Due to the increased attention to oral therapies and adherence, several professional organizations have developed standards of practice for safety and adherence of oral therapies for cancer. The Oncology Nursing Society, American Society of Clinical Oncology, the National Comprehensive Cancer Network, and the Multinational Association of Supportive Care for Cancer are examples of organizations that are committed to developing recommendations and standards for oral therapy issues. Currently there is no clinically established threshold for adherence, and there is no standard for adherence. To date, there is a lack of data on interventions to promote adherence.
The Oncology Nursing Society Oral Adherence team made several recommendations based on the review of the literature.
Interventions that were recommended for practice include:
- Patient monitoring and feedback
- Multicomponent interventions: patient education and counseling, along with other interventions such as patient monitoring devices, packaging, and physician/patient feedback
Likely to be effective:
- Text messaging
- Automated voice response (AVR)
- Treatment of depression
Effectiveness not established:
- Education, psychoeducation
- Cognitive behavioral therapy
- Motivational interviewing
- Less frequent dosing
- Automated dispensers
- Provider monitoring and feedback
- Decision aid
- Calendar aid
- Mail/online refills
- Institutional level interventions
- Supportive interventions
- Workplace care delivery
- Intervention to improve provider communication
- Cost and co-pay reduction
Practice changes to help improve adherence involve multidisciplinary efforts, including nursing, physicians/mid-level providers, pharmacy, information technology, and other support services. The development of standard procedures for education, reviewing/documenting treatment plans, and routine monitoring of adherence are new systematic issues for oral oncology medication management. Scripting of how to ask questions related to adherence is also important to promote reliable and accurate responses. Patient navigators have the potential for a key role in oral adherence, primarily due to trust, consistency, and access to the patient. Opportunities for frequent patient contact (phone, email, Facetime/Skype, and face-to-face interaction) are crucial in assessing patient tolerance, safety, and adherence to oral oncology medications.
Read more of Oncology Nurse Advisor‘s coverage of the 2017 ONA Navigation Summit by visiting the conference page.