Goh X T W, Tan Y B, Thirumoorthy T, Kwan Y H
Duke-NUS Medical School, Singapore, Singapore.
Centre for Medical Ethics and Professionalism at Singapore Medical Association, Singapore, Singapore.
J Clin Pharm Ther. 2017 Feb;42(1):1-7. doi: 10.1111/jcpt.12441. Epub 2016 Aug 31.
Treatment adherence is an essential component in ensuring best outcomes in the management of paediatric cancers. Compared to the adult population, treatment adherence in the paediatric population is a more complex subject which involves unique dimensions. In this study, we aimed to systematically review the literature to identify factors associated with treatment adherence in the paediatric oncology population.
A literature search was carried out using related keywords on electronic databases.
A total of 1036 articles were reviewed, and 39 articles were found to be relevant. A comprehensive review of these articles identified 17 factors that influence adherence. These factors were classified into five major categories: patient-/caregiver-related factors; therapy-related factors; condition-related factors; health system-related factors; and social/economic factors. A baby bear model was proposed to better visualize these five categories that affect treatment adherence, and a framework of questions was designed to help clinicians identify those at risk of non-adherence for early intervention.
Seventeen factors reviewed were categorized into five main categories, namely patient-/caregiver-related factors, therapy-related factors, condition-related factors, health system factors and social/economic factors, as causes for poor medication adherence in the paediatric oncology population. Clinicians need to be aware that these factors can interact to influence treatment adherence and that some factors may be more relevant in specific contexts (e.g. third world countries, minority groups). The baby bear model is presented to help understand the issues affecting adherence in the paediatric oncology population, and a framework of questions is proposed to help clinicians identify patients at risk of non-adherence.
治疗依从性是确保儿童癌症治疗取得最佳效果的关键要素。与成人相比，儿童群体的治疗依从性是一个更为复杂的课题，涉及独特的维度。在本研究中，我们旨在系统回顾文献，以确定与儿童肿瘤患者治疗依从性相关的因素。
使用相关关键词在电子数据库中进行文献检索。
共检索了1036篇文章，发现39篇相关。对这些文章的全面综述确定了17个影响依从性的因素。这些因素分为五大类：患者/照顾者相关因素；治疗相关因素；病情相关因素；卫生系统相关因素；以及社会/经济因素。提出了一个小熊模型，以便更好地直观呈现影响治疗依从性的这五大类因素，并设计了一个问题框架，以帮助临床医生识别有不依从风险的患者，以便早期干预。
所综述的17个因素分为五大主要类别，即患者/照顾者相关因素、治疗相关因素、病情相关因素、卫生系统因素和社会/经济因素，这些是儿童肿瘤患者药物依从性差的原因。临床医生需要意识到，这些因素可能相互作用以影响治疗依从性，并且某些因素在特定背景下（如第三世界国家、少数群体）可能更相关。提出小熊模型以帮助理解影响儿童肿瘤患者依从性的问题，并提出一个问题框架以帮助临床医生识别有不依从风险的患者。
