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Motivational Interviewing & Cognitive Behavioral Therapy To Promote Adherence In Cancer Patients Taking Oral Agent Medications: An Integrative Review
Oncology Nursing Society (2013)
  • Sandra Spoelstra, Grand Valley State University
Significance: Patients with cancer miss as much as one-third of the prescribed doses of oral anti-cancer agents required for treatment of their disease.
Problem & Purpose: This shift in treatment results in care at home, placing responsibility on patients. This review will discuss the foundation for developing a combined motivational interviewing (MI) and brief cognitive behavioral therapy (CBT) intervention and will examine evidence on MI/CBT interventions that improved adherence.
Framework: Not applicable.
Methods: Whittemore and Knafl’s review method was used, identifying studies via a search in CINAHL and PubMed using key words of MI/CBT; and reviewing of references.
Findings: 2822 MI and 48566 CBT articles were retrieved, with 206 on MI/CBT. 12 articles met inclusion criteria, and 9 report improved adherence. Total sample size was N=1386; with 4 RCTs, 5 clinical trials, 1 feasibility study, and 1 case study; including HIV/AIDS, rheumatoid arthritis, ulcerative colitis, osteoporosis, mental health disorders, Fanconi anemia, gambling, substance abuse, and weight loss. Interventions included: phone (3 to 5 calls, 7 to 11 minutes) and face-to-face or group settings interactions (1 to 28 sessions, 60 to 90 minutes). In most cases, a combination of written materials and delivery of the intervention by a clinician occurred.  Clinicians used for delivery included RNs, PTs, OTs, and psychologists. Medication adherence (Effect Size .19 to .67), depression (p=.05), and weight loss (4 pounds) improved; there was less desire for gambling; but no difference was found in substance usage. One study compared MI/CBT versus CBT alone and found MI/CBT was more effective at improving adherence.
Implications: Findings indicate a MI/CBT intervention is a means of improving adherence in challenging clinical problems that require behavior change, such as in cancer patients who are prescribed oral agent for treatment.  A recent Cochrane review on medication adherence found an 11% improvement using MI and a 23% improvement with CBT. Thus, combining MI/CBT may yield higher adherence rates to oral agents in cancer patients and support adequate dosing for effective cancer treatment, which is a challenging clinical problem.
Publication Date
Summer 2013
Citation Information
Sandra Spoelstra. "Motivational Interviewing & Cognitive Behavioral Therapy To Promote Adherence In Cancer Patients Taking Oral Agent Medications: An Integrative Review" Oncology Nursing Society (2013)
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