Treating cancer with oral medications that are taken at home sounds like a great idea, and it is, once adherence barriers are addressed. Likewise, years ago it was unthinkable that surviving cancer would have a downside, but because late and long-term effects of cancer treatments were not adequately addressed, survivorship quality was suboptimal. The good news is that if survivorship issues can be resolved, so can the problems associated with oral therapy adherence.
The featured article, "A New Era of Oral Therapies for Multiple Myeloma," covers many of the barriers associated with shifting cancer medication management from the provider to the patient. This commentary will discuss the techniques for providing patient-centered education, developing a trusting relationship with patients and caregivers, and establishing processes that focus on oral therapy adherence.
Healthcare providers have likely heard a patient or caregiver say, "No one told me about...." Chances are the issue at hand was addressed, but not at a time or in a way that promoted comprehension. Research has shown that people under stress do not process information the same way, or as effectively as when they are not stressed. The uncertainty and stress associated with a new cancer diagnosis often continues until treatment begins, placing patients at risk for not fully understanding information. It is important to validate this fact and genuinely listen to the patient's story. Meeting patients where they are in the moment is invaluable.
Assessing a patient's learning preference and health literacy can assist nurses in customizing information. Pictures, videos, and infographics are useful when describing the disease process and how a medication works. The teach-back technique assesses comprehension by asking patients to voice their understanding of the information and instructions. Notably, nurses who preface this technique with, "I want to be sure I have explained this in an understandable way," put the responsibility for comprehension on the nurse, not the patient.
Would methods for monitoring adherence be necessary if patients had a person on the healthcare team whom they could confide in and trust? The general population lists nurses as one of the most trusted healthcare professionals. Nurses begin to develop trusting relationships when they acknowledge likely barriers, such as forgetting to take the medications, fitting dosing into a normal routine, and financial concerns. Follow-up phone calls have also been shown to improve patient's self-determination for managing the challenges associated with managing their cancer medications at home.
When barriers to adherence are addressed-initially and in the long term-properly taking oral therapies will become a way of life. Importantly, healthcare providers must not assume that once medication adherence is achieved that it will continue. Over time, a lack of disease symptoms or ongoing medication side effects can lead to a decrease in adherence.
Trusting relationships must be nourished. Developing a timeline for continued follow-up at 3 months, 6 months, yearly, when medication changes, or at the first sign of a problem can promote medication adherence and patient satisfaction with the treatment plan and his or her healthcare team.