Medication adherence decision-making among adolescents and young adults with cancer.
Medication adherence decision-making among adolescents and young adults with cancer.
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DOI：
10.1016/j.ejon.2015.08.007
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发表时间：
2016-02
期刊：
影响因子：
--
通讯作者：
Pai AL
中科院分区：
文献类型：
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作者：
McGrady ME;Brown GA;Pai AL
近一半患有癌症的青少年和年轻人(AYA)难以坚持治疗方案中包括的口服化疗或抗生素预防药物。导致不依从性的机制仍不清楚，这使得卫生保健提供者几乎没有策略来提高患者的依从性。这项研究的目的是使用定性的方法来调查驱动癌症AYA患者日常依从性决策过程的机制。12名患有癌症的AYA(年龄15-31岁)参与了这项研究，他们目前的药物治疗方案包括口服化疗或抗生素预防药物。青少年和年轻人完成了半结构化访谈和卡片分类任务，以阐明影响坚持决策的主题。访谈由两名独立的评分员逐字转录和两次编码，以确定关键主题并制定总体理论框架。患有癌症的青少年和年轻人将坚持决策描述为一个复杂的、多维的过程，受到个人目标和价值观、知识、技能以及环境和社会因素的影响。各用药方案的主题总体上是一致的，但随着年龄的不同而不同，年长的AYA讨论长期影响，比年轻的AYA更多地从照顾者那里获得身体支持。驱动癌症AYA患者每日依从性决策的机制与经验支持的成人其他慢性病患者依从性模型中描述的机制是一致的。这些机制为卫生保健提供者提供了几个可修改的目标，以努力提高这一弱势群体的依从性。
Nearly half of all adolescents and young adults (AYAs) with cancer struggle to adhere to oral chemotherapy or antibiotic prophylactic medication included in treatment protocols. The mechanisms that drive non-adherence remain unknown, leaving health care providers with few strategies to improve adherence among their patients. The purpose of this study was to use qualitative methods to investigate the mechanisms that drive the daily adherence decision-making process among AYAs with cancer. Twelve AYAs (ages 15–31) with cancer who had a current medication regimen that included oral chemotherapy or antibiotic prophylactic medication participated in this study. Adolescents and young adults completed a semi-structured interview and a card sorting task to elucidate the themes that impact adherence decision-making. Interviews were transcribed verbatim and coded twice by two independent raters to identify key themes and develop an overarching theoretical framework. Adolescents and young adults with cancer described adherence decision-making as a complex, multi-dimensional process influenced by personal goals and values, knowledge, skills, and environmental and social factors. Themes were generally consistent across medication regimens but differed with age, with older AYAs discussing long-term impacts and receiving physical support from their caregivers more than younger AYAs. The mechanisms that drive daily adherence decision-making among AYAs with cancer are consistent with those described in empirically-supported models of adherence among adults with other chronic medical conditions. These mechanisms offer several modifiable targets for health care providers striving to improve adherence among this vulnerable population.