Nardi William R, Loucks Eric B, Springs Stacey, Operario Don, Kronish Ian M, Gaudiano Brandon A, Sun Shufang
Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.
Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States; Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States; Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, United States.
J Psychosom Res. 2021 Oct;149:110585. doi: 10.1016/j.jpsychores.2021.110585. Epub 2021 Jul 26.
Inadequate medication adherence is a significant limitation for achieving optimal health outcomes across chronic health conditions. Mindfulness-based interventions (MBIs) have been increasingly applied to promote medical regimen adherence as MBIs have been shown to improve patient-level barriers to adherence (i.e., depressive symptoms, cognitive impairment, stress). The purpose of this review is to investigate the state of research regarding MBIs targeting medication adherence in chronic illnesses and to identify evidence gaps to inform future studies.
The search reviewed 5 databases (e.g., PubMed, PsycINFO, Embase, CINAHL, Proquest Thesis/Dissertations) to identify trials that quantitatively evaluated the effect of MBIs on medication adherence. Study abstracts and full texts were screened identifying eligible studies, and findings were summarized using a narrative synthesis.
A total of 497 studies were reviewed; 41 were eligible for full text review and 9 were included in narrative synthesis: seven were RCTs and two were pre-post designs. Study quality varied, with five rated moderate or high risk for bias. Clinical populations tested included living with HIV (k = 3), cardiovascular disease (k = 3), psychological disorders (k = 2), and men who underwent a radical prostatectomy (k = 1). Four studies found significant improvements in medication adherence, however only two of these studies had low risk of bias.
Research on MBI's for medication adherence is developing, but the effectiveness of MBIs remains unclear due to the nascent stage of evidence and methodological limitations of existing studies. Researchers should prioritize rigorous experimental designs, theory-driven investigations of behavioral mechanisms, and the use of objective measurements of adherence.
药物依从性不足是各类慢性疾病实现最佳健康结果的重大限制因素。基于正念的干预措施（MBIs）已越来越多地应用于促进药物治疗方案的依从性，因为研究表明，MBIs可改善患者层面的依从性障碍（如抑郁症状、认知障碍、压力）。本综述的目的是调查针对慢性病药物依从性的MBIs的研究现状，并找出证据空白，为未来研究提供参考。
检索了5个数据库（如PubMed、PsycINFO、Embase、CINAHL、Proquest论文数据库），以确定定量评估MBIs对药物依从性影响的试验。对研究摘要和全文进行筛选，确定符合条件的研究，并采用叙述性综合法对研究结果进行总结。
共检索到497项研究；41项符合全文审查条件，9项纳入叙述性综合分析：7项为随机对照试验，2项为前后设计。研究质量参差不齐，5项研究的偏倚风险为中度或高度。所测试的临床人群包括艾滋病毒感染者（k = 3）、心血管疾病患者（k = 3）、心理障碍患者（k = 2）和接受根治性前列腺切除术的男性（k = 1）。4项研究发现药物依从性有显著改善，但其中只有2项研究的偏倚风险较低。
针对药物依从性的MBIs研究正在发展，但由于现有研究的证据尚处于初期阶段且存在方法学局限性，MBIs的有效性仍不明确。研究人员应优先考虑严谨的实验设计、对行为机制进行理论驱动的研究以及使用客观的依从性测量方法。
