Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Department of Psychiatry and Perelmen School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Adolesc Young Adult Oncol. 2020 Dec;9(6):651-661. doi: 10.1089/jayao.2020.0013. Epub 2020 May 11.
This mixed methods study sought to assess adolescent and young adult (AYA) adherence to three cancer treatment recommendations (medications, diet, physical activity), and determine the individual, family, and health system factors associated with suboptimal adherence. In Stage 1, 72 AYA-caregiver dyads completed a validated adherence interview and surveys about individual and family functioning. Matched providers ( = 34 who reported on 61 AYAs) completed global adherence ratings through survey. In Stage 2, a subset ( = 31) completed qualitative interviews. Medication adherence was higher ( = 94.8%) than diet ( = 73.9%) and physical activity ( = 55.4%), although ≥50% demonstrated "Imperfect Adherence" for each subtask. Univariately, AYAs who missed a medication had more depressive symptoms, worse health-related quality of life (HRQOL), and more medication barriers; their families had more financial stress, worse family functioning, and lower self-efficacy. The odds of adhering to medications were lower with worse HRQOL (odds ratio [OR] = 1.08; 95% confidence interval [CI], 1.02-1.15) and family functioning (OR = 0.18; 95% CI, 0.04-0.91). The odds of adhering to physical activity and diet were lower with worse family functioning (OR = 0.09; 95% CI, 0.01-0.91) and more barriers (OR = 0.24, CI: 0.10-0.61), respectively. Qualitative themes further supported multilevel influences on AYA adherence. Adherence challenges were identified across medications, diet, and physical activity. Multilevel contextual factors were associated with suboptimal adherence, including poorer HRQOL and family functioning. Findings support the need to improve clinical adherence assessment and develop contextually tailored interventions.
这项混合方法研究旨在评估青少年和年轻成年人（AYA）对三种癌症治疗建议（药物、饮食、身体活动）的依从性，并确定与不依从相关的个体、家庭和医疗系统因素。在第 1 阶段，72 对 AYA-照顾者完成了一项经验证的依从性访谈和关于个体和家庭功能的调查。匹配的提供者（ = 34 名报告了 61 名 AYA）通过调查完成了整体依从性评分。在第 2 阶段，一个亚组（ = 31 名）完成了定性访谈。药物依从性较高（ = 94.8%），饮食依从性较低（ = 73.9%），身体活动依从性较低（ = 55.4%），尽管≥50%的参与者在每个子任务中都表现出“不完美的依从性”。单变量分析表明，错过药物治疗的 AYA 患者抑郁症状更严重、健康相关生活质量（HRQOL）更差、药物治疗障碍更多；他们的家庭经济压力更大、家庭功能更差、自我效能感更低。HRQOL 较差（比值比 [OR] = 1.08；95%置信区间 [CI]，1.02-1.15）和家庭功能较差（OR = 0.18；95% CI，0.04-0.91）时，服用药物的依从性较低。家庭功能较差（OR = 0.09；95% CI，0.01-0.91）和障碍较多（OR = 0.24，CI：0.10-0.61）时，遵守饮食和运动的依从性较低。定性主题进一步支持了对 AYA 依从性的多层次影响。在药物、饮食和身体活动方面都存在依从性挑战。多层次的环境因素与不依从相关，包括较差的 HRQOL 和家庭功能。研究结果支持需要改进临床依从性评估并制定针对具体情况的干预措施。
