Oral Medication Adherence Among Adolescents and Young Adults with Cancer Before and Following Use of a Smartphone-Based Medication Reminder App

Abstract

This study evaluated oral medication adherence among adolescents and young adults (AYAs) with cancer during a trial of a smartphone-based medication reminder application (app). Methods: Twenty-three AYAs receiving at least one prescribed, scheduled oral medication related to their outpatient cancer treatment participated in this 12-week single-group interrupted time series longitudinal design study. Baseline oral medication adherence was monitored using electronic monitoring caps for 4 weeks. Participants then used a medication reminder app and continued to have their oral medication adherence monitored for 8 weeks. Participants completed an electronically administered weekly survey addressing perceived adherence and reasons for nonadherence. Results: Four adherence phenotypes were identified using visual graphical analysis of individual participants' weekly adherence: (1) high adherence during the preintervention and intervention periods (n = 13), (2) low preintervention adherence and improved adherence during the intervention period (n = 3), (3) low adherence during both periods (n = 6), and (4) high preintervention adherence and low adherence during the intervention period (n = 1). Growth curve models did not show significant changes in adherence by preintervention versus intervention trajectories (p > 0.05); however, the variance in adherence during the intervention narrowed for more highly adherent AYAs. ''Forgetfulness'' was the most frequently reported reason for nonadherence. Conclusion: Although overall adherence did not improve following use of the app, the variance decreased for more highly adherent participants. Additional or alternative interventions are needed for AYAs with persistently poor adherence. Assessment of adherence patterns may support individualized recommendation of tailored interventions.

Promoting adherence in adolescents and young adults with cancer to optimize outcomes: A developmentally oriented narrative review

“…Applying this framework, we then reviewed evidence‐based adherence‐enhancing strategies (AESs) targeted toward key dimensions of adherence among AYAs (Table ). It should be noted that only two intervention studies targeting adherence exclusively among AYAs with cancer were identified . Given the limited literature examining strategies to enhance adherence among AYAs with cancer, this review also draws from evidence for AESs in AYAs with other chronic conditions with similar treatment demands to cancer.…”

“…Finally, “forgetting” to take medications is a frequently cited barrier to adherence among the AYA population . Adolescents are neurodevelopmentally less future oriented than adults and have a different approach to managing and prioritizing competing demands .…”

“…Interventions that address simple forgetfulness include reminder systems such as adherence aids, mnemonic devices, alarms, medication scorecards, text message reminders, preloaded medication cases, and organizational skills training. 15 However, a recent study of a medication‐reminder smartphone application did not demonstrate an effect on pharmacoadherence among AYAs with cancer, with study authors suggesting that the design and content of such reminder systems need to be better tailored to individual users.…”

“…Finally, "forgetting" to take medications is a frequently cited barrier to adherence among the AYA population. 4,14,38,54,63,80,91,92 Adolescents are neurodevelopmentally less future oriented than adults and have a different approach to managing and prioritizing competing demands. 79 Poorer capacity to anticipate future events has been associated with decreased adherence among AYAs with cancer.…”

Clinical Application of Digital Technologies in Adolescent and Young Adult Oncology Supportive Care

“…19 Oral medication nonadherence in the AYA population ranges between 27% and 60% and has been attributed to forgetfulness, a state of significant transition, and changing insurance status. 20,21 A pilot study done with 23 AYA patients using a smartphone application to improve adherence to oral medications found that >50% of patients took their medications with the reminders. 21 A recent study evaluated an application called ''Pain Squad''-a mobile health application that ''gamified'' pain assessment and management in the AYA population.…”