Presenters: James Collins, IV, PharmD, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC; Benyam Muluneh, PharmD, BCOP, CPP, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
Co-Authors: Michele A. Muir, PharmD, GSK, Chapel Hill, NC; Matthew Foster, MD, University of North Carolina School of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Daniel Richardson, MD, MSc, MA, University of North Carolina School of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Lola Olajide, MD, University of North Carolina REX Healthcare, Raleigh, NC; Kaitlyn Buhlinger, PharmD, CPP, University of North Carolina Medical Center, Chapel Hill, NC; Rebecca Sawchak, RN, MSN, AGPCNP-C, University of North Carolina Medical Center, Chapel Hill, NC; Ashley Bryant, PhD, RN, OCN, FAAN, University of North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina School of Nursing, Chapel Hill, NC; Stephanie Jean, PharmD, MS, University of North Carolina Medical Center, Chapel Hill, NC; Jeffrey Reichard, PharmD, MS, University of North Carolina Medical Center, Chapel Hill, NC; John Valgus, PharmD, MHA, BCOP, University of North Carolina Medical Center, Chapel Hill, NC; Maurice Alexander, PharmD, BCOP, CPP, University of North Carolina Medical Center, Chapel Hill, NC; Stephanie Duncan, University of North Carolina Medical Center, Chapel Hill, NC; Walter Laundon, PharmD, MS, BCOP, University of North Carolina REX Healthcare, Raleigh, NC; Julia Rodriguez-O'Donnell, LCSW, OSW-C, University of North Carolina Medical Center, Chapel Hill, NC; Brendan Fitzpatrick, MBA, University of North Carolina Medical Center, Chapel Hill, NC; Michael Tilkens, PharmD, DPLA, University of North Carolina Health, Shared Services Pharmacy, Chapel Hill, NC; Mary-Haston Vest, PharmD, MS, BCPS, University of North Carolina Medical Center, Chapel Hill, NC; Rebecca Jones, PharmD, BCOP, CPP, University of North Carolina REX Healthcare, Raleigh, NC
BACKGROUND: Oral anticancer (OAC) agents have transformed cancer care for patients, extending survival and delaying disease progression in certain cases. However, this benefit often requires a medication adherence rate of >90%.1 Innovative models to improve patient knowledge and adherence to OACs exist.2-4 However, these models have had varying success, which is limited by a lack of clear strategies to improve their adoption, implementation, and maintenance. Previously, we identified barriers and facilitators to the implementation and maintenance of a medication adherence intervention for OACs to design evidence-based implementation strategies.
OBJECTIVE: To design pragmatic and stakeholder-informed strategies for the oral medication adherence program’s adoption, implementation, and maintenance.
METHOD: We assembled an advisory panel with clinicians (N = 9), administrators (N = 7), and patients (N = 2) in 2 settings (an academic setting and a community cancer center) to design practical strategies for the adoption, implementation, and maintenance of a structured adherence intervention using a systematic approach called implementation mapping.5 Using focus group discussions and Likert-type surveys, we specified the outcomes and objectives for the intervention, selected implementation strategies, produced implementation protocols and materials, and defined program evaluation outcomes.
RESULTS: Overall, 5 qualitative consensus-based discussions and 3 quantitative surveys were conducted with the advisory panel. In all, 10 performance outcomes and 18 performance objectives were identified. A total of 7 participants completed a survey with moderate-to-high agreement (range, 4-5) on all 28 items. Next, we proposed 21 potential strategies to our advisory panel after a series of focus group discussions; 9 participants completed a survey, which yielded moderate-to-high levels of agreement (range, 3.78-5) for all strategies. After the final 2 focus group discussions, this list was refined to 7 distinct strategies (3 for adoption, 3 for implementation, and 1 for maintenance) as necessary for the success of the adherence program. The final produced strategies included (1) formal program commitment documents, (2) key performance indicators, (3) a slide deck justifying the program to leadership, (4) standard operating procedures outlining roles and responsibilities, (5) a workshop on motivational interviewing and adherence, (6) standardized adherence assessment integrated into the electronic health record, and (7) measurable performance indicators and metrics.
CONCLUSION: Using implementation mapping, the advisory panel identified 7 strategies that are necessary to overcome previously identified barriers to an OAC adherence program. Future research conducting a preimplementation survey with clinicians, administrators, and patients is necessary to identify the acceptability, appropriateness, and feasibility of the developed implementation strategies from this study followed by a pilot implementation study.
- Kong JH, Go T-H, Lee JY, et al. Adherence to tyrosine kinase inhibitor affects overall survival in adult Korean chronic myeloid leukemia patients; based on the National Health Information database. Blood. 2018;132(suppl 1):1745-1745.
- Muluneh B, Schneider M, Faso A, et al. Improved adherence rates and clinical outcomes of an integrated, closed-loop, pharmacist-led oral chemotherapy management program. J Oncol Pract. 2018;14:e324-e334. Epub 2018 May 25.
- Zerillo JA, Goldenberg BA, Kotecha RR, et al. Interventions to improve oral chemotherapy safety and quality: a systematic review. JAMA Oncol. 2018;4:105-117.
- Rosenberg SM, Petrie KJ, Stanton AL, et al. Interventions to enhance adherence to oral antineoplastic agents: a scoping review. J Natl Cancer Inst. 2020;112:443-465.
- Cherrington A, Martin MY, Hayes M, et al. Intervention mapping as a guide for the development of a diabetes peer support intervention in rural Alabama. Prev Chronic Dis. 2012;9:E36.