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Date of Award

2018

Document Type

Thesis

Degree Name

Master of Science in Nursing (MSN)

Department

Nursing

Thesis Committee Chairperson

Janice Hobba-Glose, DNS, MSN, RN

Second Reader

Christina C. Tobin RN, MS OCN NEA-BC

Abstract

Purpose: The purpose of this quantitative descriptive research study is to determine the baseline medication adherence rate with oral chemotherapy at home among cancer patients at the Neurology and Breast Clinics at a large cancer treatment facility in Western New York. The baseline data will provide information regarding the barriers and facilitators for outpatients on oral chemotherapy. The theoretical framework for this study is Orem’s theory of self-care where individuals initiate and perform activities on their own behalf to maintain health and well-being (McEwen & Willis, 2014). Because oral chemotherapy among outpatients requires self-care, the nurse practitioner is in a unique position to encourage and stimulate self-care with medication adherence. By identifying and acknowledging the deficits present for medication adherence, the nurse practitioner is able to provide education, assistance, and referrals to appropriate providers and agencies as an advocate for the patient.

Method: A quantitative, descriptive design was implemented in this study. Data was collected via an anonymous survey. Data was collected using the Tool to Assess Adherence for each Individual Drug taken by a Patient (Sidorkiewicz, Tran, Cousyn, Perrodeau & Ravaud, 2016). The focus of this descriptive study was to measure the adherence rates for outpatients at a cancer treatment facility in Buffalo, New York receiving oral chemotherapy. The inclusion criteria for participation are as follows:

  1. Outpatients in the Neurology and Breast clinics
  2. At least 18 years old
  3. Able to read, write, and understand English
  4. Prescribed one of the following oral chemotherapy medications: a) Temodar (temozolamide) b) Ibrance (palbociclib) c) Xeloda (capecitabine) d) Afinitor (everolimus) e) Tykerb (lapatinib)

Data was analyzed using Data was analyzed using the Statistical Package for the Social Sciences (SPSS) Version 23.

Findings: Fifty-one surveys were analyzed and described for medication adherence and demographic characteristics. Of the 51 participants, 39 (76.5%) were female, and 12 (23.5%) were male. Participant ages ranged from 40 to 93 years old, with a mean of 63.3 years old and standard deviation of 11.23. Of the 51 surveys that were analyzed, only two patients reported stopping their medication. One patient had completed the therapy regimen, and one patient had to stop due to a hepatic adverse reaction. No patients reported skipping multiple doses. No patients reported stopping their therapy for any time interval. Six patients (11.8%) reported missing a dose of medication once or twice a month and six patients reported delaying a dose for between four and 12 hours. Forty –five patients (88.2%) reported a medication adherence rate of 100% and six patients had a calculated adherence rate of 97%. Forgetting to take medication was the most common reason listed for nonadherence, and cost of chemotherapy was the second most common concern reported in the study.

Conclusions: The present study does reveal some potential concerns that may lead to nonadherence with this patient population. There are key opportunities for the nurse practitioner to explore these concerns with the patient in order to ensure the best possible outcomes for any oral chemotherapy regimen.

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