癌症青少年和青年的用药依从性决策
Medication adherence decision-making among adolescents and young adults with cancer.
作者信息
McGrady Meghan E, Brown Gabriella A, Pai Ahna L H
机构信息
Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, MLC 7039, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, MLC 7039, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA.
Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, MLC 7039, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, MLC 7039, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA.
出版信息
Eur J Oncol Nurs. 2016 Feb;20:207-14. doi: 10.1016/j.ejon.2015.08.007. Epub 2015 Sep 12.
PURPOSE
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
目的
近一半患有癌症的青少年和青年（AYA）在坚持治疗方案中包含的口服化疗药物或抗生素预防性药物方面存在困难。导致不依从的机制尚不清楚，这使得医疗保健提供者几乎没有策略来提高患者的依从性。本研究的目的是使用定性方法调查驱动患有癌症的AYA日常依从性决策过程的机制。
方法
12名患有癌症的AYA（年龄在15 - 31岁之间），其当前药物治疗方案包括口服化疗或抗生素预防性药物，参与了本研究。青少年和青年完成了一项半结构化访谈和一项卡片分类任务，以阐明影响依从性决策的主题。访谈逐字记录，并由两名独立评分者进行两次编码，以确定关键主题并构建一个总体理论框架。
结果
患有癌症的青少年和青年将依从性决策描述为一个复杂的、多维度的过程，受个人目标和价值观、知识、技能以及环境和社会因素的影响。各药物治疗方案的主题总体一致，但因年龄而异，年龄较大的AYA比年龄较小的AYA更多地讨论长期影响并从其照顾者那里获得身体支持。
结论
驱动患有癌症的AYA日常依从性决策的机制与其他慢性疾病成年患者经实证支持的依从性模型中所描述的机制一致。这些机制为努力提高这一弱势群体依从性的医疗保健提供者提供了几个可修改的目标。
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