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Mueller EL, Cochrane AR, Carroll AE. Perceptions of chemotherapy calendar creation among US pediatric oncologists. Pediatr Blood Cancer 2023; 70:e30688. [PMID: 37737717 PMCID: PMC10615882 DOI: 10.1002/pbc.30688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/08/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND An effective chemotherapy calendar system between the clinician and the patient/caregiver can improve patient-centered outcomes. There is lack of research on how chemotherapy calendars are created and what aspects are important to pediatric oncology physicians. PROCEDURE In an online survey of pediatric oncology physicians, we evaluated institutional practices, perceptions of chemotherapy calendar creation, and desires for future tools. A total of 220 survey participants provided data (10.4% participant response rate) from 123 institutions (53.5% represented institutions). RESULTS Participants indicated that 72% always or most of the time their institution provides a chemotherapy calendar, most commonly at the start of a new cycle (90%) or with a dosing change (68%). Factors such as the health literacy of the family, prior nonadherence, type of cancer, and desire of the family affected the creation decision. Advanced practice providers (45%) or nurse coordinator/navigators (43%) were most likely to create the chemotherapy calendar. No significant difference was found between the likelihood of creating a chemotherapy calendar and institutional size (p = .09) or physician years in practice (p = .26). Approximately 95% of participants indicated chemotherapy calendar creation software that improved ease and efficiency would be moderately to extremely useful. CONCLUSION Future efforts should focus on co-design of an efficient and effective chemotherapy calendar by engaging with nursing and advanced practice providers along with caregivers of children with cancer.
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Affiliation(s)
- Emily L Mueller
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, IN 46202
- Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University, Indianapolis, IN 46202
| | - Anneli R Cochrane
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, IN 46202
- Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University, Indianapolis, IN 46202
| | - Aaron E Carroll
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, IN 46202
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Vaffis S, Whaley S, Axon DR, Hall-Lipsy E, Hincapie A, Slack M, Warholak T. Features of Cancer mHealth Apps and Evidence for Patient Preferences: Scoping Literature Review. JMIR Cancer 2023; 9:e37330. [PMID: 37115587 PMCID: PMC10182455 DOI: 10.2196/37330] [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: 02/15/2022] [Revised: 07/28/2022] [Accepted: 12/12/2022] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Cancer is increasingly being treated as a chronic disease rather than an acute one-time illness. Additionally, oral anticancer therapies, as opposed to intravenous chemotherapy, are now available for an increasing number of cancer indications. Mobile health (mHealth) apps for use on mobile devices (eg, smartphones or tablets) are designed to help patients with medication adherence, symptom tracking, and disease management. Several previous literature reviews have been conducted regarding mHealth apps for cancer. However, these studies did not address patient preferences for the features of cancer mHealth apps. OBJECTIVE The primary aim was to review the scientific literature that describes the features and functions of mHealth apps designed for cancer self-management. METHODS As the purpose of this review was to explore the depth and breadth of research on mHealth app features for cancer self-management, a scoping review methodology was adopted. Four databases were used for this review: PubMed/MEDLINE, Embase, CINAHL, and PsycINFO. Citation and reference searches were conducted for manuscripts meeting the inclusion criteria. A gray literature search was also conducted. Data extracted from manuscripts included author, title, publication date, study type, sampling type, cancer type, treatment, age of participants, features, availability (free or subscription), design input, and patient preferences. Finally, the features listed for each app were compared, highlighting similarities across platforms as well as features unique to each app. RESULTS After the removal of duplicates, 522 manuscripts remained for the title and abstract review, with 51 undergoing full-text review. A total of 7 manuscripts (referred to as studies hereafter) were included in the final scoping review. App features described in each study varied from 2 to 11, with a median of 4 features per app. The most reported feature was a symptom or side effect tracker, which was reported in 6 studies. Two apps specified the inclusion of patients and health care providers during the design, while 1 app noted that IT and communications experts provided design input. The utility of the apps for end users was measured in several ways, including acceptability (measuring the end users' experience), usability (assessing the functionality and performance by observing real users completing tasks), or qualitative data (reports from end users collected from interviews or focus groups). CONCLUSIONS This review explored the literature on cancer mHealth apps. Popular features within these mHealth apps include symptom trackers, cancer education, and medication trackers. However, these apps and features are often developed with little input from patients. Additionally, there is little information regarding patient preferences for the features of existing apps. While the number of cancer-related apps available for download continues to increase, further exploration of patient preferences for app features could result in apps that better meet patient disease self-management needs.
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Affiliation(s)
- Shannon Vaffis
- College of Pharmacy, University of Arizona, Tucson, AZ, United States
| | - Soluna Whaley
- College of Pharmacy, University of Arizona, Tucson, AZ, United States
| | - David Rhys Axon
- College of Pharmacy, University of Arizona, Tucson, AZ, United States
| | | | - Ana Hincapie
- James L Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, United States
| | - Marion Slack
- College of Pharmacy, University of Arizona, Tucson, AZ, United States
| | - Terri Warholak
- College of Pharmacy, University of Arizona, Tucson, AZ, United States
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Park J, Han AY. Medication safety education in nursing research: Text network analysis and topic modeling. NURSE EDUCATION TODAY 2023; 121:105674. [PMID: 36481524 DOI: 10.1016/j.nedt.2022.105674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES This study aimed to identify the knowledge structure of medication safety nursing education literature by developing schematic diagrams of the relationship between keywords from a macro perspective. This study also identifies the research topics and trends over time. DESIGN This quantitative content study used text network analysis to explore keywords and research topics using topic modeling within the medication safety nursing education literature. DATA SOURCES PubMed, EMBASE, and Cochrane databases were used to search for the medication safety nursing education literature published until December 2021. METHODS Keywords from 2085 articles were examined using text network analysis and topic modeling with NetMiner 4.4.3. RESULTS The keywords with the most frequency and the highest networking degree in centrality were "patient," "medication," "program," "nurse," and "care." The emerging keywords assessed by time periods were identified; the first phase ("heart failure," "insulin," "chemotherapy," and "infusion"), the second phase ("medication errors," "staff," and "information"), the third phase ("program," "management," and "data"). The results of topic modeling were as follows: safe medication administration, safe medication reconciliation process, medication education for patients, medication errors in nursing practice, and multidisciplinary teamwork for medication safety. CONCLUSION These findings will help nursing researchers and educators to understand the trends and insights for medication safety education and educate future nurses to provide safer nursing care.
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Affiliation(s)
- Jinkyung Park
- College of Nursing, Chonnam National University, 160 Baekseo-ro, Dong-gu, Gwangju 61469, Republic of Korea
| | - A Young Han
- Department of Nursing, College of Life Science and Industry, Sunchon National University, 255, Jungang-ro, Suncheon-Si, Jeollanam-do 57922, Republic of Korea.
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Vazquez L, Coussirou J, Grenier J, Billemont B, Mege A, de Rauglaudre G, Stancu A, David C, Durand A, Decrozals F, Arnaud A. [Needs assessment for the establishment of an Oral Therapy Unit]. Bull Cancer 2023; 110:184-192. [PMID: 36411129 DOI: 10.1016/j.bulcan.2022.10.005] [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: 04/07/2022] [Revised: 09/22/2022] [Accepted: 10/20/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Oncological at home-treatment improves patient quality of life and autonomy but requires close watchfulness of adverse events and compliance to treatment. For nearly ten years, pharmaceutical consultations for home-based anticancer oral therapies patients are proposed on medical request in Avignon-Provence Cancer Institute (ICAP). Organizational changes led us to modify this management by integrating dedicated nurses to create an Oral Therapy Unit (OTU). MATERIALS ET METHODS Needs and expectations assessment questionnaires were proposed to healthcare professionals and patients treated by oral therapies. The analysis of these questionnaires allows to set up an OTU, integrating a dedicated nurse, adapted to the expectations of patients and healthcare professionals. About 8 months later, a new evaluation was carried out to assess the impact of this new support for patient care and health professionals' organization. RESULTS The results of the studies carried out before OTU implementation highlight the importance of multi-professional support for patients from the start of treatment and during the follow-up. With the new OTU pathway, professionals expect a patient course improvement (94%), a better compliance (88%), a therapeutic accidents reduction (81%) and an improvement in the patient-caregiver relationship (69%). Regarding the organization, 56% of them are expecting to save medical and pharmaceutical time. CONCLUSION The OTU creation in our institution and these new multi-professionals' teams' management of patients has obtained a favourable opinion from healthcare professionals and patient satisfaction.
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Affiliation(s)
- Léa Vazquez
- Institut du Cancer Avignon-Provence(ICAP), 250, chemin des Baignes-Pieds, 84000 Avignon, France.
| | - Julie Coussirou
- Institut du Cancer Avignon-Provence(ICAP), 250, chemin des Baignes-Pieds, 84000 Avignon, France
| | - Julien Grenier
- Institut du Cancer Avignon-Provence(ICAP), 250, chemin des Baignes-Pieds, 84000 Avignon, France
| | - Bertrand Billemont
- Institut du Cancer Avignon-Provence(ICAP), 250, chemin des Baignes-Pieds, 84000 Avignon, France
| | - Alice Mege
- Institut du Cancer Avignon-Provence(ICAP), 250, chemin des Baignes-Pieds, 84000 Avignon, France
| | - Gaetan de Rauglaudre
- Institut du Cancer Avignon-Provence(ICAP), 250, chemin des Baignes-Pieds, 84000 Avignon, France
| | - Alma Stancu
- Institut du Cancer Avignon-Provence(ICAP), 250, chemin des Baignes-Pieds, 84000 Avignon, France
| | - Celeste David
- Institut du Cancer Avignon-Provence(ICAP), 250, chemin des Baignes-Pieds, 84000 Avignon, France
| | - Anais Durand
- Institut du Cancer Avignon-Provence(ICAP), 250, chemin des Baignes-Pieds, 84000 Avignon, France
| | - Françoise Decrozals
- Institut du Cancer Avignon-Provence(ICAP), 250, chemin des Baignes-Pieds, 84000 Avignon, France
| | - Antoine Arnaud
- Institut du Cancer Avignon-Provence(ICAP), 250, chemin des Baignes-Pieds, 84000 Avignon, France
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Dang TH, Forkan ARM, Wickramasinghe N, Jayaraman PP, Alexander M, Burbury K, Schofield P. Investigation of intervention solutions to enhance adherence to oral anti-cancer medicines in adults: an overview of reviews (Preprint). JMIR Cancer 2021; 8:e34833. [PMID: 35475978 PMCID: PMC9096640 DOI: 10.2196/34833] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/26/2022] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background Adherence to anticancer medicines is critical for the success of cancer treatments; however, nonadherence remains challenging, and there is limited evidence of interventions to improve adherence to medicines in patients with cancer. Objective This overview of reviews aimed to identify and summarize available reviews of interventions to improve adherence to oral anticancer medicines in adult cancer survivors. Methods A comprehensive search of 7 electronic databases was conducted by 2 reviewers who independently conducted the study selection, quality assessment using the A Measurement Tool to Assess Systematic Reviews 2, and data extraction. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist was adapted to report the results. Results A total of 29 reviews were included in the narrative synthesis. The overall quality of the systematic reviews was low. The 4 main strategies to promote adherence were focused on education, reminders, behavior and monitoring, and multicomponent approaches. Digital technology–based interventions were reported in most reviews (27/29, 93%). A few interventions applied theories (10/29, 34%), design frameworks (2/29, 7%), or engaged stakeholders (1/29, 3%) in the development processes. The effectiveness of interventions was inconsistent between and within reviews. However, interventions using multiple strategies to promote adherence were more likely to be effective than single-strategy interventions (12/29, 41% reviews). Unidirectional communication (7/29, 24% reviews) and technology alone (11/29, 38% reviews) were not sufficient to demonstrate improvement in adherence outcomes. Nurses and pharmacists played a critical role in promoting patient adherence to oral cancer therapies, especially with the support of digital technologies (7/29, 24% reviews). Conclusions Multicomponent interventions are potentially effective in promoting patient adherence to oral anticancer medicines. The seamless integration of digital solutions with direct clinical contacts is likely to be effective in promoting adherence. Future research for developing comprehensive digital adherence interventions should be evidence-based, theory-based, and rigorously evaluated.
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Affiliation(s)
- Thu Ha Dang
- Department of Psychology, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
- Behavioural Sciences Unit, Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Digital Health Cooperative Research Centre, Sydney, Australia
| | - Abdur Rahim Mohammad Forkan
- Digital Innovation Lab, School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Melbourne, Australia
| | - Nilmini Wickramasinghe
- Department Health and Bio Statistics, School of Health Sciences and Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia
- Epworth Healthcare, Melbourne, Australia
| | - Prem Prakash Jayaraman
- Digital Innovation Lab, School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Melbourne, Australia
| | - Marliese Alexander
- Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Kate Burbury
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Digital and Healthcare Innovation, Peter McCallum Cancer Centre, Melbourne, Australia
| | - Penelope Schofield
- Behavioural Sciences Unit, Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Department of Psychology, and Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia
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Cazeau N. Mobile Health Interventions: Examining Medication Adherence Outcomes Among Patients With Cancer. Clin J Oncol Nurs 2021; 25:431-438. [PMID: 34269338 DOI: 10.1188/21.cjon.431-438] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Treatment for cancer is trending toward oral therapies, which patients can self-manage from home. Proper adherence to oral therapy is vital to safe and optimal care in this setting. Mobile health interventions (i.e., text message reminders, mobile applications, and automated calls) are an evolving strategy aimed at improving medication adherence for patients on long-term oral therapies. OBJECTIVES This review aims to provide an overview of research outcomes for the use of mobile health interventions among patients with cancer. METHODS A comprehensive review of CINAHL®, MEDLINE®, and PubMed® was completed. Eleven articles were eligible for inclusion in this review. FINDINGS Mobile health interventions are an acceptable approach among patients with cancer and may improve adherence outcomes for those at highest risk for suboptimal adherence.
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Monestime S, Page R, Shaw N, Martin R, Jordan W, Rangel J, Aryal S. Factors associated with adherence to follow-up calls in cancer patients receiving care at a community oncology practice. J Oncol Pharm Pract 2021; 27:1094-1101. [PMID: 32819197 PMCID: PMC8246406 DOI: 10.1177/1078155220950003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/18/2020] [Accepted: 07/24/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Follow-up calls in the oncology setting are frequently used to augment care and encourage oral antineoplastic adherence. However, limited data are available on patient populations that would benefit from this intervention versus populations that may require alternative interventions. The purpose of this study was to identify characteristics among patients on oral antineoplastic agents that influence their likelihood to respond to follow-up calls. METHODS Patients receiving care from one of the eight community oncology clinics within the same branch were analyzed. Patients were included if they were ≥18 years, received a new oral antineoplastic agent that was electronically prescribed between August 2018-October 2018, and picked up their first fill from their pharmacy of choice. Patients received up to six follow-up calls after picking up their first prescription. Calls were categorized as adherent (≥3 monthly interactions) or non-adherent (<3 monthly interactions). Logistic regression models were used to evaluate factors associated with follow-up call adherence. Factors included demographics, cancer stage, marital status, employment, pharmacy setting (internal pharmacy versus external pharmacy), and insurance used by the patient. Descriptive analysis was performed to analyze response rates, cancer diagnosis, and to determine the best time and day patients responded to follow-up calls. RESULTS Data from 125 patients were analyzed, of which 65 patients (52%) were adherent to follow-up calls and the mean response rate over six months was 45% (range: 35% -- 54%). High success rates for follow-up calls were seen between 12-3 pm and on Tuesdays and Thursdays. After adjusting for covariates, patients with stage III-IV were 89% less likely to respond to follow-up calls compared to those with stage 0-II (95% CI: 0.02-0.64; p = 0.01), patients with commercial insurance were 79% less likely to adhere to follow-up calls compared to those on government insurance (95% CI: 0.06-0.71; p = 0.01), and patients using an external pharmacy had a 2.8 times increase odds of being adherent (95% CI 0.98-8.34; p = 0.05). All other factors were not significant. CONCLUSIONS For patients taking oral antineoplastics, non-adherence to follow-up calls was observed in more than 45% of patients receiving care from a community oncology clinic. Findings demonstrated that those with advanced stages of cancer, on commercial insurance, and going to an internal pharmacy were at higher risk for not adhering to follow up calls. Therefore, alternative methods for managing adherence and side effects in these populations are warranted.
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Affiliation(s)
- Shanada Monestime
- Department of Pharmacotherapy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Ray Page
- The Center for Cancer and Blood Disorders, Fort Worth, TX, USA
| | - Nicole Shaw
- Department of Pharmacotherapy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Randy Martin
- Department of Medical Education, Texas Health Harris Methodist Hospital Fort Worth, Fort Worth, TX, USA
| | - William Jordan
- The Center for Cancer and Blood Disorders, Fort Worth, TX, USA
- SaferCare Texas, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Jessica Rangel
- SaferCare Texas, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Subhash Aryal
- SaferCare Texas, University of North Texas Health Science Center, Fort Worth, TX, USA
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Donevant S, Heiney SP, Wineglass C, Schooley B, Singh A, Sheng J. Perceptions of Endocrine Therapy in African-American Breast Cancer Survivors: Mixed Methods Study. JMIR Form Res 2021; 5:e23884. [PMID: 34114955 PMCID: PMC8235283 DOI: 10.2196/23884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 03/05/2021] [Accepted: 04/30/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Although the incidence of breast cancer is lower in African-American women than in White women, African-American women have a decreased survival rate. The difference in survival rate may stem from poor endocrine therapy adherence, which increases breast cancer recurrence. Therefore, accessible and culturally sensitive interventions to increase endocrine therapy adherence are necessary. OBJECTIVE The purpose of this concurrent convergent mixed methods study was to provide further data to guide the development of the proposed culturally sensitive mHealth app, STORY+ for African-American women with breast cancer. METHODS We recruited 20 African-American women diagnosed with estrogen-positive breast cancer and currently prescribed endocrine therapy. We used a concurrent convergent data collection method to (1) assess the use of smartphones and computers related to health care and (2) identify foundational aspects to support endocrine therapy adherence for incorporation in a mobile health app. RESULTS Overwhelmingly, the participants preferred using smartphones to using computers for health care. Communicating with health care providers and pharmacies was the most frequent health care use of smartphones, followed by exercise tracking, and accessing the patient portal. We identified 4 aspects of adherence to endocrine therapy and smartphone use for incorporation in app development. The factors that emerged from the integrated qualitative and quantitative data were (1) willingness to use, (2) side effects, (3) social connection, and (4) beliefs about endocrine therapy. CONCLUSIONS Further research is needed to develop a culturally sensitive app for African-American women with breast cancer to improve adherence to endocrine therapy. Our work strongly suggests that this population would use the app to connect with other African-American breast cancer survivors and manage endocrine therapy.
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Affiliation(s)
- Sara Donevant
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Sue P Heiney
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Cassandra Wineglass
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Benjamin Schooley
- Department of Integrated Information Technology, College of Engineering and Computing, University of South Carolina, Columbia, SC, United States
| | - Akanksha Singh
- Department of Integrated Information Technology, College of Engineering and Computing, University of South Carolina, Columbia, SC, United States
| | - Jingxi Sheng
- College of Nursing, University of South Carolina, Columbia, SC, United States
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The effect of a mobile application on treatment adherence and symptom management in patients using oral anticancer agents: A randomized controlled trial. Eur J Oncol Nurs 2021; 52:101969. [PMID: 33991868 DOI: 10.1016/j.ejon.2021.101969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/23/2021] [Accepted: 04/18/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE The use of mobile health technologies in the management of oral anticancer agents (OAA) can be beneficial in terms of treatment adherence and symptom management. This study was conducted to investigate the effect of a mobile application developed for patients using OAA on treatment adherence and symptom management. METHOD The study was conducted using a randomized controlled trial design, and it was carried out on 77 patients. Data were collected from the Oral Chemotherapy Adherence Scale (OCAS), and the Memorial Symptom Assessment Scale (MSAS). Data were collected at the beginning of the research, and face-to-face interviews were conducted after one, three, and six months. Patients in the intervention group were followed up for six months using the mobile application. RESULTS It was found that there was no difference between the intervention and control groups in the baseline OCAS mean scores (p > 0.05), and the mean score of the intervention group increased over the first, third- and sixth-month measurements (p < 0.05). It was found that there was no difference between the intervention and control groups in the MSAS mean scores (p > .05), and there was a decrease in the mean MSAS score of the intervention group between the third- and sixth-month follow-up (p < .05). CONCLUSION The present study results showed that the mobile application is effective in managing symptoms and increasing treatment adherence. A well-designed mobile health application that increases treatment adherence, decreases symptom severity, and supports patients' self-management could be beneficial for patients using OAA. CLINICALTRIALS. GOV IDENTIFIER NCT04626830.
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10
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Mazzella Ebstein AM, Barton-Burke M, Anthony V, Smith A, Zhang Z, Robson M. Oral self-management of palbociclib (Ibrance®) using mobile technology protocol. J Adv Nurs 2021; 77:1556-1566. [PMID: 33245144 PMCID: PMC8454747 DOI: 10.1111/jan.14659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/14/2020] [Indexed: 11/28/2022]
Abstract
AIM This study will test the feasibility and effectiveness of mobile technology intervention on the patients' self-management of oral anticancer medication. Secondary objectives include acceptability, the usefulness of text messages, and satisfaction by participants and nurses. METHODS This prospective two-arm study will recruit patients (N = 220) with metastatic breast cancer and initiating treatment with palbociclib (Ibrance ®). Allowing for attrition, patients will be randomized into the control (N = 100) or intervention (N = 100) group. Unidirectional text message reminders will be sent during the treatment cycle through a secure web application using the patient's smartphone. Self-reported survey responses will be collected at three time points; at consent, end of treatment cycles, and the follow-up clinic visit and include a demographic questionnaire, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Post study questionnaire and the R-15 Patient Satisfaction Questionnaire. Nurses providing care for study patients will complete the Adaptation of Stamps Nurse Workload questionnaire. Data will be analysed an intent-to-treat analysis comparing the two arms. Study approval was obtained in December 2019 and funded in January 2020. DISCUSSION Smartphones are globally available and have text messaging capability which is increasingly being used as an intervention in healthcare studies. This study will test a low-cost, nurse-led intervention that enhances the patient's experience with oral anti-cancer medications, improves access to care, reduces costs, and improves the satisfaction of nurses caring for oncology patients. IMPACT Despite the ease of administering oral anti-cancer medications, oncology patients maynot take them as prescribed and consequently, these factors affect patient outcomes and disease control. Given the importance of taking oral anti-cancer medications and the difficulties patients experience in achieving it, the effective use of mobile technology interventions can actively engage patients in their care and improve medication self-management of anticancer treatment regimens.
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Affiliation(s)
| | - Margaret Barton-Burke
- Office of Nursing Research, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Venice Anthony
- Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea Smith
- Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Zhigang Zhang
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark Robson
- Office of Nursing Research, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Kongshaug N, Skolbekken JA, Faxvaag A, Hofsli E. Cancer Patients' Perceived Value of a Smartphone App to Enhance the Safety of Home-Based Chemotherapy: Feasibility Study. JMIR Form Res 2021; 5:e20636. [PMID: 33404505 PMCID: PMC7817355 DOI: 10.2196/20636] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/05/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Oral anticancer therapies can be self-administered by patients outside the hospital setting, which poses challenges of adherence to a drug plan and monitoring of side effects. Modern information technology may be developed and implemented to address these pertinent issues. OBJECTIVE The aim of this study was to explore how a smartphone app developed through a stepwise, iterative process can help patients using oral chemotherapy to take their drug, and to report adherence and side effects in a reliable and verifiable manner. METHODS Fourteen patients starting capecitabine treatment were included in this study and used the smartphone app in addition to regular follow up of capecitabine treatment. Nine of these patients fulfilled the treatment plan and were interviewed based on a semistructured interview guide and the System Usability Scale (SUS). In addition, two focus groups were completed with 7 oncologists and 7 oncology nurses, respectively. Interview data were analyzed in accordance with the principles of systematic text condensation. Features of the app were also assessed. RESULTS The smartphone app provided the patients with a feeling of reassurance regarding correct adherence of their oral chemotherapy treatment. They used the app as a memory tool about their treatment and possible serious side effects, as well as for treatment education. Patients expressed concerns about using the app to report side effects that were not considered to be obviously serious, fearing overreporting. The health personnel expressed an overall positive attitude to integrate this new tool in their everyday work. CONCLUSIONS Patients on oral chemotherapy treatment at home felt safe and found the app to be helpful. The app promoted learning about their treatment and made the patients more independent of the cancer clinic, reducing the need for the clinic's limited resources for follow up of patients on oral anticancer medications.
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Affiliation(s)
- Nina Kongshaug
- Cancer Clinic, St. Olav's University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Scienes, Norwegian University of Science and Technology, Trondheim, Norway
| | - John-Arne Skolbekken
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arild Faxvaag
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eva Hofsli
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Scienes, Norwegian University of Science and Technology, Trondheim, Norway
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Chen Y, Wu X, Xian X, Zhang Y, Gong N, Qin H, Zhang M. Adherence to oral chemotherapy among colorectal cancer patients: A longitudinal study. Eur J Oncol Nurs 2020; 48:101822. [DOI: 10.1016/j.ejon.2020.101822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 01/03/2023]
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Lorusso D, García-Donas J, Sehouli J, Joly F. Management of Adverse Events During Rucaparib Treatment for Relapsed Ovarian Cancer: A Review of Published Studies and Practical Guidance. Target Oncol 2020; 15:391-406. [PMID: 32495160 PMCID: PMC7283207 DOI: 10.1007/s11523-020-00715-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The poly(ADP-ribose) polymerase inhibitor rucaparib is approved as monotherapy in the treatment and maintenance settings for women with relapsed ovarian cancer in the European Union and the United States. We review the safety profile of rucaparib in both settings and provide recommendations for the clinical management of the main adverse events (AEs) that may occur during rucaparib treatment. We searched PubMed and congress proceedings for safety data on oral rucaparib monotherapy (600 mg twice daily) from clinical trials involving patients with relapsed ovarian cancer. AE management guidance was developed from clinical trial protocols, rucaparib prescribing information, oncology association guidelines, and author experience. The most frequent any-grade treatment-emergent AEs (TEAEs) included gastrointestinal symptoms, asthenia/fatigue, dysgeusia, anemia/decreased hemoglobin, and increased alanine/aspartate aminotransferase. Across clinical trials, 61.8% of patients had one or more grade 3 or higher TEAEs. Clinicians should employ close follow-up for TEAEs, particularly early in treatment, and educate patients about expected TEAEs and methods for their monitoring and management (e.g., antiemetics for nausea/vomiting, transfusions for hematologic TEAEs, or dose interruptions/reductions for moderate/severe TEAEs). Overall, 16.2% of patients discontinued rucaparib due to TEAEs. Management of AEs that may occur during rucaparib treatment is crucial for patients to obtain optimal clinical benefit by remaining on therapy and to avoid their detrimental impact on quality of life.
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Affiliation(s)
- Domenica Lorusso
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Jesús García-Donas
- Medical Oncology Service, HM Hospitales-Centro Integral Oncológico Hospital de Madrid Clara Campal, Madrid, Spain
| | - Jalid Sehouli
- Department of Gynecology and Oncological Surgery, Charité University Medicine of Berlin and NOGGO, Berlin, Germany
| | - Florence Joly
- Medical Oncology Department, Centre François Baclesse, Université Unicaen and GINECO, Caen, France
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Medeiros KS, Queiroz JF, Monteiro MN, Costa WA, Cobucci RN, Stransky B, Gonçalves AK. Impact of mobile applications on adherence to cancer treatment: a systematic review and meta-analysis protocol. BMJ Open 2019; 9:e027246. [PMID: 31699713 PMCID: PMC6858102 DOI: 10.1136/bmjopen-2018-027246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 09/14/2019] [Accepted: 09/25/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The number of patients taking oral chemotherapy is increasing around the world. It is essential to maximise the adherence to oral chemotherapy to improve the overall survival and life expectancy of the patients. In this systematic review and meta-analysis, we aim to evaluate the effectiveness of mobile applications in improving the adherence to oral chemotherapy and adjuvant hormonal therapy in cancer survivors. METHODS AND ANALYSIS MEDLINE, Embase, LILACS, clinicaltrials.gov, Scopus and the Cochrane Central Register of Controlled Trials will be searched for randomised or quasi-experimental studies published between January 2009 and July 2019. This systematic review and meta-analysis will include studies investigating the use of mobile applications by cancer survivors to aid adherence to oral chemotherapy and adjuvant hormonal therapy. Patient education, reminder tools, calendars, pillboxes and electronic reminders will not be evaluated. The primary outcome will be the improvement in adherence to anticancer drugs. The secondary outcomes will be an improvement in the overall survival and life expectancy, improved quality of life and control of cancer-related symptoms. Three independent reviewers will select the studies and extract data from the original publications. The risk-of-bias will be assessed using the Cochrane risk-of-bias tool. Data synthesis will be performed using the Review Manager software (RevMan V.5.2.3). To assess heterogeneity, we will compute the I2 statistics. Additionally, a quantitative synthesis will be performed if the included studies are sufficiently homogenous. ETHICS AND DISSEMINATION This study will be a review of the published data, and thus, ethical approval is not required. Findings of this systematic review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018102172.
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Affiliation(s)
- Kleyton Santos Medeiros
- Health Science Postgraduate Program, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Janice França Queiroz
- Health Science Postgraduate Program, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | | | | | | | - Beatriz Stransky
- Universidade Federal do Rio Grande do Norte, Centro de Tecnologia, Natal, Brazil
| | - Ana Katherine Gonçalves
- Health Science Postgraduate Program, Universidade Federal do Rio Grande do Norte, Natal, Brazil
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Chen L, Payne JB, Dance KV, Imbody CB, Ho CD, Ayers AA, Flowers CR. Priorities for Rural Lymphoma Survivors: A Qualitative Study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:47-52.e3. [PMID: 31708453 DOI: 10.1016/j.clml.2019.09.599] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/23/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND We gathered rural patient perspectives on lymphoma care and unmet needs throughout the treatment course to better understand their attitudes toward treatment and their barriers to participating in clinical research studies. PATIENTS AND METHODS We conducted 12 individual semi-structured telephone interviews in the spring of 2018 with lymphoma survivors from rural counties in Georgia. Patients were identified by a residential address in counties classified as rural according to the Rural-Urban Commuting Areas codes. Participants were recruited from regional patient education conferences and from current research participants at a university research hospital in Georgia. The interviews were recorded and transcribed verbatim. Thematic analysis and MAXQDA, version 18.0.8, were used to facilitate a constant comparative coding process during theme development. RESULTS The greatest barrier to care was the travel distance. The participants described difficulty navigating between local clinics and larger cancer centers. The lack of communication between the local and specialized clinics complicated the process, and participants had difficulty contacting or seeking advice from the team at the larger cancer centers. Seeking treatment from specialized clinics farther away introduced additional barriers. Most participants agreed that the use of technology was important for improved communication. Participants described lymphoma etiology, subtype-specific studies, alternative therapies, and quality of life as key research priorities. CONCLUSION These findings suggest that targeted research and interventions are necessary to address the specific needs of rural patients with and survivors of lymphoma. To address the disparity in health outcomes within rural populations, healthcare professionals and investigators can use these data to engage rural patients in treatment decision-making and research planning.
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Affiliation(s)
- Lillian Chen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Jackelyn B Payne
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA; Department of Psychology, Stony Brook University, Stony Brook, NY
| | - Kaylin V Dance
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Conner B Imbody
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA; Rollins School of Public Health, Emory University, Atlanta, GA
| | - Cathy D Ho
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Amy A Ayers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Christopher R Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
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Mobile applications in oncology: A systematic review of health science databases. Int J Med Inform 2019; 133:104001. [PMID: 31706229 DOI: 10.1016/j.ijmedinf.2019.104001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/21/2019] [Accepted: 10/01/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION In recent years there has been an exponential growth in the number of mobile applications (apps) relating to the early diagnosis of cancer and prevention of side effects during cancer treatment. For health care professionals and users, it can thus be difficult to determine the most appropriate app for given needs and assess the level of scientific evidence supporting their use. Therefore, this review aims to examine the research studies that deal with this issue and determine the characteristics of the apps involved. METHODOLOGY This study involved a systematic review of the scientific literature on randomized clinical trials that use apps to improve cancer management among patients, using the Pubmed (Medline), Latin America and the Caribbean in Health Sciences (LILACS), and Cochrane databases. The search was limited to articles written in English and Spanish published in the last 10 years. A search of the App Store for iOS devices and Google Play for Android devices was performed to find the apps identified in the included research articles. RESULTS In total, 54 articles were found to analyze the development of an application in the field of oncology. These articles were most frequently related to the use of apps for the early detection of cancer (n = 28), particularly melanoma (n = 9). In total, 21 studies reflected the application used. The apps featured in nine articles were located using the App Store and Google Play (n = 9), of which five were created to manage cancer-related issues. The rest of the apps were designed for use in the general population (n = 4). CONCLUSIONS There is an increasing number of research articles that study the use of apps in the field of oncology; however, these mobile applications tend to disappear from app stores after the studies are completed.
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Chaudhri K, Kearney M, Day RO, Rodgers A, Atkins E. Effect of dose administration aids on adherence to self-administered medications: a systematic review protocol. BMJ Open 2019; 9:e030536. [PMID: 31585972 PMCID: PMC6797326 DOI: 10.1136/bmjopen-2019-030536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/23/2019] [Accepted: 08/20/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Forgetting to take a medication is the most common reason for non-adherence to self-administered medication. Dose administration aids (DAAs) are a simple and common solution to improve unintentional non-adherence for oral tablets. DAAs can be in the form of compartmentalised pill boxes, automated medication dispensing devices, blister packs and sachets packets. This protocol aims to outline the methods that will be used in a systematic review of the current literature to assess the impact of DAAs on adherence to medications and health outcomes. METHODS AND ANALYSIS Randomised controlled trials will be identified through electronic searches in databases including EMBASE, MEDLINE, CINAHL and the Cochrane Library, from the beginning of each database until January 2020. Two reviewers will independently screen studies and extract data using the standardised forms. Data extracted will include general study information, characteristics of the study, participant characteristics, intervention characteristics and outcomes. Primary outcome is to assess the effects of DAAs on medication adherence. Secondary outcome is to evaluate the changes in health outcomes. The risk of bias will be ascertained by two reviewers in parallel using The Cochrane Risk of Bias Tool. A meta-analysis will be performed if data are homogenous. ETHICS AND DISSEMINATION Ethics approval will not be required for this study. The results of the review described within this protocol will be disseminated through publication in a peer-reviewed journal and relevant conference presentations. PROSPERO REGISTRATION NUMBER CRD42018096087.
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Affiliation(s)
- Kanika Chaudhri
- Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Clinical Pharmacology and Toxicology, St Vincents Hospital Sydney, Darlinghurst, New South Wales, Australia
| | - Madeleine Kearney
- Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Richard O Day
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Clinical Pharmacology and Toxicology, St Vincents Hospital Sydney, Darlinghurst, New South Wales, Australia
| | - Anthony Rodgers
- Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Emily Atkins
- Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Schooley B, San Nicolas-Rocca T, Burkhard R. Cloud-based multi-media systems for patient education and adherence: a pilot study to explore patient compliance with colonoscopy procedure preparation. Health Syst (Basingstoke) 2019; 10:89-103. [PMID: 34104428 DOI: 10.1080/20476965.2019.1663974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Technology based patient education and adherence approaches are increasingly utilized to instruct and remind patients to prepare correctly for medical procedures. This study examines the interaction between two primary factors: patterns of patient adherence to challenging medical preparation procedures; and the demonstrated, measurable potential for cloud-based multi-media information technology (IT) interventions to improve patient adherence. An IT artifact was developed through prior design science research to serve information, reminders, and online video instruction modules to patients. The application was tested with 297 patients who were assessed clinically by physicians. Results indicate modest potential (43.4% relative improvement) for the IT-based approach for improving patient adherence to endoscopy preparations. Purposively designed cloud-based applications hold promise for aiding patients with complex medical procedure preparation. Health care provider involvement in the design and evaluation of a patient application may be an effective strategy to produce medical evidence and encourage the adoption of adherence apps.
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Affiliation(s)
- Benjamin Schooley
- Health Information Technology, University of South Carolina, College of Engineering and Computing, Columbia, SC, USA
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Marshall VK, Cairns PL. Challenges of Caregivers of Cancer Patients who are on Oral Oncolytic Therapy. Semin Oncol Nurs 2019; 35:363-369. [PMID: 31229341 DOI: 10.1016/j.soncn.2019.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the major challenges faced by caregivers of patients receiving oral oncolytic therapy (OOT). DATA SOURCES Published literature, national clinical practice guidelines, standards of care. CONCLUSION Caregivers of patients receiving OOT have unmet needs. Caregivers need standardized OOT education and coping support to improve patient outcomes through enhanced drug safety practices, better management of complex treatment regimens and adherence, patient symptoms, treatment side effects, care decision-making, and financial assistance for costly OOT. IMPLICATIONS FOR NURSING PRACTICE Nurses are well-positioned to take leadership roles in facilitating optimal utilization of multidisciplinary health care resources necessary to support caregivers and improve outcomes in patients receiving OOT.
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Affiliation(s)
| | - Paula L Cairns
- University of South Florida College of Nursing, Tampa, FL
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Crawford SY, Boyd AD, Nayak AK, Venepalli NK, Cuellar S, Wirth SM, Hsu GIH. Patient-centered design in developing a mobile application for oral anticancer medications. J Am Pharm Assoc (2003) 2019; 59:S86-S95.e1. [PMID: 30745188 DOI: 10.1016/j.japh.2018.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 11/28/2018] [Accepted: 12/11/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To develop and test the usability and feasibility of a customizable mobile application (app) designed to help educate patients about their oral anticancer medications (OAMs) and regimens. SETTING Outpatient cancer center and oncology pharmacy for urban, Midwestern academic health system. PRACTICE DESCRIPTION Clinically-supervised educational intervention to support patients learning about OAMs. PRACTICE INNOVATION With input from patient partners, our interdisciplinary team designed the first known tablet-based educational app that can interface with a patient's electronic medical record. The app is based on learning style and adherence theories and is customizable for individually prescribed OAMs. The app can accommodate multiple learning styles through text at 6th-grade reading level, pictures, animations, and audio voiceovers. Functionalities include interactive educational modules on 11 OAMs and case-based patient stories on common barriers to OAM adherence. EVALUATION Early phase testing provided the opportunity to observe the user interface with the app and app functionality. Data were summarized descriptively from observations and comments of patient subjects. RESULTS Thirty patient subjects provided input-19 in phase 1 usability testing and 11 in phase 2 feasibility testing. Comments provided by patient subjects during usability testing were largely positive. Responses included self-identification with patient stories, usefulness of drug information, preferences for text messages, and app limitations (e.g., perceived generational digital divide in technology use and potential patient inability to receive text messages). Using their feedback, modifications were made to the prototype app. Responses in feasibility testing demonstrated the app's usefulness across a wide range of ages. Highest opinion ratings on app usefulness were stated by patients who were newer to OAM therapy. CONCLUSION User feedback suggests the potential benefit of the app as a tool to help patients with cancer, particularly after the first months for those starting new OAM regimens. Processes and lessons learned are transferable to other settings.
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Asfaw AA, Yan CH, Sweiss K, Wirth S, Ramirez VH, Patel PR, Sharp LK. Barriers and Facilitators of Using Sensored Medication Adherence Devices in a Diverse Sample of Patients With Multiple Myeloma: Qualitative Study. JMIR Cancer 2018; 4:e12. [PMID: 30425032 PMCID: PMC6256103 DOI: 10.2196/cancer.9918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 08/02/2018] [Accepted: 09/20/2018] [Indexed: 11/13/2022] Open
Abstract
Background Many recently approved medications to manage multiple myeloma (MM) are oral, require supportive medications to prevent adverse effects, and are taken under complex schedules. Medication adherence is a concern; however, little attention has been directed toward understanding adherence in MM or associated barriers and facilitators. Advanced sensored medication devices (SMDs) offer opportunities to intervene; however, acceptability among patients with MM, particularly African American patients, is untested. Objective This study aimed to explore patients’ (1) perceptions of their health before MM including experiences with chronic medications, (2) perceptions of adherence barriers and facilitators, and (3) attitudes toward using SMDs. Methods An in-person, semistructured, qualitative interview was conducted with a convenience sample of patients being treated for MM. Patients were recruited from within an urban, minority-serving, academic medical center that had an established cancer center. A standardized interview guide included questions targeting medication use, attitudes, adherence, barriers, and facilitators. Demographics included the use of cell phone technology. Patients were shown 2 different pill bottles with sensor technology—Medication Event Monitoring System and the SMRxT bottle. After receiving information on the transmission ability of the bottles, patients were asked to discuss their reactions and concerns with the idea of using such a device. Medical records were reviewed to capture information on medication and diagnoses. The interviews were audio-recorded and transcribed. Interviews were independently coded by 2 members of the team with a third member providing guidance. Results A total of 20 patients with a mean age of 56 years (median=59 years; range=29-71 years) participated in this study and 80% (16/20) were African American. In addition, 18 (90%, 18/20) owned a smartphone and 85% (17/20) were comfortable using the internet, text messaging, and cell phone apps. The average number of medications reported per patient was 13 medications (median=10; range=3-24). Moreover, 14 (70%, 14/20) patients reported missed doses for a range of reasons such as fatigue, feeling ill, a busy schedule, forgetting, or side effects. Interest in using an SMD ranged from great interest to complete lack of interest. Examples of concerns related to the SMDs included privacy issues, potential added cost, and the size of the bottle (ie, too large). Despite the concerns, 60% (12/20) of the patients expressed interest in trying a bottle in the future. Conclusions Results identified numerous patient-reported barriers and facilitators to missed doses of oral anticancer therapy. Many appear to be potentially mutable if uncovered and addressed. SMDs may allow for capture of these data. Although patients expressed concerns with SMDs, most remained willing to use one. A feasibility trial with SMDs is planned.
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Affiliation(s)
- Alemseged Ayele Asfaw
- Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
| | - Connie H Yan
- Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
| | - Karen Sweiss
- Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
| | - Scott Wirth
- Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
| | - Victor H Ramirez
- College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Pritesh R Patel
- Department of Medicine, Section of Hematology/Oncology, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Lisa K Sharp
- Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
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Jupp JCY, Sultani H, Cooper CA, Peterson KA, Truong TH. Evaluation of mobile phone applications to support medication adherence and symptom management in oncology patients. Pediatr Blood Cancer 2018; 65:e27278. [PMID: 29943893 DOI: 10.1002/pbc.27278] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 05/10/2018] [Accepted: 05/11/2018] [Indexed: 01/19/2023]
Abstract
Mobile phone applications (apps), may support pediatric oncology patients with medication and disease management. A scoping review of the literature, a search of the iTunes App and Google Play Stores, was conducted to identify medication and symptom management apps for adult and pediatric oncology patients. Pooled results yielded 28 apps which were assessed for quality using the Mobile Application Rating Scale, with mean overall scores ranging from 2.8 to 4.3. Most apps received low scores in the Engagement domain. Our study assessed the quality of available mobile oncology apps and identified areas for improvement in design and function.
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Affiliation(s)
- Jennifer C Y Jupp
- Division of Pediatric Oncology, Blood and Marrow Transplant, Alberta, Children's Hospital, Alberta, Canada.,Pharmacy Services, Alberta Health Services, Alberta, Canada
| | | | - Cassandra A Cooper
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Alberta, Canada
| | | | - Tony H Truong
- Division of Pediatric Oncology, Blood and Marrow Transplant, Alberta, Children's Hospital, Alberta, Canada.,Department of Oncology and Pediatrics, University of Calgary, Alberta, Canada
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Loh KP, Ramsdale E, Culakova E, Mendler JH, Liesveld JL, O'Dwyer KM, McHugh C, Gilles M, Lloyd T, Goodman M, Klepin HD, Mustian KM, Schnall R, Mohile SG. Novel mHealth App to Deliver Geriatric Assessment-Driven Interventions for Older Adults With Cancer: Pilot Feasibility and Usability Study. JMIR Cancer 2018; 4:e10296. [PMID: 30373733 PMCID: PMC6234352 DOI: 10.2196/10296] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 08/15/2018] [Accepted: 09/10/2018] [Indexed: 12/22/2022] Open
Abstract
Background Older patients with cancer are at an increased risk of adverse outcomes. A geriatric assessment (GA) is a compilation of reliable and validated tools to assess domains that are predictors of morbidity and mortality, and it can be used to guide interventions. However, the implementation of GA and GA-driven interventions is low due to resource and time limitations. GA-driven interventions delivered through a mobile app may support the complex needs of older patients with cancer and their caregivers. Objective We aimed to evaluate the feasibility and usability of a novel app (TouchStream) and to identify barriers to its use. As an exploratory aim, we gathered preliminary data on symptom burden, health care utilization, and satisfaction. Methods In a single-site pilot study, we included patients aged ≥65 years undergoing treatment for systemic cancer and their caregivers. TouchStream consists of a mobile app and a Web portal. Patients underwent a GA at baseline with the study team (on paper), and the results were used to guide interventions delivered through the app. A tablet preloaded with the app was provided for use at home for 4 weeks. Feasibility metrics included usability (system usability scale of >68 is considered above average), recruitment, retention (number of subjects consented who completed postintervention assessments), and percentage of days subjects used the app. For the last 8 patients, we assessed their symptom burden (severity and interference with 17-items scored from 0-10 where a higher score indicates worse symptoms) using a clinical symptom inventory, health care utilization from the electronic medical records, and satisfaction (6 items scored on a 5-point Likert Scale for both patients and caregivers where a higher score indicates higher satisfaction) using a modified satisfaction survey. Barriers to use were elicited through interviews. Results A total of 18 patients (mean age 76.8, range 68-87) and 13 caregivers (mean age 69.8, range 38-81) completed the baseline assessment. Recruitment and retention rates were 67% and 80%, respectively. The mean SUS score was 74.0 for patients and 72.2 for caregivers. Mean percentage of days the TouchStream app was used was 78.7%. Mean symptom severity and interference scores were 1.6 and 2.8 at preintervention, and 0.9 and 1.5 at postintervention, respectively. There was a total of 27 clinic calls during the intervention period and 15 during the postintervention period (week 5-8). One patient was hospitalized during the intervention period (week 1-4) and two patients during the postintervention period (week 5-8). Mean satisfaction scores of patients and caregivers with the mobile app were 20.4 and 23.4, respectively. Barriers fell into 3 themes: general experience, design, and functionality. Conclusions TouchStream is feasible and usable for older patients on cancer treatment and their caregivers. Future studies should evaluate the effects of the TouchStream on symptoms and health care utilization in a randomized fashion.
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Affiliation(s)
- Kah Poh Loh
- Division of Hematology/Oncology, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Erika Ramsdale
- Division of Hematology/Oncology, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Eva Culakova
- Department of Surgery (Cancer Control), James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Jason H Mendler
- Division of Hematology/Oncology, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Jane L Liesveld
- Division of Hematology/Oncology, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Kristen M O'Dwyer
- Division of Hematology/Oncology, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Colin McHugh
- Division of Hematology/Oncology, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Maxence Gilles
- Division of Hematology/Oncology, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Terri Lloyd
- Division of Hematology/Oncology, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Molly Goodman
- Division of Hematology/Oncology, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Heidi D Klepin
- Section on Hematology/Oncology, Department of Internal Medicine, Wake Forest Baptist Health, Winston Salem, NC, United States
| | - Karen M Mustian
- Department of Surgery (Cancer Control), James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Rebecca Schnall
- School of Nursing, Coumbia University, New York City, NY, United States
| | - Supriya G Mohile
- Division of Hematology/Oncology, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
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Wu YP, Linder LA, Kanokvimankul P, Fowler B, Parsons BG, Macpherson CF, Johnson RH. Use of a Smartphone Application for Prompting Oral Medication Adherence Among Adolescents and Young Adults With Cancer. Oncol Nurs Forum 2018; 45:69-76. [PMID: 29251285 DOI: 10.1188/18.onf.69-76] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To explore the feasibility and acceptability of use of a smartphone medication reminder application to promote adherence to oral medications among adolescents and young adults (AYAs) with cancer.
. SAMPLE & SETTING 23 AYAs with cancer from a Children's Oncology Group-affiliated children's hospital and a National Cancer Institute-designated comprehensive cancer center in Salt Lake City, UT.
. METHODS & VARIABLES Participants were asked to use the application for eight weeks. Data on application usage were obtained from a cloud-based server hosted by the application developers. Weekly self-report questionnaires were completed. Feasibility was assessed through participants' usage and responses. Acceptability was assessed through participants' perceived ease of use and usefulness.
. RESULTS Almost all participants used the application at least once. More than half reported that they took their medications immediately when they received reminders. Participants also reported that the application was easy to set up and use, and that it was useful for prompting medication taking.
. IMPLICATIONS FOR NURSING Nurses could continue to test the efficacy of integrating e-health modalities, such as smartphone applications, into efforts to promote medication adherence.
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Affiliation(s)
| | | | | | | | | | | | - Rebecca H Johnson
- Mary Bridge Children's Hospital and Health Center/MultiCare Health System
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25
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Adherence to Oral Anticancer Medications: Evolving Interprofessional Roles and Pharmacist Workforce Considerations. PHARMACY 2018. [PMID: 29518017 PMCID: PMC5874562 DOI: 10.3390/pharmacy6010023] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Interprofessional care is exhibited in outpatient oncology practices where practitioners from a myriad of specialties (e.g., oncology, nursing, pharmacy, health informatics and others) work collectively with patients to enhance therapeutic outcomes and minimize adverse effects. Historically, most ambulatory-based anticancer medication therapies have been administrated in infusion clinics or physician offices. Oral anticancer medications (OAMs) have become increasingly prevalent and preferred by patients for use in residential or other non-clinic settings. Self-administration of OAMs represents a significant shift in the management of cancer care and role responsibilities for patients and clinicians. While patients have a greater sense of empowerment and convenience when taking OAMs, adherence is a greater challenge than with intravenous therapies. This paper proposes use of a qualitative systems evaluation, based on theoretical frameworks for interdisciplinary team collaboration and systems science, to examine the social interactionism involved with the use of intravenous anticancer treatments and OAMs (as treatment technologies) by describing patient, organizational, and social systems considerations in communication, care, control, and context (i.e., Kaplan’s 4Cs). This conceptualization can help the healthcare system prepare for substantial workforce changes in cancer management, including increased utilization of oncology pharmacists.
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Loh KP, McHugh C, Mohile SG, Mustian K, Flannery M, Klepin H, Schnall R, Culakova E, Ramsdale E. Using Information Technology in the Assessment and Monitoring of Geriatric Oncology Patients. Curr Oncol Rep 2018; 20:25. [PMID: 29511850 DOI: 10.1007/s11912-018-0672-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Older adults with cancer have complex medical needs and often experience higher rates of treatment-related toxicities compared to their younger counterparts. The advent of health information technologies can address multiple gaps in the care of this population. We review the role of existing and emerging technologies in facilitating the use of comprehensive geriatric assessment (CGA) in routine clinics, promoting symptom reporting, and monitoring medication adherence. RECENT FINDINGS Increasingly, studies demonstrate the feasibility of implementing electronic CGA in routine oncology practices. Evidence also suggests that electronic symptom reporting can improve outcomes in patients with cancer. In addition, technology devices can be used to promote adherence to cancer therapy. There are many opportunities for information technology to be integrated into the management and treatment of older adults with cancer. However, further evaluation of these technologies is needed to ensure that they meet the needs of the targeted end users.
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Affiliation(s)
- Kah Poh Loh
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA.
| | - Colin McHugh
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA
| | - Supriya G Mohile
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA
| | - Karen Mustian
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA
| | - Marie Flannery
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA
| | - Heidi Klepin
- Wake Forest Baptist Health, Winston-Salem, NC, USA
| | | | - Eva Culakova
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA
| | - Erika Ramsdale
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA
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Dalby M. Current models of support from community pharmacies for patients on oral anticancer medicines. J Oncol Pharm Pract 2017; 25:140-147. [DOI: 10.1177/1078155217732399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Administration of chemotherapy is moving into the community as more and more therapies to treat cancer are being developed as oral medications. Patients taking these oral medications still require support, as many of these agents can be toxic. This support could be simple side effect management, compliance issues or even reassurance with regards to their diagnosis as examples. Community pharmacies are ideally placed within the community to help these patients. The purpose of this review is to determine what support community pharmacies are currently providing for patients taking oral anticancer medication and if there is a model that can be adopted or adapted to be used elsewhere. Searches were undertaken using two databases, Medline and Embase. Other evidence-based articles were discovered from other sources. The different services currently available from community pharmacies were largely varied. There are some key aspects to each which could be used in the development of a new model. Further research is required to determine the views of the patients, carers and community pharmacy staff.
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Affiliation(s)
- Melanie Dalby
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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28
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LeFebvre KB, Felice TL. Nursing Application of Oral Chemotherapy Safety Standards:An Informal Survey. Clin J Oncol Nurs 2017; 20:258-62. [PMID: 27206292 DOI: 10.1188/16.cjon.258-262] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As the use of oral chemotherapy continues to rise, new approaches are needed to ensure patient safety. To help address this issue, the American Society of Clinical Oncology/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards were expanded in 2013 to include additional measures addressing oral anticancer drugs (OACs). Because minimal data assessing the application of these standards exist, ONS conducted an independent survey of oncology nurses to evaluate the application of these standards in practice as they relate to several areas of OAC use: assessment, consent, patient education, drug verification, and monitoring. The data revealed that, although the standards are followed in many settings, a large number of settings do not have processes in place to support safety standards and ensure patient safety when administering OACs. Information gained in this informal survey can be used to guide additional research and educational initiatives.
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29
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White T, Larson H, Minnella A, Hochster H. Metastatic Colorectal Cancer: Management With Trifluridine/Tipiracil. Clin J Oncol Nurs 2017; 21:E30-E37. [DOI: 10.1188/17.cjon.e30-e37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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30
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Davis SW, Oakley-Girvan I. Achieving value in mobile health applications for cancer survivors. J Cancer Surviv 2017; 11:498-504. [PMID: 28342093 DOI: 10.1007/s11764-017-0608-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 02/16/2017] [Indexed: 01/12/2023]
Abstract
PURPOSE This study aimed to identify appropriate development and testing strategies for mobile health applications for cancer survivors. METHODS In January of 2016, we conducted a PubMed search for mobile applications for cancer survivors. A total of 32 articles were selected for inclusion, including 13 review articles, and 19 articles describing an mHealth application or intervention. We assessed mobile app development and testing strategies and standards as described in these articles. RESULTS We identified seven elements of patient empowerment applications for cancer survivors, strategies for application development that take advantage of smartphone capabilities, issues for consideration in developing new applications, and steps for creating user-centered mobile health applications that provide meaningful value for cancer survivors. However, few mobile health apps implemented empowerment elements, underwent rigorous design approaches, or included assessment of use in the cancer survivor population. CONCLUSIONS There is tremendous potential for mobile health apps to benefit cancer survivors. However, there are specific issues for consideration in developing new applications and steps for creating user-centered applications which are not routinely used. This diminishes the value for the cancer survivor population but could be easily addressed through standardized development and testing procedures. IMPLICATIONS FOR CANCER SURVIVORS Smartphone applications have the potential to improve the cancer survivorship experience, but users should look for evidence that the application was appropriately developed and tested.
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Affiliation(s)
- Sharon Watkins Davis
- Cancer Prevention Institute of California, 2201 Walnut Ave, Ste 300, Fremont, CA, 94538, USA
| | - Ingrid Oakley-Girvan
- Cancer Prevention Institute of California, 2201 Walnut Ave, Ste 300, Fremont, CA, 94538, USA. .,Department of Health Research and Policy, Stanford Cancer Institute and Canary Center at Stanford for Cancer Early Detection, Stanford University School of Medicine, Stanford, CA, 94305, USA.
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31
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Irwin M. Theoretical foundations of adherence behaviors: synthesis and application in adherence to oral oncology agents. Clin J Oncol Nurs 2017; 19:31-5. [PMID: 26030390 DOI: 10.1188/15.s1.cjon.31-35] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The use of theory can provide structure for understanding the dynamics of adherence to oral agents for cancer (OACs) and facilitate the development of strategies for patient assessment and care planning related to oral adherence. OBJECTIVES The focus of this article is to identify common theories pertinent to medication-taking behavior, as well as their applications toward assessment and care planning regarding adherence to OACs. Approaches to apply these theories and their concepts in clinical practice are identified. METHODS Theories applied to adherence behaviors were reviewed, and their concepts were compared and synthesized. These concepts were then applied to medication adherence behavior. FINDINGS Various theories can help healthcare providers to better understand the influences and determinants of patients' adherence decisions and behaviors. They can then be used to structure assessment and plan related aspects of care.
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33
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Buis L, Hirzel L, Dawood RM, Dawood KL, Nichols LP, Artinian NT, Schwiebert L, Yarandi HN, Roberson DN, Plegue MA, Mango LC, Levy PD. Text Messaging to Improve Hypertension Medication Adherence in African Americans From Primary Care and Emergency Department Settings: Results From Two Randomized Feasibility Studies. JMIR Mhealth Uhealth 2017; 5:e9. [PMID: 28148474 PMCID: PMC5311421 DOI: 10.2196/mhealth.6630] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/02/2016] [Accepted: 11/17/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hypertension (HTN) is an important problem in the United States, with an estimated 78 million Americans aged 20 years and older suffering from this condition. Health disparities related to HTN are common in the United States, with African Americans suffering from greater prevalence of the condition than whites, as well as greater severity, earlier onset, and more complications. Medication adherence is an important component of HTN management, but adherence is often poor, and simply forgetting to take medications is often cited as a reason. Mobile health (mHealth) strategies have the potential to be a low-cost and effective method for improving medication adherence that also has broad reach. OBJECTIVE Our goal was to determine the feasibility, acceptability, and preliminary clinical effectiveness of BPMED, an intervention designed to improve medication adherence among African Americans with uncontrolled HTN, through fully automated text messaging support. METHODS We conducted two parallel, unblinded randomized controlled pilot trials with African-American patients who had uncontrolled HTN, recruited from primary care and emergency department (ED) settings. In each trial, participants were randomized to receive either usual care or the BPMED intervention for one month. Data were collected in-person at baseline and one-month follow-up, assessing the effect on medication adherence, systolic and diastolic blood pressure (SBP and DBP), medication adherence self-efficacy, and participant satisfaction. Data for both randomized controlled pilot trials were analyzed separately and combined. RESULTS A total of 58 primary care and 65 ED participants were recruited with retention rates of 91% (53/58) and 88% (57/65), respectively. BPMED participants consistently showed numerically greater, yet nonsignificant, improvements in measures of medication adherence (mean change 0.9, SD 2.0 vs mean change 0.5, SD 1.5, P=.26), SBP (mean change -12.6, SD 24.0 vs mean change -11.3, SD 25.5 mm Hg, P=.78), and DBP (mean change -4.9, SD 13.1 mm Hg vs mean change -3.3, SD 14.3 mm Hg, P=.54). Control and BPMED participants had slight improvements to medication adherence self-efficacy (mean change 0.8, SD 9.8 vs mean change 0.7, SD 7.0) with no significant differences found between groups (P=.92). On linear regression analysis, baseline SBP was the only predictor of SBP change; participants with higher SBP at enrollment exhibited significantly greater improvements at one-month follow-up (β=-0.63, P<.001). In total, 94% (51/54) of BPMED participants agreed/strongly agreed that they were satisfied with the program, regardless of pilot setting. CONCLUSIONS Use of text message reminders to improve medication adherence is a feasible and acceptable approach among African Americans with uncontrolled HTN. Although differences in actual medication adherence and blood pressure between BPMED and usual care controls were not significant, patterns of improvement in the BPMED condition suggest that text message medication reminders may have an effect and fully powered investigations with longer-term follow-up are warranted. TRIAL REGISTRATION Clinicaltrials.gov NCT01465217; https://clinicaltrials.gov/ct2/show/NCT01465217 (Archived by WebCite at http://www.webcitation.org/6V0tto0lZ).
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Affiliation(s)
- Lorraine Buis
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Lindsey Hirzel
- College of Nursing, Wayne State University, Detroit, MI, United States
| | - Rachelle M Dawood
- Department of Emergency Medicine, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Katee L Dawood
- Department of Emergency Medicine, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Lauren P Nichols
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Nancy T Artinian
- College of Nursing, Wayne State University, Detroit, MI, United States
| | - Loren Schwiebert
- College of Engineering, Wayne State University, Detroit, MI, United States
| | - Hossein N Yarandi
- College of Nursing, Wayne State University, Detroit, MI, United States
| | - Dana N Roberson
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - LynnMarie C Mango
- Department of Emergency Medicine, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Phillip D Levy
- Department of Emergency Medicine, School of Medicine, Wayne State University, Detroit, MI, United States
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