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Patient Beliefs and their Influence on Adherence to Oral Anti-Cancer Agents
Oncology Nursing Society (2012)
  • Sandra Spoelstra, Grand Valley State University
Significance: To focus clinicians on what to address with patients on oral agents to promote adherence.
Problem & Purpose:  With increased use of oral anti-cancer agents, patients are responsible for adhering to complex regimens. The aim of this study was to explore beliefs about oral anti-cancer agents and describe how those beliefs were associated with adherence to the regimens among 119 solid tumor cancer patients taking oral agent regimens.  
Framework: The trial assessed beliefs about oral anti-cancer agents and used a cognitive behavioral model to compare the impact of: usual care with strategies to manage symptoms and adherence, and a third arm that focused only on managing adherence. 
Methods & Analyses: Exploratory factor analysis (EFA) with varimax rotation was used to assess beliefs items and t-tests examined responses to beliefs on adherence, regardless of study arm. Twenty-eight items directed at assessing patient beliefs about oral agents were collected at baseline with responses on a 5 point scale (strongly disagree to strongly agree). Adherence measures were collected weekly (8) and at exit.
Findings:  The sample consisted of 37 men and 82 women, who were age 28 to 86, and 76% Caucasian. Based on EFA, 19 of the 28 questions asked regarding beliefs were retained in the model. These 19-items loaded onto 4-factors: ‘Reduce dosing to manage symptoms’, ‘Confusion with dosing’, ‘Belief in effectiveness of oral agent’, and ‘Trouble with affordability’. Cronbach’s alpha corresponding to these 4-factors was 0.82, 0.89, 0.84, and 0.72 respectively. Validation of subscales was assessed by observing differences in adherence to oral agents. Differences in adherence were found for ‘Confusion with dosing’ (p=0.012) and ‘Trouble with affordability’ (p=0.003), while no differences were found for “Reduces dosing to manage symptoms’ or ‘Belief in effectiveness of oral agent’ (p>0.05). Patients who believed they were less confused about the regimen dosing schedule or had  fewer affordability problems, were more likely to adhere to oral agents.
Implications:  Nurses should provide detailed written and verbal information on the oral agent regimen dosing schedule, and confirm patient understanding, to reduce confusion with dosing. Affordability with oral agents should be assessed for all patients, and assistance with payment should be sought from insurers or drug companies, for those who need it.                                                
Publication Date
Spring 2012
Citation Information
Sandra Spoelstra. "Patient Beliefs and their Influence on Adherence to Oral Anti-Cancer Agents" Oncology Nursing Society (2012)
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