Barriers and Facilitators of Using Sensored Medication Adherence Devices in a Diverse Sample of Patients With Multiple Myeloma: Qualitative Study

Abstract

BackgroundMany recently approved medications to manage multiple myeloma (MM) are oral, require supportive medications to prevent adverse effects, and are taken under complex schedules. Medication adherence is a concern; however, little attention has been directed toward understanding adherence in MM or associated barriers and facilitators. Advanced sensored medication devices (SMDs) offer opportunities to intervene; however, acceptability among patients with MM, particularly African American patients, is untested.ObjectiveThis study aimed to explore patients’ (1) perceptions of their health before MM including experiences with chronic medications, (2) perceptions of adherence barriers and facilitators, and (3) attitudes toward using SMDs.MethodsAn in-person, semistructured, qualitative interview was conducted with a convenience sample of patients being treated for MM. Patients were recruited from within an urban, minority-serving, academic medical center that had an established cancer center. A standardized interview guide included questions targeting medication use, attitudes, adherence, barriers, and facilitators. Demographics included the use of cell phone technology. Patients were shown 2 different pill bottles with sensor technology—Medication Event Monitoring System and the SMRxT bottle. After receiving information on the transmission ability of the bottles, patients were asked to discuss their reactions and concerns with the idea of using such a device. Medical records were reviewed to capture information on medication and diagnoses. The interviews were audio-recorded and transcribed. Interviews were independently coded by 2 members of the team with a third member providing guidance.ResultsA total of 20 patients with a mean age of 56 years (median=59 years; range=29-71 years) participated in this study and 80% (16/20) were African American. In addition, 18 (90%, 18/20) owned a smartphone and 85% (17/20) were comfortable using the internet, text messaging, and cell phone apps. The average number of medications reported per patient was 13 medications (median=10; range=3-24). Moreover, 14 (70%, 14/20) patients reported missed doses for a range of reasons such as fatigue, feeling ill, a busy schedule, forgetting, or side effects. Interest in using an SMD ranged from great interest to complete lack of interest. Examples of concerns related to the SMDs included privacy issues, potential added cost, and the size of the bottle (ie, too large). Despite the concerns, 60% (12/20) of the patients expressed interest in trying a bottle in the future.ConclusionsResults identified numerous patient-reported barriers and facilitators to missed doses of oral anticancer therapy. Many appear to be potentially mutable if uncovered and addressed. SMDs may allow for capture of these data. Although patients expressed concerns with SMDs, most remained willing to use one. A feasibility trial with SMDs is planned.

Patient, Caregiver, and Clinician Experience with a Technologically Enabled Pillbox: A Qualitative Study

“…Our study's focus on implementation of technologically enabled pillboxes at the time of hospital discharge adds to existing qualitative studies in the ambulatory setting. 19,22,[27][28][29][30][31][32][33][34][35][36] These studies have examined the use of a smart pillbox in a variety of geographic locations (e.g., U.S. academic medical centers, clinics in sub-Saharan Africa, urban clinics in India) for a variety of conditions. Similar to what we found in our study, these studies also identified technology and tools as a prominent barrier to implementation.…”

“…Patients identified issues with device connectivity 19,31 and with alarms being either inappropriate or obtrusive. 27,35,37 Other qualitative studies also highlight patient-reported issues with device portability during commuting or travel. 22,27,30,32,33,35,36 Our study adds barriers not previously noted in the literature, including patient concerns regarding medication complexity and having multiple medications in the pillbox wells given multiple medical conditions, different from other studies that were largely disease specific.…”

“…[12][13][14] Several studies to date have touted the success of such interventions in reducing medication discrepancies and, in some cases, improving chronic disease control in the ambulatory setting for a wide range of conditions such as hypertension, 15,16 diabetes, 15,17 human immunodeficiency virus (HIV), 12,[18][19][20][21][22][23][24] tuberculosis (TB), 18,25 multiple myeloma, 26 and post-kidney transplantation. 15 Additionally, and importantly given the novelty of smart pillbox devices, several studies have also explored user perspectives of this technology, the majority of which have focused on patient 19,22,[27][28][29][30][31][32][33][34][35][36] rather than clinician 32,35,37 perspectives.…”

Multiple Myeloma in People of Working Age: A Systematic Review and Evidence Synthesis of Experiences of Paid and Unpaid Work

“…Tose accessing treatment without copays, deductions, or employer insurance experienced fewer ramifcations with their employment and income. Employers providing health insurance were able to exert power and infuence over health, which can both reassure (fnancial peace of mind) and cause stress (being unable to change employer for loss of benefts) [58,71]. Financial impact is also a concern for people reducing their hours or exiting paid employment [49] including relatives providing informal care [52].…”

Utilização de medicamentos que induzem osteoporose ou fratura em idosos com mieloma múltiplo: estudo transversal

“…In this sense, using this therapeutic class in patients with MM deserves attention due to the bone alterations associated with pathophysiology of the disease 1 . MM is prevalent in older adults, who frequently make use of multiple medications to treat chronic non-communicable diseases 1,10 . Polypharmacy in patients with MM is relevant due to the need to also use medications from different therapeutic classes for supportive therapy to the antineoplastic treatment 1,3,4,5 . Injuries related to bone disease can exert an impact on reducing quality of life, increasing health costs, decreasing functional independence, predisposing older adults to the risk of pathological fractures, disabilities, spinal cord compression, severe bone pain and the need for surgical interventions, posing threats to patient safety and well-being 5,11,12 .…”