Psychosocial determinants of adherence with oral anticancer treatment: ‘we don’t need no education’

Abstract

Introduction: Given the potentially fatal consequences of inadequate adherence with oral anticancer treatment in persons with cancer, understanding the determinants of adherence is vital. This paper aims at identifying psychosocial determinants of adherence to oral anticancer treatment. Methods: We reviewed the literature on psychosocial determinants of adherence with oral anticancer treatment, based on published literature in English, from 2015 to present. Literature searches were performed in PubMed, Embase, Web of Science, Cochrane library, Emcare, and PsychINFO, with 'cancer', 'medication adherence', 'psychology', and 'oral anticancer treatment' as search terms. The obtained 608 papers were screened by two independent reviewers. Results: In the 25 studies identified, illness perceptions, medication beliefs, health beliefs, and depression were found to be the major psychosocial determinants of adherence to oral anticancer treatment; sociodemographic and clinical characteristics were found to be of no major importance. The quality of the identified studies as assessed by two independent reviewers was found to be acceptable overall. The majority of papers were from North America and focused on patients with breast cancer; sample size varied from 13 to 1371; adherence was assessed with questionnaires derived from various theoretical models, pill counts and electronic pharmacy records; illness perceptions reflecting adaptive coping, and medication beliefs reflecting high necessity and low concerns were found to be associated with adherence. Conclusion: Psychosocial concepts are major determinants of adherence with oral anticancer treatment. 'Beliefs about medicines' and 'illness perceptions' in particular determine adherence with this treatment. Studies aiming at impacting adherence would benefit from interventions with a solid basis in behavioral theory in order to help health care providers explore and address illness perceptions and medication beliefs. Pre-consultation screening of adherence behavior may be a helpful supportive approach to improve adherence. Blaming the victim ('patients should be educated about the importance of adherence') is better replaced by encouraging health professionals to identify and address maladaptive psychosocial determinants of adherence.

The Impact of the Coronavirus Disease 2019 Pandemic on Adherence to Ocular Hypotensive Medication in Patients with Primary Open-Angle Glaucoma

“…We assessed the association between demographic, clinical, and psychosocial factors and adherence in the periods preceding and following the onset of the pandemic. Psychosocial factors included resilience, 10 coping styles, 11 illness perception 12 and self-efficacy, 13 which have been associated with adherence and visual function.…”

Self‐reported cognitive impairments and quality of life in patients with gastrointestinal stromal tumor: Results of a multinational survey

“…However, medical record review of medication dosing may not equate to actual patient dosing because of medication adherence problems. 58 Third, our sample had a generally high level of education (59% reported college and postgraduate education). Thus, our results may be limited in generalizability to individuals with less formal education.…”

“…Second, the lack of medical record review as well as not taking into consideration any past or present neurologic history or medications that could affect self‐reported cognitive symptoms is a limitation. However, medical record review of medication dosing may not equate to actual patient dosing because of medication adherence problems 58 . Third, our sample had a generally high level of education (59% reported college and postgraduate education).…”

Torn between two lovers – on being a psychologist in a university medical centre

“…Robinson et al ( 2018 ), for example, reported that adherence to adjuvant endocrine therapy in women with breast cancer, a very important intervention method to reduce morbidity and mortality after a breast cancer diagnosis, diminished quite dramatically after a few years, implying the need to develop interventions that help increase this adherence. Systematic reviews and meta-analyses abundantly show that ‘providing information on the necessity to be adherent’ are almost completely missing their target in this population (Kaptein et al, 2021 ). Nevertheless, the mantra in almost all studies in this area is, ‘this study offers support for the need to develop interventions such as reminder letters or telephone calls to enhance persistence rates, especially when patients reach the later years of adjuvant endocrine therapy’ (Robinson et al, p. e14).…”

“…See also the study by Jansen et al ( 2013 ) where illness perceptions and treatment beliefs of people on hemodialysis were challenged and changed and brought in alignment with current nephrological expertise) . In an attempt to mock this view, the subtitle, ‘We don’t need no education’ was added to a paper on adherence to targeted therapy ( Figure 3 ; Kaptein et al, 2021 ). The Editor of the journal deserves praise for her decision to leave that subtitle untouched.…”