A pilot to study to assess a pharmacist- and medication navigator-led intervention to enhance oral chemotherapy adherence
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BACKGROUND: Over the past 10 years, molecular-based and targeted therapies in oral forms have emerged and continue to change the landscape of cancer care and care delivery. While cancer treatments traditionally have been administered at the hospital, oral anti-cancer medications (OAM) can be taken by patients at the comfort and convenience of their homes. However, this also creates implications for ensuring that patients take their oral chemotherapies correctly, timely, and safely, all of which can impact outcomes and tolerance. Studies have shown concerning gaps in patients’ knowledge of taking and handling their OAM, including lower rates of adherence. Interventions have largely consisted of a combination of nurse- and pharmacist-led approaches along with the use of various educational and reminder tools. However, few studies have examined the potential of an intervention led by a pharmacist and a medication (patient) navigator. OBJECTIVE: This ongoing pilot study aims to assess the feasibility of the intervention, the impact on patients’ understanding and adherence to their oral anti-cancer medications, and the patient perceptions of the helpfulness of the intervention. METHODS: Patients who were initiating oral chemotherapy were enrolled at Tufts Medical Center Cancer Center, which was the study site for this pilot intervention. Study participants met with the Specialty Pharmacist and Medication Navigator for their initial education session and teach-back using the Oral Agent Teaching Tool (MOATT). They were also given Information Sheets and individualized Calendars for their OAM. The Pharmacist and/or Navigator subsequently followed up with the participants for three more check-ins and educational boosters. Participants completed study measures including the self-reported Adherence Measure, MD Anderson Symptom Inventory, and study evaluation. RESULTS: A total of 37 patients have so far been enrolled in the study and completed their initial education session with the Pharmacist and 33 of those patients completed the Navigator-led booster check-in approximately one week later. These patients are receiving ongoing follow-up for their two remaining check-ins in the study. After the first teach-back with the Pharmacist, patients largely showed sufficient understanding of how to take and handle their medication. This level of understanding was sustained a week later at the Navigator booster. Despite high levels of self-reported adherence, patients showed insufficient understanding of refill logistics. Patients were highly satisfied with the intervention and had found both the check-ins and the educational tools provided useful. CONCLUSION: This Pharmacist- and Navigator-led intervention was found to be feasible to deliver, capable in enhancing patient understanding and adherence to their medications, and helpful to the patients throughout taking their OAM.
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