were significant factors influencing non-adherence. Qualitative analysis indicated that fear of long-term outcomes, opioid side effects, ineffective pain control, attempts to make the regimen more acceptable, poor understanding, and non-acceptance of disease related to non-adherence. Conclusion: Non-adherence to opioids for cancer patients is a common problem. Awareness of patient factors, medication-related factors, and illness-related factors will provide the knowledge and adequate advice that may enhance adherence to medications.
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Affiliation(s)
- Rattaphol Seangrung
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Mallika Ahuja
- Department of Anesthesiology, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, 30000, Thailand
| | - Koravee Pasutharnchat
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Rungwipha Mahawan
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
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11
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Seangrung R, Ahuja M, Pasutharnchat K, Mahawan R. Factors influencing non-adherence to opioids in cancer patients: a mixed-methods cross-sectional study. F1000Res 2020; 9:1471. [PMID: 33815776 PMCID: PMC7984143 DOI: 10.12688/f1000research.27725.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Strong opioids are mainly utilized to attenuate pain in cancer patients. Adherence to analgesic drugs significantly promotes adequate pain management and improves quality of life. We aimed to identify the factors influencing non-adherence to strong opioids in cancer patients. Methods: A descriptive, cross-sectional, two-phased, mixed methods design was conducted prospectively to evaluate a cohort of 101 cancer patients who are currently prescribed strong opioids from a pain clinic in Thailand between January and March 2018. Participants were asked to complete a questionnaire that included the following sections: general characteristics; the Medication Taking Behavior in Thai (MTB-Thai) for assessing adherence to medications; and factors influencing nonadherence, which were analyzed using multivariate logistic regression. In addition, face-to-face in depth interviews were conducted with patients showing non-adherence to strong opioids (MTB-Thai score ≤21) and analyzed using thematic content analysis. Results: Of 101 cancer pain patients that completed the questionnaire, 39.6% showed non-adherence to strong opioids. Illness understanding (P=0.047) and the use of more than three types of pain medication (P=0.032) were significant factors influencing non-adherence. Qualitative analysis indicated that fear of long-term outcomes, opioid side effects, ineffective pain control, attempts to make the regimen more acceptable, poor understanding, and non-acceptance of disease related to non-adherence. Conclusion: Non-adherence to opioids for cancer patients is a common problem. Awareness of patient factors, medication-related factors, and illness-related factors will provide the knowledge and adequate advice that may enhance adherence to medications.
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Affiliation(s)
- Rattaphol Seangrung
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Mallika Ahuja
- Department of Anesthesiology, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, 30000, Thailand
| | - Koravee Pasutharnchat
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Rungwipha Mahawan
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
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12
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A self-management application “pain-housekeeper” to control cancer pain: a randomized controlled trial study protocol†. FRONTIERS OF NURSING 2020. [DOI: 10.2478/fon-2020-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective
Pain is a prevalent and distressing symptom in patients with cancer which has a significant impact on patients’ physical health, psychological well-being, and quality of life (QOL). Deficiency of pain care, inadequate pain communication, and reluctance toward pain medication contribute to the difficulties in improving the situation of patients with cancer pain. Fortunately, the integration of self-management and professional healthcare provides new opportunities for patients with cancer pain.
Methods
A two-arm randomized controlled trial will be conducted to assess the effectiveness of self-management application compared with routine care among patients with cancer pain. Based on Orem's self-care theory and Naylor's transitional care theory, cancer pain self-management application “Pain-housekeeper” was developed with dual client: patient client and medical client. A total of 120 patients with cancer pain are recruited from two university-affiliated tertiary public hospitals in China. They are randomly assigned to the control group and the intervention group. The patients in the control group get routine care while the patients in the intervention group get routine care and Pain-housekeeper App. The intervention is delivered by registered doctors, nurses, and postgraduate nursing students specialized in pain care. Effect measurements for both groups are carried out with questionnaires at baseline (T0), after 4 weeks (T1) and after 12 weeks (T2). The primary outcomes include pain condition, self-efficacy, and QOL. The secondary outcomes include pain medication adherence, satisfaction, anxiety, and depression. Compliance of data submission, economic evaluation, usage, and clinical data are also considered in the test. Data for the evaluation are gathered continuously during the study period.
Discussion
This article provides insight into the effectiveness of a theory-based self-management mobile application intervention delivered to patients with uncontrolled cancer pain. The results are used to help patients to improve cancer pain control, self-efficacy, and QOL.
Conclusions
The findings of this article provide evidence to support the implementation of an innovative and easily accessible intervention that enhances health outcomes.
Trial registration
ChiCTR: ChiCTR1800020295, Registered 22 December, 2018.
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13
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Cognition and Sociodemographic Determinants for Effective Pain Control in Patients with Cancer Pain: a Cross-sectional Survey in China. Curr Med Sci 2020; 40:249-256. [DOI: 10.1007/s11596-020-2167-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/15/2020] [Indexed: 10/24/2022]
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14
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Zeng D, Li K, Lin X, Mizuno M. Attitudinal Barriers to Pain Management and Associated Factors Among Cancer Patients in Mainland China: Implications for Cancer Education. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:284-291. [PMID: 30607804 DOI: 10.1007/s13187-018-1463-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Attitudinal barriers to pain management are supposed to contribute to the uncontrolled cancer pain in mainland China. The purpose of this study was (1) to investigate the attitudinal barriers to pain management among cancer patients in mainland China, (2) to examine relationships between the attitudinal barriers and patients' pain management conditions in the light of medication adherence and adequacy of analgesic use, and (3) to identify factors associated with the attitudinal barriers. A cross-sectional questionnaire survey, including the Barriers Questionnaire-Chinese (BQ-C) and two scales that measure the medication adherence and the adequacy of analgesic use, was carried out among patients with a variety of cancers. The questionnaires were completed by 246 cancer patients (response rate 94.6%); their mean age was 51.5 years (SD = 11.7). Almost all the patients had various attitudinal barriers to pain management. The mean scores for the total scale and several subscales of the BQ-C were significantly different by the patients' characteristics, the medication adherence, and the adequacy of analgesic use. The associations with these variables for a given subscale, e.g., the subscale regarding concerns about side effects, were different from those for other subscales, e.g., the subscale regarding fatalism that cancer pain is uncontrollable. The findings suggest that a nurse-led educational program in the light of patients' characteristics is required for overcoming the attitudinal barriers to pain management among cancer patients in mainland China.
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Affiliation(s)
- Dongyan Zeng
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, 305-8577, Japan
- School of Nursing, Sun Yat-sen University, Guangzhou, 510080, People's Republic of China
| | - Kun Li
- School of Nursing, Sun Yat-sen University, Guangzhou, 510080, People's Republic of China.
| | - Xiyin Lin
- School of Nursing, Sun Yat-sen University, Guangzhou, 510080, People's Republic of China
| | - Michiyo Mizuno
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8577, Japan
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15
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Gender Difference in Cancer Patients' Adherence to Analgesics and Related Outcomes of Pain Management. Cancer Nurs 2019; 41:E11-E18. [PMID: 28753193 DOI: 10.1097/ncc.0000000000000532] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Males and females have significant differences in certain medical outcomes. However, little research has explored the gender differences in cancer patient perceptions of analgesics, the relationship between gender and analgesic adherence, or the effectiveness of pain management. OBJECTIVE The objectives of this study were to compare gender differences associated with hesitancy to use analgesics, analgesic adherence, or pain management effectiveness and to examine whether gender can precisely predict analgesic adherence. METHODS The study was conducted in the outpatient oncology department of a medical center in Taiwan. A descriptive and cross-sectional design was used. The study samples were collected from 362 cancer patients. The participants completed the short version of the Barriers Questionnaire-Taiwan, the Morisky Analgesics Adherence Measure-Taiwan version, the Brief Pain Inventory-Chinese version, the Pain Management Index, and a demographic and disease questionnaire. RESULTS The pain intensity and hesitancy to use analgesics scores were significantly higher among females than among males. The Pain Management Index results indicated that a larger percentage of males had adequate pain management. In addition, being male was a significant predictor of higher analgesic adherence (odds ratio, 1.93; P < .05). CONCLUSIONS Gender could precisely predict cancer patients' medication adherence. Women experienced significantly greater pain than did men but also had more hesitancy to use analgesics, lower adherence, and inadequate pain management. IMPLICATIONS FOR PRACTICE Healthcare professionals should consider women as a high-risk group for inadequate pain control. It is crucial for health providers to consider the gender discrepancy when attempting to improve cancer pain management.
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16
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Yeager KA, Williams B, Bai J, Cooper HLF, Quest T, Meghani SH, Bruner DW. Factors Related to Adherence to Opioids in Black Patients With Cancer Pain. J Pain Symptom Manage 2019; 57:28-36. [PMID: 30316809 PMCID: PMC6310640 DOI: 10.1016/j.jpainsymman.2018.10.491] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/03/2018] [Accepted: 10/05/2018] [Indexed: 11/15/2022]
Abstract
CONTEXT Cancer pain relief is often inadequate because of poor adherence to pain medication, especially for black patients. OBJECTIVES The purpose of this study is to describe factors related to adherence to around-the-clock opioids among 110 black patients being treated for cancer pain. METHODS Sociodemographic, clinical, symptoms, and social support data were collected at baseline; pain and adherence data were collected at 30 days. Associations between these variables and opioid adherence measured by Medication Event Monitoring System were estimated using multiple regression. RESULTS Mean age was 56 (±10.1), the majority were women (63%) and college educated (56%). Mean pain severity at baseline equaled 4.6 (±2.3). Mean dose adherence was 60% (±28.5), while mean schedule adherence was 33.0% (±31.0). In adjusted analysis, 26% of the variance in dose adherence was explained by recent chemotherapy, changes in pain, concerns about nausea, and doctors' focus on cure versus pain control (P<0.001); 27% of the variance in schedule adherence was explained by recent chemotherapy, changes in pain, symptom burden, and concerns about doctors focus on cure versus pain control (P<0.001). CONCLUSION Findings confirm pain medication adherence is poor and pain was not well relieved. Multiple factors influence adherence to around-the-clock opioids. Clinicians need to partner with patients by providing a personalized pain treatment plan including an in-depth assessment of treatment choices and adherence.
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Affiliation(s)
- Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA; Winship Cancer Institute, Emory University, Atlanta, Georgia, USA.
| | - Bryan Williams
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Jinbing Bai
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Hannah L F Cooper
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Tammie Quest
- School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Salimah H Meghani
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Deborah W Bruner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA; Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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A nationwide survey of adherence to analgesic drugs among cancer patients in Taiwan: prevalence, determinants, and impact on quality of life. Support Care Cancer 2018; 27:2857-2867. [PMID: 30552596 DOI: 10.1007/s00520-018-4599-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 12/10/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Poor adherence to analgesic drugs is one of the most common barriers to adequate pain management. This prospective, cross-sectional, patient-oriented observational study aimed to explore the adherence rate, clinical factors, and impact of adherence to analgesic drugs on the quality of life (QoL) among cancer outpatients in Taiwan. METHODS Eight hundred ninety-seven consecutive adult outpatients with cancer who had reported tumor pain and received regular analgesic drug treatment were enrolled from 16 medical centers across Taiwan. The Brief Pain Inventory was used to assess pain intensity and QoL. Morisky's four-item medication adherence scale was used to assess adherence to analgesic drugs. Clinical factors possibly associated with good adherence to analgesic drugs were analyzed using multivariate logistic regression analyses. RESULTS Of the 897 patients, 26.9% met criteria for the good, 35.5% for the moderate, and 37.6% for the poor adherence groups. The good adherence group had significantly better QoL outcomes than the moderate and poor adherence groups (all p < 0.05). Age ≥ 50 years, head and neck or hematological malignancies, cancer-related pain, patients who agreed or strongly agreed that the side effects of analgesic drugs were tolerable, and patients who disagreed or strongly disagreed that the dosing schedule could be flexibly self-adjusted to deal with the actual pain were predictors of good adherence to analgesic drugs. CONCLUSIONS Awareness of the clinical factors associated with adherence to analgesic drugs may help clinicians to identify cancer patients at a greater risk of non-adherence, reinforce optimal pain management, and improve the QoL by enhancing adherence to pain medications.
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18
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Lau Y, Chan KS. Psychometric evaluation of the Chinese version of the fear of intimacy with helping professionals scale. PLoS One 2018; 13:e0196774. [PMID: 29795563 PMCID: PMC5967800 DOI: 10.1371/journal.pone.0196774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 04/19/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the internal consistency, reliability, convergent validity, known-group comparisons, and structural validity of the Chinese version of Fear of Intimacy with Helping Professionals (C-FIS-HP) scale in Macau. METHODS A cross-sectional design was used on a sample of 593 older people in 6 health centers. We used Chinese version of Exercise of Self-Care Agency Scale (C-ESCAS) and Morisky 4-item medication adherence scale to evaluate self-care actions and medication adherence. The internal consistency and reliability of C-FIS-HP were analyzed using the Spearman-Brown split-half reliability, Cronbach's alpha, and test-retest reliability. Convergent validity was tested the construct of C-FIS-HP and self-care actions. Known-group comparisons differentiated predefined groups in an expected direction. Two separated samples were used to test the structural validity. An exploratory factor analysis (EFA) tested the factor structure of C-FISHP using the principal axis factoring. A confirmatory factor analysis (CFA) was further conducted to confirm the factor structure constructed in the prior EFA. RESULTS The C-FIS-HP had a Spearman-Brown split-half coefficient, Cronbach's alpha, and intraclass correlation coefficient of 0.96, 0.93, and 0.96, respectively. Convergent validity was satisfactory with significantly correlations between the C-FIS-HP and C-ESCAS. C-FIS-HP to differentiate the differences between high-, moderate-, and low- medication adherence groups. EFA demonstrated a two-factor structure among 297 older people. A first-order CFA was performed to confirm the construct dimensionality of C-FIS-HP with satisfactory fit indices (NFI = 0.92; IFI = 0.95; TLI = 0.94; CFI = 0.95 and RMSEA = 0.07) among 296 older people. CONCLUSIONS C-FIS-HP is a reliable and valid test for assessing helping relationships in older Chinese people. Health professionals can use C-FIS-HP as a clinical tool to assess the comfort level of patients in a helping relationship, and use this information to develop culturally sensitive therapeutic interventions and treatment plans. Further studies need to be conducted concerning the different psychometric properties, as well as the application of C-FIS-HP in various regions.
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Affiliation(s)
- Ying Lau
- Department of Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kin Sun Chan
- Faculty of Social Sciences and Humanities, the University of Macau, Macau Special Administration Region, China
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Stephenson E, DeLongis A, Bruel B, Badr H. Outpatient Pain Medication Use: An Electronic Daily Diary Study in Metastatic Breast Cancer. J Pain Symptom Manage 2018; 55:1131-1137. [PMID: 29221847 DOI: 10.1016/j.jpainsymman.2017.11.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 11/30/2022]
Abstract
CONTEXT Understanding cancer patients' everyday pain experiences and their concomitant use of pain medication may help identify ways to improve pain management among outpatients. OBJECTIVES This study examined the between-person and within-person associations between pain intensity and analgesic use in metastatic breast cancer patients. METHODS Fifty-three women who were initiating treatment for metastatic breast cancer completed electronic diary assessments six times per day for 14 days. RESULTS The likelihood of taking medication was found to depend on patients' average pain levels and on whether their pain was better or worse than usual at the time. Patients who typically experienced moderate-to-high pain were more likely to be prescribed and to take analgesics than were patients who typically experienced low pain. However, these patients tended not to vary their medication use based on within-person fluctuations in pain. In contrast, patients who typically experienced low pain tended to increase their medication use at times when their pain was higher than usual but were less likely to use medication than were patients who typically experienced higher levels of pain. CONCLUSION Our findings provide some evidence that patients with advanced cancer tend to use their pain medications appropriately. Patients with lower pain appear to be taking medications in response to increases in pain, whereas patients whose pain is typically more intense may be relying on other cues to prompt them to take analgesic medication. Clinicians may need to be sensitive to individual differences in the factors associated with pain medication use in daily life.
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Affiliation(s)
- Ellen Stephenson
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anita DeLongis
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Bruel
- Baylor College of Medicine, Houston, Texas, USA
| | - Hoda Badr
- Baylor College of Medicine, Houston, Texas, USA.
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Oldenmenger WH, Sillevis Smitt PAE, de Raaf PJ, van der Rijt CCD. Adherence to Analgesics in Oncology Outpatients: Focus on Taking Analgesics on Time. Pain Pract 2016; 17:616-624. [DOI: 10.1111/papr.12490] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/10/2016] [Accepted: 06/07/2016] [Indexed: 02/04/2023]
Affiliation(s)
- Wendy H. Oldenmenger
- Department of Medical Oncology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
| | | | - Pleun J. de Raaf
- Department of Medical Oncology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
| | - Carin C. D. van der Rijt
- Department of Medical Oncology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
- Netherlands Comprehensive Cancer Organisation; Utrecht The Netherlands
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21
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Multidimensional factors affecting medication adherence among community-dwelling older adults: a structural-equation-modeling approach. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0764-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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22
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A cross-sectional survey of medication adherence and associated factors for rural patients with hypertension. Appl Nurs Res 2016; 31:94-9. [DOI: 10.1016/j.apnr.2016.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/20/2015] [Accepted: 01/14/2016] [Indexed: 11/18/2022]
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Dabaghian FH, Rassouli M, Sadighi J, Ghods R. Adherence to prescribed medications of Iranian traditional medicine in a group of patients with chronic disease. J Res Pharm Pract 2016; 5:52-7. [PMID: 26985436 PMCID: PMC4776547 DOI: 10.4103/2279-042x.176563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE The extent to which a person's health-related behavior corresponds with medical instructions (adherence) is an important modifier of health system effectiveness. This study was designed to determine the patients' adherence to Iranian traditional medicine in a group of patients with chronic disease. METHODS Convenience sampling was used to enroll 320 patients with chronic diseases from January 2014 to January 2015 in clinics of traditional medicine affiliated with medical universities in Tehran. Morisky Medication Adherence Scale (MMAS) was used to measure the adherence. After describing the variables and the frequency of adherence, logistic regression analysis was used to determine the influencing factors. FINDINGS Mean age was 40.8 (standard deviation [SD] =13) years. The mean of the duration of disease was 54.6 (SD = 56.1) months and mean of the duration of referring to the clinics 6.5 (SD = 6.9) months. Total score of MMAS was zero in 33 (10.3%) of patients (high adherence), one or two in 128 (40%) of patients (moderate adherence), and more than two in 159 (49.7%) of patients (low adherence). Forgetfulness, bad taste, not availability, and the high cost of the drugs were the most commonly reported causes of non-adherence. Adherence was associated with age (odds ratio [OR] =1.05, 95% confidence interval [95% CI] 1-1.1), marriage (OR = 10.8, 95% CI 2.05-57.6), number of prescribed drugs (OR = 0.05, 95% CI 0.02-0.14), and duration of disease (OR = 1.01, 95% CI 1-1.02). CONCLUSION Considering the low adherence in users of medications of Iranian traditional medicine, health care practitioners need to be trained in adherence and the influencing factors and also to use some interventions to increase the adherence.
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Affiliation(s)
- Fataneh Hashem Dabaghian
- Department of Research, Research Institute for Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Rassouli
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jila Sadighi
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Roshanak Ghods
- Iranian Traditional Medicine, Research Institute for Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, Iran
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Li X, Zhang S, Xu H, Tang X, Zhou H, Yuan J, Wang X, Qu Z, Wang F, Zhu H, Guo S, Tian D, Zhang W. Type D Personality Predicts Poor Medication Adherence in Chinese Patients with Type 2 Diabetes Mellitus: A Six-Month Follow-Up Study. PLoS One 2016; 11:e0146892. [PMID: 26894925 PMCID: PMC4760773 DOI: 10.1371/journal.pone.0146892] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/24/2015] [Indexed: 01/19/2023] Open
Abstract
Background Type D personality and medication nonadherence have been shown to be associated with poor health outcomes. Type D personality is associated with poor medication adherence in patients with coronary artery disease, myocardial infarction, and heart failure. However, the relationship between type D personality and medication adherence in patients with Type 2 Diabetes Mellitus (T2DM) remains unknown. This study aims to examine whether type D personality was associated with medication adherence in patients with T2DM. Design and Settings A follow-up study was conducted in general hospital of the People's Liberation Army in Beijing. Methods 412 T2DM patients (205 females), who were recruited by circular systematic random sampling, provided demographic and baseline data about medical information and completed measures of Type D personality. Then, 330 patients went on to complete a self-report measure of medication adherence at the sixth month after baseline data collection. Chi-square test, t tests, and hierarchical multiple regression analyses were conducted, as needed. Results Patients with type D personality were significantly more likely to have poor medication adherence (p<0.001). Type D personality predicts poor medication adherence before and after controlling for covariates when it was analyzed as a categorical variable. However, the dimensional construct of type D personality was not associated with medication adherence when analyzed as a continuous variable. Conclusion Although, as a dimensional construct, type D personality may not reflect the components of the personality associated with poor medication adherence in patients with T2DM, screening for type D personality may help to identify those who are at higher risk of poor medication adherence. Interventions, aiming to improve medication adherence, should be launched for these high-risk patients.
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Affiliation(s)
- Xuemei Li
- Clinics of Cadre, Department of Outpatient, General Hospital of the People's Liberation Army (301 Hospital), Beijing, China
| | - Shengfa Zhang
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China
| | - Huiwen Xu
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States of America
| | - Xinfeng Tang
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China
| | - Huixuan Zhou
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China
| | - Jiaqi Yuan
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China
| | - Xiaohua Wang
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China
| | - Zhiyong Qu
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China
| | - Fugang Wang
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China
| | - He Zhu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, United States of America
| | - Shuai Guo
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China
| | - Donghua Tian
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China
- * E-mail: (DT); (WZ)
| | - Weijun Zhang
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China
- * E-mail: (DT); (WZ)
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Lu Y, Arthur D, Hu L, Cheng G, An F, Li Z. Beliefs about antidepressant medication and associated adherence among older Chinese patients with major depression: A cross-sectional survey. Int J Ment Health Nurs 2016; 25:71-9. [PMID: 26692425 DOI: 10.1111/inm.12181] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 08/18/2015] [Accepted: 08/25/2015] [Indexed: 11/27/2022]
Abstract
Antidepressant non-adherence among people with depressive disorder is a major, ongoing public health issue, yet few studies have focused on older adults and their medication adherence. Although treatment adherence is determined by multiple factors, one of the important and modifiable predictors are patients' attitudes and beliefs about medication. We explored a sample of 135 older Chinese people with major depression, and the relationship between beliefs about antidepressants and medication adherence. Sociodemographic and illness variables were also examined. In all, high antidepressant adherence was reported in 37.8%, moderate adherence in 39.2%, and low adherence in 23%. Ordinal regression analysis showed perceived necessity (P < 0.01) and concern (P < 0.01) about antidepressants were significant influencing factors. Other variables with a positive association with higher adherence were lower average income (P < 0.05), fewer number of prior episodes of depression (P < 0.01), and comorbid anxiety (P < 0.05). The present study highlights low adherence in a sample of older depressed Chinese people, and highlights how beliefs about medication affect adherence. Therefore, more attention should be focused on non-adherence in older patients, and there is a need to establish accessible and systematic education programmes to correct misconceptions to improve their adherence.
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Affiliation(s)
- Yang Lu
- Department of Respiratory and Critical Care Medicine, Beijing Chao Yang Hospital, Peking Union Medical College, Beijing, China
| | - David Arthur
- School of Health, Charles Darwin University, Melbourne, Victoria, Australia
| | - Lili Hu
- Beijing An Ding Hospital, Capital Medical University, Peking Union Medical College, Beijing, China
| | - Gen Cheng
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Fengrong An
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Zheng Li
- School of Nursing, Peking Union Medical College, Beijing, China
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Meghani SH, Knafl GJ. Patterns of analgesic adherence predict health care utilization among outpatients with cancer pain. Patient Prefer Adherence 2016; 10:81-98. [PMID: 26869772 PMCID: PMC4734825 DOI: 10.2147/ppa.s93726] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Studies in chronic noncancer pain settings have found that opioid use increases health care utilization. Despite the key role of analgesics, specifically opioids, in the setting of cancer pain, there is no literature to our knowledge about the relationship between adherence to prescribed around-the-clock (ATC) analgesics and acute health care utilization (hospitalization) among patients with cancer pain. PURPOSE To identify adherence patterns over time for cancer patients taking ATC analgesics for pain, cluster these patterns into adherence types, combine the types into an adherence risk factor for hospitalization, identify other risk factors for hospitalization, and identify risk factors for inconsistent analgesic adherence. MATERIALS AND METHODS Data from a 3-month prospective observational study of patients diagnosed with solid tumors or multiple myeloma, having cancer-related pain, and having at least one prescription of oral ATC analgesics were collected. Adherence data were collected electronically using the medication event-monitoring system. Analyses were conducted using adaptive modeling methods based on heuristic search through alternative models controlled by likelihood cross-validation scores. RESULTS Six adherence types were identified and combined into the risk factor for hospitalization of inconsistent versus consistent adherence over time. Twenty other individually significant risk factors for hospitalization were identified, but inconsistent analgesic adherence was the strongest of these predictors (ie, generating the largest likelihood cross-validation score). These risk factors were adaptively combined into a model for hospitalization based on six pairwise interaction risk factors with exceptional discrimination (ie, area under the receiver-operating-characteristic curve of 0.91). Patients had from zero to five of these risk factors, with an odds ratio of 5.44 (95% confidence interval 3.09-9.58) for hospitalization, with a unit increase in the number of such risk factors. CONCLUSION Inconsistent adherence to prescribed ATC analgesics, specifically the interaction of strong opioids and inconsistent adherence, is a strong risk factor for hospitalization among cancer outpatients with pain.
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Affiliation(s)
- Salimah H Meghani
- Department of Biobehavioral Health Sciences, NewCourtland Center of Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Correspondence: Salimah H Meghani, Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Claire M Fagin Hall, 418 Curie Boulevard – Room 337, Philadelphia, PA 19104-4217, USA, Tel +1 215 573 7128, Fax +1 215 573 7507, Email
| | - George J Knafl
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Lee BO, Liu Y, Wang YH, Hsu HT, Chen CL, Chou PL, Hsu WC. Mediating Effect of Family Caregivers' Hesitancy to Use Analgesics on Homecare Cancer Patients' Analgesic Adherence. J Pain Symptom Manage 2015; 50:814-21. [PMID: 26297852 DOI: 10.1016/j.jpainsymman.2015.06.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/19/2015] [Accepted: 07/06/2015] [Indexed: 02/08/2023]
Abstract
CONTEXT Family caregivers play an increasingly critical role in cancer patients' symptom management as the number of cancer patients receiving home care grows. However, there is a lack of research measuring the impact of the family caregivers' hesitancy to use analgesics on analgesic adherence and the resulting influence on patient pain intensity. OBJECTIVES To examine whether family caregivers' hesitancy to use analgesics is a mediator that influences patient adherence and investigate how analgesic regimen adherence affects pain intensity. METHODS This study used a cross-sectional and descriptive design. One hundred seventy-six patient-family caregiver dyads (N = 352) were recruited from one local hospital in southern Taiwan. Instruments included the Short Version of the Barriers Questionnaire-Taiwan, the Morisky Medication Adherence Measure-Taiwan, the Brief Pain Inventory-Chinese, and demographic and illness questionnaires. A one-way analysis of variance and post hoc comparisons were performed to assess the influence of analgesic regimen adherence on pain intensity. Sobel tests were used to examine mediating effects. RESULTS Family caregivers' hesitancy to use analgesics was a significant mediator between patient barriers to use analgesics and patient analgesic regimen adherence (P < 0.0001). Patients with low and moderate adherence levels reported significantly higher levels of pain severity (F = 3.83, P < 0.05). CONCLUSION This study showed that family caregivers' hesitancy to use analgesics was a significant mediator associated with their hesitancy to use analgesics and the patients' analgesic adherence. It is important for health care providers to consider family caregivers' hesitancy to use analgesics when attempting to improve adherence to pain management regimens in clinical practice.
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Affiliation(s)
- Bih-O Lee
- Department of Nursing, Chang Gung University of Science and Technology, Chia-Yi Campus, Taiwan, Republic of China
| | - Yi Liu
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Yi-Hsien Wang
- Research Center for Nonlinear Analysis & Optimization, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Hsin-Tien Hsu
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Chien-Liang Chen
- Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan, Republic of China
| | - Pi-Ling Chou
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.
| | - Wen-Chung Hsu
- Institute of Human Resource Management, National Sun Yat-sen University, Kaohsiung, Taiwan, Republic of China
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Wong MCS, Wu CHM, Wang HHX, Li HW, Hui EMT, Lam AT, Chung RYN, Yip BHK, Morisky DE. Association between the 8-item Morisky medication adherence scale (MMAS-8) score and glycaemic control among Chinese diabetes patients. J Clin Pharmacol 2014; 55:279-87. [PMID: 25293349 DOI: 10.1002/jcph.408] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 10/03/2014] [Indexed: 11/11/2022]
Abstract
Adherence with oral hypoglycaemic agent is crucial to achieve optimal glycaemic control. The 8-item Morisky Medication Adherence Scale (MMAS-8) has been frequently used, yet the association between MMAS-8 score and glycaemic control among Chinese diabetes patients is largely unknown. Two general out-patient clinics were randomly selected in a district with socio-demographic characteristics representative of the entire Hong Kong population. A consecutive sample of adult type-2 diabetes patients currently taking oral hypoglycaemic agents was included. The glycaemic control was reflected by the level of hemoglobin A1c (HbA1c) taken within the previous 6 months. Factors associated with poor glycaemic control (HbA1c ≥ 7.0%) were evaluated by linear regression analysis. From 565 eligible Chinese patients with an average age of 63.2 years (SD 9.7) and male proportion of 46.5%, the average HbA1c was 7.1% (SD 1.1%), and 52.0% had poor glycaemic control. The proportion of poor medication adherence (MMAS-8 ≤ 6) was 32.2%. After controlling for socio-demographics, lifestyle, medication use, and health characteristics, the MMAS-8 score was correlated with better glycaemic control (beta -0.095; 95%CI -0.164 to -0.026, P = .007). The MMAS-8 score had a weak and negative correlation with HbA1c level. The instrument should be applied with caution when predicting glycaemic control in clinical practice.
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Affiliation(s)
- Martin C S Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Carmen H M Wu
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, Hong Kong
| | - Harry H X Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 9LX, UK
| | - Heung Wing Li
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, Hong Kong
| | - Eric M T Hui
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, Hong Kong
| | - Augustine T Lam
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, Hong Kong
| | - Roger Y N Chung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Benjamin H K Yip
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Donald E Morisky
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Schumacher KL, Plano Clark VL, West CM, Dodd MJ, Rabow MW, Miaskowski C. Pain medication management processes used by oncology outpatients and family caregivers part I: health systems contexts. J Pain Symptom Manage 2014; 48:770-83. [PMID: 24704800 PMCID: PMC4185257 DOI: 10.1016/j.jpainsymman.2013.12.242] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 12/20/2013] [Accepted: 12/31/2013] [Indexed: 11/18/2022]
Abstract
CONTEXT Oncology patients with persistent pain treated in outpatient settings and their family caregivers have significant responsibility for managing pain medications. However, little is known about their practical day-to-day experiences with pain medication management. OBJECTIVES The aim was to describe day-to-day pain medication management from the perspectives of oncology outpatients and their family caregivers who participated in a randomized clinical trial of a psychoeducational intervention called the Pro-Self(©) Plus Pain Control Program. In this article, we focus on pain medication management by patients and family caregivers in the context of multiple complex health systems. METHODS We qualitatively analyzed audio-recorded intervention sessions that included extensive dialogue between patients, family caregivers, and nurses about pain medication management during the 10-week intervention. RESULTS The health systems context for pain medication management included multiple complex systems for clinical care, reimbursement, and regulation of analgesic prescriptions. Pain medication management processes particularly relevant to this context were getting prescriptions and obtaining medications. Responsibilities that fell primarily to patients and family caregivers included facilitating communication and coordination among multiple clinicians, overcoming barriers to access, and serving as a final safety checkpoint. Significant effort was required of patients and family caregivers to insure safe and effective pain medication management. CONCLUSION Health systems issues related to access to needed analgesics, medication safety in outpatient settings, and the effort expended by oncology patients and their family caregivers require more attention in future research and health-care reform initiatives.
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Affiliation(s)
- Karen L Schumacher
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USA.
| | | | - Claudia M West
- University of California, San Francisco, San Francisco, California, USA
| | - Marylin J Dodd
- University of California, San Francisco, San Francisco, California, USA
| | - Michael W Rabow
- University of California, San Francisco, San Francisco, California, USA
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Almeida ED, Rodrigues LCS, Vieira JLF. Estimates of adherence to treatment of vivax malaria. Malar J 2014; 13:321. [PMID: 25127886 PMCID: PMC4141083 DOI: 10.1186/1475-2875-13-321] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 08/08/2014] [Indexed: 12/04/2022] Open
Abstract
Background The relation between therapeutic failure and non-adherence to treatment of malaria has been clearly established. Several measures have been used to estimate adherence to Plasmodium vivax therapy, but few protocols have been validated to ensure reliability of the estimates of adherence. The objective of this study was to validate a five-item-reported-questionnaire derived from original Morisky four-item scale to estimate adherence to P. vivax malaria therapy. Methods A five-item-reported questionnaire was applied to patients after treatment of P. vivax malaria, considering behaviours regarding to forgetfulness, carelessness as to time of administration, cessation or discontinuation of use and replication of dose. Data were collected in dichotomous and Likert scales. Reliability was assessed by Cronbach’s alpha and by the contribution of each item to total. The concurrent validation was done with pill count and concordance between measures of adherence by coefficient of Kappa. Sensitivity, specificity and accuracy were also determined. Results A total of 135 patients were enrolled in the study. Adherence ranged from 63.8 to 72.7% in both psychometric measures and pill count. The responses on the Likert scale showed higher proportion of non-adherence behaviour, greater variance and concordance with pill count, as well as more sensitive to characterize the behaviour of self-medication. The internal consistency of questionnaire was moderate. Significant correlations were seen with items regarding the forgiveness or careless in taking pills in all scales. The agreement between psychometric measures and pill count was considered satisfactory. The non-adherence to malaria therapy in an endemic area of Amazon basin was 33.3%. Conclusion The five-item-reported questionnaire with responses on Likert scale is a feasible option for reliable estimation of adherence to malaria therapy in endemic areas.
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Affiliation(s)
| | | | - José Luiz F Vieira
- Laboratório de Toxicologia da Universidade Federal do Pará, Rua Augusto Correa, 01- Campus Universitário do Guamá, Belém-Pará, Zip code: 66075-740, Brazil.
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Medication adherence and its associated factors among Chinese community-dwelling older adults with hypertension. Heart Lung 2014; 43:278-83. [PMID: 24856232 DOI: 10.1016/j.hrtlng.2014.05.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/02/2014] [Accepted: 05/02/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the factors that influence medication adherence in Chinese community-dwelling older adults with hypertension. METHODS A cross-sectional study was conducted with a convenience sample of 382 older adults with hypertension recruited from six health centers in Macao, China. Chinese versions of the Morisky 4-Item Self-Report Measure of Medication-Taking Behavior, Fear of Intimacy with Helping Professionals scale and Exercise of Self-care Agency scale were administered to participants. RESULTS Participants older than 65 years (β = .118, p = .017), with a low level of education (β = .128, p = .01), who had more than one other common disease (β = .120, p = .015), were on long-term medication (β = .221, p < .001) and who reported higher self-care (β = .188, p = .001), had better medication adherence. CONCLUSIONS Health care professionals should consider these factors when planning medication regimens for Chinese older adults with hypertension, to enhance medication adherence and improve patient outcomes.
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Assessing medication adherence: options to consider. Int J Clin Pharm 2013; 36:55-69. [DOI: 10.1007/s11096-013-9865-x] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 10/03/2013] [Indexed: 12/20/2022]
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Lau Y, Chow A, Chan S, Wang W. Fear of intimacy with helping professionals and its impact on elderly Chinese. Geriatr Gerontol Int 2013; 14:474-80. [DOI: 10.1111/ggi.12121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Ying Lau
- Alice Lee Center for Nursing Studies; National University of Singapore; Singapore
| | - Aloysius Chow
- Alice Lee Center for Nursing Studies; National University of Singapore; Singapore
| | - Sally Chan
- Alice Lee Center for Nursing Studies; National University of Singapore; Singapore
| | - Wenru Wang
- Alice Lee Center for Nursing Studies; National University of Singapore; Singapore
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Lin YS, Ho Y, Hu CJ, Su WW, Hsu KY, Shen WW, Chiueh CC, Yuan RY. Development of a Taiwan Version of the Eight-item Morisky Medication Adherence Scale and Factors Influencing Patients' Comprehension. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.jecm.2013.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Nguyen LMT, Rhondali W, De la Cruz M, Hui D, Palmer L, Kang DH, Parsons HA, Bruera E. Frequency and predictors of patient deviation from prescribed opioids and barriers to opioid pain management in patients with advanced cancer. J Pain Symptom Manage 2013; 45:506-16. [PMID: 22940562 PMCID: PMC3856203 DOI: 10.1016/j.jpainsymman.2012.02.023] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 02/25/2012] [Accepted: 02/28/2012] [Indexed: 12/16/2022]
Abstract
CONTEXT Approximately 80% of patients with advanced cancer report pain and receive opioids. Information is limited about deviations from prescribed opioid doses and barriers to pain control, but poor opioid adherence has been reported in 49%-70% of patients. OBJECTIVES To evaluate the frequency and severity of self-reported opioid deviation and barriers to opioid pain management in outpatients with advanced cancer. METHODS We surveyed 198 patients and collected pain scores (0-10), prescribed opioid dose, confidential patient-reported opioid prescription dose and intake (as long as there was no severe opioid deviation), barriers to pain management (Barriers Questionnaire-II [BQ-II]) scores, and adherence scores. Opioid deviation was defined as <70% or >130% of the prescribed dose. RESULTS Median patient age was 55 years; 91 (46%) were female. Median pain intensity and morphine equivalent daily dose were 4 (interquartile range=3-7) and 120mg (interquartile range=45-270mg), respectively. Prescribed and patient-reported prescribed doses were highly correlated for regular (r=0.90, P<0.001) and regular plus breakthrough opioid intake (r=0.94, P<0.001). Nineteen (9.6%) patients deviated. Deviation was more frequent in males (P=0.039) and nonwhites (P=0.0270). Nonwhite patients had higher scores on the BQ-II than white patients (P=0.038). Low adherence scores were significantly associated with higher BQ-II scores (1.99±0.80) for lower motivation score vs. 1.61±0.77 for higher score, P=0.007; and 2.13±0.79 for lower knowledge score vs. 1.57±0.72 for higher score, P=0.001. CONCLUSION Very few patients reported dose deviations, which were mostly toward lower dose. More research is necessary to better characterize the frequency and predictors of opioid deviation in this population.
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Affiliation(s)
- Linh M T Nguyen
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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Sanders S, Herr KA, Fine PG, Fiala C, Tang X, Forcucci C. An examination of adherence to pain medication plans in older cancer patients in hospice care. J Pain Symptom Manage 2013; 45:43-55. [PMID: 22841408 PMCID: PMC3521075 DOI: 10.1016/j.jpainsymman.2012.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 01/11/2012] [Accepted: 01/19/2012] [Indexed: 11/20/2022]
Abstract
CONTEXT Timely and appropriate management of pain is essential to promote comfort at the end of life. OBJECTIVES To determine if pain-related factors and nonpharmacologic interventions affect medication adherence in older cancer patients in community-based hospices. METHODS The study involved cancer patients aged 55 years and older, newly admitted to one of the 13 community-based hospices in the midwestern U.S. A descriptive design with patients or their proxies providing information during two telephonic interviews and review of their hospice medical records were used. RESULTS A total sample of 65 patients was obtained, with data directly from 32 patients during Interview 1 (T(1)), 25 during Interview 2 (T(2)), and proxy reports for 33 (T(1)) and 30 (T(2)) patients. The overall mean pain medication adherence scores (maximum 9) for all patients were 8.43 (T(1)) and 8.38 (T(2)). For component analysis (three components; maximum of three points each), patients were the least adherent with opioid orders at both time points (2.65). Patients were the most adherent to nonsteroidal anti-inflammatory/acetaminophen orders at T(1) (2.91) and medications for neuropathic pain at T(2) (2.89). Data provided statistical evidence that patients with more hours of controlled pain in the past 24 hours were more likely to have had better adherence, whereas patients with higher levels of comfort over the last few days were more likely to have had worse adherence. CONCLUSION This study identified that pain medication adherence among older adults with cancer receiving hospice care is high. However, hospices must be alert to the fact that even as patients become more comfortable, adherence must continue to be emphasized to ensure that pain does not redevelop or exacerbate, if pain relief is a patient priority.
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Affiliation(s)
- Sara Sanders
- School of Social Work, University of Iowa, Iowa City, Iowa, USA
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Wang Y, Lee J, Toh MPHS, Tang WE, Ko Y. Validity and reliability of a self-reported measure of medication adherence in patients with Type 2 diabetes mellitus in Singapore. Diabet Med 2012; 29:e338-44. [PMID: 22672497 DOI: 10.1111/j.1464-5491.2012.03733.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS A reliable and valid measure is essential for the assessment of medication adherence. Until now, no patient-reported medication adherence measure has been validated in Singapore. The aim of this study was to validate a modified 4-item Morisky-Green-Levine Medication Adherence Scale in patients with Type 2 diabetes in Singapore. METHODS A cross-sectional survey was conducted in a sample of outpatients with Type 2 diabetes in Singapore from September to December in 2009. Respondents completed either an English or Chinese version of the modified 4-item Morisky-Green-Levine Medication Adherence Scale. The scale scores ranged from 0 to 4, with higher scores indicating better medication adherence. Reliability was assessed using Cronbach's alpha. Content validity was assessed by expert review. Construct validity was examined using factor analysis and hypothesis testing. RESULTS Of the 294 respondents who completed the modified Morisky-Green-Levine Medication Adherence Scale, 13.3, 21.4, 35.7 and 29.6% had a score of 0-1, 2, 3 and 4, respectively. The internal consistency of the scale was moderate (Cronbach's alpha = 0.62). Principal component analysis showed that the four items loaded onto one factor (eigenvalue = 1.95). Respondents with higher scores were older (P < 0.001), had lower HbA(1c) levels (P < 0.001) and had better adherence to physician-recommended diet (P < 0.001) and physical exercise (P = 0.02). CONCLUSIONS The psychometric properties of the modified Morisky-Green-Levine Medication Adherence Scale were less than satisfactory. A ceiling effect was observed. The scale may not be an adequate measure to assess medication adherence in patients with Type 2 diabetes in Singapore. Future research could target refining the scale and investigating its use in other patient populations.
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Affiliation(s)
- Y Wang
- Department of Pharmacy, Faculty of Science, National University of Singapore
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Manning M, Bettencourt BA. Depression and medication adherence among breast cancer survivors: Bridging the gap with the theory of planned behaviour. Psychol Health 2011; 26:1173-87. [DOI: 10.1080/08870446.2010.542815] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Chou PL, Lin CC. A pain education programme to improve patient satisfaction with cancer pain management: a randomised control trial. J Clin Nurs 2011; 20:1858-69. [DOI: 10.1111/j.1365-2702.2011.03740.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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A pilot study to identify correlates of intentional versus unintentional nonadherence to analgesic treatment for cancer pain. Pain Manag Nurs 2011; 14:e22-30. [PMID: 23688368 DOI: 10.1016/j.pmn.2011.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 03/04/2011] [Accepted: 03/10/2011] [Indexed: 01/31/2023]
Abstract
Existing studies of medication adherence treat "nonadherence" as a monolithic concept. The goal of this study was to isolate correlates of intentional versus unintentional nonadherence for analgesic treatment for cancer pain. Patients were recruited from outpatient oncology clinics in the middle Atlantic region, ≥18 years old, and diagnosed with solid tumors, and had an active prescription of at least one around-the-clock analgesic. The Morisky Medication Adherence Scale (MMAS) was used to assesses "unintentional" (forgetfulness/carelessness) and "intentional" (stopping use of medication if feeling better or worse) dimensions of analgesic nonadherence. A visual analog scale was used to assess the percentage of analgesic doses taken in the preceding month. A majority of participants (85.5%) took prescribed analgesics in the index period. However, 51% reported taking only up to 60% of the analgesic doses prescribed to them. Stopping taking analgesics when feeling better was the most commonly reported nonadherence behavior (74%); those reporting "intentional" nonadherence when feeling better were more likely to report not using analgesics in the index week (100% vs. 67.7%; p = .029) and agree that pain medication can keep you from knowing what is going on in your body (p = .029) and were less likely to need stronger pain medication (33.3% vs. 81.5%; p = .003). "Unintentional" nonadherence, i.e., forgetfulness/carelessness, though associated with many analgesic beliefs, was not associated with measures of analgesic use in the index period. These preliminary data indicate that different heuristics underlie intentional versus unintentional nonadherence to analgesia and that intentional and unintentional nonadherence behaviors may have different implications for pain treatment outcomes.
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Prescribed opioids adherence among Taiwanese oncology outpatients. Pain Manag Nurs 2011; 14:155-60. [PMID: 23972866 DOI: 10.1016/j.pmn.2011.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Revised: 02/09/2011] [Accepted: 02/15/2011] [Indexed: 11/21/2022]
Abstract
The purpose of this study was to evaluate adherence to prescribed opioids in Taiwanese oncology outpatients and to examine the associations between various demographic and medical characteristics and prescribed opioids adherence. Ninety-two outpatients who had taken prescribed opioid analgesics for cancer-related pain at least once in the past week participated in this study. Patients were asked to recall the dose of each opioid analgesic that they had taken in the past 24 hours. Mean adherence rates were calculated for analgesic adherence. For mean adherence rates, all opioid analgesics were converted to morphine equivalents. The results of this study reveal a priority issue of poor opioid analgesic adherence. The adherence rate of 63.6% for the around-the-clock opioid analgesics in this study is well below acceptable levels. Also, an adherence rate of 30.9% for the as-needed opioid analgesics is very low. This study identified that women tend to be less adherent to their prescribed opioid analgesic regimen than men. Findings of this study suggest that to improve pain control, efforts to promote patients' opioid regimen adherence should be given high priority. Clinicians should be particularly aware that there may be some gender difference in adherence to prescribed opioid analgesics. There is a need for better programmatic efforts to improve analgesic adherence.
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Development and psychometric testing of a short version of the Barriers Questionnaire-Taiwan form for cancer patients. Int J Nurs Stud 2011; 48:1071-9. [PMID: 21396643 DOI: 10.1016/j.ijnurstu.2011.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 02/01/2011] [Accepted: 02/05/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND A comprehensive assessment of patient hesitancy to use analgesics and accurate knowledge related to the promotion of analgesic adherence is necessary for effective pain management. Unfortunately, there has been a lack of a short and concise questionnaire to assess patients' hesitancy to use analgesics in clinical practice. OBJECTIVE This paper is a report of the development and psychometric properties of the short version of the Barriers Questionnaire-Taiwan form (S-BQT). DESIGN This study employed a descriptive design. SETTING A convenience sample was recruited from oncology clinics at two medical centers in Taiwan. PARTICIPANTS One hundred and eighty-three (N=183) patients receiving analgesics for cancer pain participated in the study. METHODS Instruments included the Barriers Questionnaire-Taiwan form (BQT), the Taiwanese version of the Morisky Medication Adherence Measure-Taiwan form (MMAM-T). Two self-administered questionnaires were performed at the same time, and the ratio of analgesic usage was computed over a two-week period. Reliability was established by calculating Cronbach's α and test-retest reliability. The validity was estimated by construct validity, criterion-related validity, and known group validity. RESULTS To develop the S-BQT, we used reliability analysis to extract nine items from nine subscales. Internal consistency of the S-BQT was indicated by a Cronbach's alphas score of 0.86. Test-retest reliability was assessed as 0.83 over a two-week interval. Factor analysis revealed two factor structures. Criterion-related validity was examined by correlating the S-BQT score, and MMAM-T score, and the ratio of analgesic use. Known group validity was examined by comparing the S-BQT scores of patients with hesitancy to report pain and take analgesics vs. patients demonstrating no such hesitancy in the previous week. Known group validity was also established by comparing the S-BQT scores among patients with low, moderate, and high adherence to the usage of medication. CONCLUSIONS The S-BQT shows excellent reliability and validity. The use of this instrument can help to improve communication between patients and clinicians regarding the use of analgesics in the management of pain.
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Jacobsen R, Møldrup C, Christrup L, Sjøgren P, Hansen OB. Psychological and behavioural predictors of pain management outcomes in patients with cancer. Scand J Caring Sci 2011; 24:781-90. [PMID: 20487402 DOI: 10.1111/j.1471-6712.2010.00776.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To better understand the phenomenon of patient-related barriers to cancer pain management and address them more effectively in interventional studies, a theoretical model related to psychological aspects of pain experience and pain-related behaviours was elaborated. The aim of the study was to analyse the impact of patient-related barriers on cancer pain management outcomes following this model. Thirty-three patients responded to the Brief Pain Inventory Pain scale, the Danish Barriers Questionnaire II (DBQ-II), the Hospital Anxiety and Depression scale (HADS), the Danish version of Patient Perceived Involvement in Care Scale measuring the quality of patient-physician pain communication, and the Danish version of Medication Adherence Report Scale (DMARS-4). Statistical analysis was performed with SPSS 16.00. The results of the multivariable linear regression analyses showed that pain intensity was explained by patients' emotional distress (symptoms of anxiety and depression) and that pain relief was explained by cognitive barriers. In conclusion, interventions in emotional distress and patients' concerns may supposedly result in better cancer pain management outcomes.
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Affiliation(s)
- Ramune Jacobsen
- Department of Pharmacology and Pharmacotherapy, The Faculty of Pharmaceutical Sciences, University of Copenhagen, Universitetsparken, Copenhagen, Denmark.
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Abstract
OBJECTIVES To report on the results of a recent large-scale, internet-based survey of the population, prevalence and attributes of pain experience in the United Kingdom (UK), France, Spain, Germany and Italy. METHODS The results reported here are taken from the internet-based, 2008 National Health and Wellness Survey (NHWS). In addition to detailing the prevalence of pain, the survey reports on the correlates of pain - socio-demographic characteristics of respondents, health status and health related quality of life, pain associated comorbidities, satisfaction with care, employment and productivity and utilization of health care resources. In addition, the survey also captures treatment patterns, satisfaction with medications (both prescription and over the counter [OTC]) and adherence experience. RESULTS An estimated 49.7 million persons in these five countries reported pain by both its severity and frequency in the previous month. Of these, 11.2 million reported severe pain, 29.4 million reported moderate pain and 9.0 million reported mild pain. The population prevalence of daily pain is 8.85% with 3.47% reporting severe daily pain and 4.70% moderate daily pain. The cumulative burden of pain is demonstrated in terms of HRQoL, employment status and workforce activities as well as in healthcare resource utilization. The most striking impacts are seen in the impact of severe and frequent pain on HRQoL. Of the measures employed, the impact on the physical component score (PCS) of the SF-12 and the SF-6D absolute utility scores are substantial. The presence of severe and daily pain not only reduces the PCS score against that reported for the no pain population by over 20 points (or approximately 40%) but the impact on the absolute utility score is to reduce it from a no pain average of 0.74 to a score of 0.54. As far as productivity losses to the community are concerned the impact of severe pain is equally dramatic. CONCLUSIONS The reported prevalence of pain in these five countries represents a substantial burden to individuals, employers, healthcare systems and society in general. The fact that one in five of the adult population has experienced pain presents a major policy challenge. This would involve not only reducing the prevalence of pain - where chronic pain may be considered a disease in its own right - but to co-ordinate pain management programs across a range of disease states and socio-economic groups.
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Affiliation(s)
- P C Langley
- University of Minnesota, Minneapolis, MN 55455, USA.
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Langley PC, Ruiz-Iban MA, Molina JT, De Andres J, Castellón JRGE. The prevalence, correlates and treatment of pain in Spain. J Med Econ 2011; 14:367-80. [PMID: 21574899 DOI: 10.3111/13696998.2011.583303] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The aims of this paper are to report on the prevalence, correlates and treatment of pain in the adult Spanish population. The analysis also explores the association between the experience of pain and health-related quality of life (HRQoL), employment and productivity, and healthcare resource utilization. METHODS Data are from the Internet-based, 2010 National Health and Wellness Survey (NHWS) Spain. The sample was weighted by age and sex to correspond to the 2010 adult Spanish population. All respondents to the NHWS reported on socio-demographic and economic characteristics, medication adherence and major health conditions. They also reported on their HRQoL (the SF-12), their employment status and workplace productivity experience (WPAI instrument) and their healthcare resource utilization. Persons reporting experiencing pain gave details on conditions causing pain, prescription and over the counter (OTC) medication utilization, duration of utilization and satisfaction with medications. A supplementary analysis evaluated the population prevalence of pain for the five most populous Spanish autonomous communities (regions). RESULTS An estimated 6.10 million (17.25%) of the adult population of Spain reported experiencing pain in the last month. Of these 11.69% experienced severe pain, 64.17% moderate pain and 24.14% mild pain. Daily pain was experienced by 6.95% of the population The major conditions causing pain are back pain (60.53%) followed by joint pain (40.21%). Sleep difficulties (42.24%) and anxiety (40.62%) were most commonly cited as comorbidities. Prescription medication utilization was most important in the severe and moderate pain categories, with 71.62% reporting they were satisfied with their prescription pain medications. Adherence to pain medications was high with an overall Morisky score of 0.99 (range 0-4). Pain had a major negative effect on labor force participation for those reporting moderate and severe pain with a participation rate of only 42.62% for those with severe pain. Pain was associated with substantial health-related quality of life deficits as measured by the physical and mental score components of the SF-12. In the case of SF-6D utilities, the utility score for the pain population was markedly below that for the no-pain population (0.65 vs. 0.75; p < 0.05).The experience of pain also negatively impacted rates of absenteeism and presenteeism, as well as being associated with greater healthcare resource utilization. Finally, for the five most populous autonomous communities of Spain estimated pain prevalence ranged from 14.80% for Madrid to 18.79% for Comunidad Valenciana. The are a number of limitations which should be noted. First, this is an internet-based sample study and the respondent population may not be representative of the Spanish adult population. Second, respondents are asked to report their experience of pain with no independent clinical conformation. Finally, while a number of obvious acute pain categories are excluded, there is no attempt to arbitrarily define a chronic pain population or to identify pain categories such as neuropathic pain. CONCLUSIONS The experience of pain represents a substantial burden on both individuals and the Spanish economy. The experience of pain is associated with a substantial reduction in both the PCS component of the SF-12 and SF-6D absolute utilities--most notably in respect of severe pain. The experience of pain is also associated, not only with reduced labor force participation and increased absenteeism and presenteeism, but with substantially higher patterns of healthcare resource utilization.
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Affiliation(s)
- Paul C Langley
- College of Pharmacy, University of Minnesota, 308 Harvard Street SE, Minneapolis, MN 55455, USA.
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Bourdeanu L, Wong SF. Supporting Asian patients with metastatic breast cancer during ixabepilone therapy. Expert Opin Drug Saf 2010; 9:383-96. [DOI: 10.1517/14740331003592082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Laura Bourdeanu
- City of Hope, Department of Medical Oncology & Therapeutics Research, 1500 East Duarte Road, Duarte, CA 91010-3000, USA ;
| | - Siu-Fun Wong
- Western University of Health Sciences, College of Pharmacy, 309 East Second Street, Pomona, CA 91766-1854, USA
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Jacobsen R, Samsanaviciene J, Liuabarskiene Z, Sciupokas A. Barriers to pain management among Lithuanian cancer patients. Pain Pract 2010; 10:145-57. [PMID: 20070553 DOI: 10.1111/j.1533-2500.2009.00333.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The objectives of this study are (1) to describe Lithuanian cancer patients' barriers to pain management as well as pain management outcomes, (2) to check the reliability and validity of the questionnaires used in Lithuanian for the first time, and (3) to formulate patient-centered recommendations for better cancer pain management. METHODS Thirty patients from the Pain Clinic of Kaunas University of Medicine Hospital responded to the Lithuanian versions of: (1) Brief Pain Inventory pain scale, (2) Barriers Questionnaire-II, (3) Hospital Anxiety and Depression Scale, (4) Modified version of the Perceived Involvement in Care Scale, and (5) Medication Adherence Report Scale. RESULTS The translated questionnaires had fear internal consistency reliability and construct validity. Reported average (standard deviation [SD]) pain intensity among Lithuanian cancer patients was 3.9 (1.30) on a scale 0-10. The mean (SD) scores of anxiety and depression among the surveyed patients were 8.7 (4.86) and 7.5 (5.05) on a scale 0-21, respectively. The percentage of the patients, who reported stopping taking pain medicine because of its side effects, was 33.3%. The biggest patients' concerns were about physiological consequences and harmful effects of opioid use. The average (SD) level of perceived communication among Lithuanian patients was 3.1 (0.95) on a scale 0-5, whereas the average level (SD) of self-reported adherence to pain medication among Lithuanians was 13.0 (3.65) on a scale 4-20. CONCLUSIONS The authors believe, that to improve cancer pain management in Lithuania (1) more attention should be paid to psychological status of patients, (2) patients should be more educated about the need and consequences of opioid use for cancer pain, and (3) adherence to pain management regimens should be improved.
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Affiliation(s)
- Ramune Jacobsen
- Department of Pharmacology and Pharmacotherapy, Faculty of Pharmaceutical Sciences, University of Copenhagen, Copenhagen DK-2100, Denmark.
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Jacobsen R, Møldrup C, Christrup L, Sjøgren P, Hansen OB. The Danish version of the Medication Adherence Report Scale: Preliminary Validation in Cancer Pain Patients. Pain Pract 2009; 9:1-7. [DOI: 10.1111/j.1533-2500.2008.00245.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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