Health Sciences Department, University of Florence, Florence, Italy.
NEUROFARBA Department, University of Florence, Florence, Italy.
Eur J Oncol Nurs. 2023 Dec;67:102410. doi: 10.1016/j.ejon.2023.102410. Epub 2023 Sep 16.
Patients undergoing allogenic hematopoietic stem cell transplantation (allo-HSCT) are required to strictly adhere to immunosuppressive medications to avoid rejection and infective complications. Since medication adherence is among the most important modifiable behaviors to achieve better outcomes, the aims of this study were to measure the baseline and longitudinal trends of medication adherence and investigate the psychological factors associated with medication adherence in allo-HSCT patients.
This was a single-center, longitudinal study of patients who underwent allo-HSCT to treat hematological malignancies at the University hospital of Florence (Italy). Adherence was measured with the Immunosuppressive Medication Self-Management Scale; psychological factors (i.e., beliefs about medicines and health locus of control) were measured with the Beliefs About Medicines Questionnaire and Multidimensional Health locus of Control Scale. Data were collected 1, 3, 6 and 12 months after discharge. A mixed effects model was performed after adjusting for demographic characteristics.
50 adult patients were included in this study. Adherence to immunosuppressant was optimal and increased significantly 3 months after bone marrow transplantation (B = 0.23, p = 0.041). Patients with lower concerns about immunosuppressive medications were more likely to be adherent (B = 0.02, p = 0.040), while those having beliefs that their disease was due to external factors were less likely to be adherent (B = -0.02, p = 0.026) than their counterparts.
These results underline the importance of psychological factors in affecting adherence to immunosuppressants of allo-HSCT patients. Healthcare providers and researchers should target medication beliefs and reorient locus of control with appropriate interventions, in order to improve adherence.
接受同种异体造血干细胞移植（allo-HSCT）的患者需要严格遵循免疫抑制药物治疗方案，以避免排斥和感染并发症。由于药物依从性是实现更好结果的最重要的可改变行为之一，本研究旨在测量 allo-HSCT 患者的药物依从性基线和纵向趋势，并调查与药物依从性相关的心理因素。
这是一项单中心、纵向研究，在意大利佛罗伦萨大学医院（意大利）接受 allo-HSCT 治疗血液系统恶性肿瘤的患者参与了该研究。使用免疫抑制药物自我管理量表测量依从性；使用信念关于药物和多维健康控制量表测量心理因素（即对药物的信念和健康控制源）。在出院后 1、3、6 和 12 个月收集数据。在调整人口统计学特征后，进行混合效应模型分析。
本研究共纳入 50 例成年患者。骨髓移植后 3 个月，免疫抑制剂的依从性最佳且显著增加（B=0.23，p=0.041）。对免疫抑制药物的担忧程度较低的患者更有可能依从（B=0.02，p=0.040），而那些认为疾病是由外部因素引起的患者则不太可能依从（B=-0.02，p=0.026）。
这些结果强调了心理因素在影响 allo-HSCT 患者对免疫抑制剂的依从性方面的重要性。医疗保健提供者和研究人员应该针对药物信念和重新定位控制源，通过适当的干预措施，以提高依从性。
