Maggi Banning

A review of interventions used to improve adherence to medication in older people

BACKGROUND Medication mismanagement is a continuous problem particularly in older people. Numerous interventions have been developed and tested in an attempt to improve adherence with medication in this client group. OBJECTIVES This review aimed to examine the simple to complex interventions that have been used to assess and improve adherence with medication in older people. DESIGN An extensive review of the literature was performed and 20 relevant research papers and one report were chosen. FINDINGS Research papers were evaluated according to design, RCTs were analysed using the JADAD scoring system, systematic reviews and reviews of the literature were reviewed using the Critical Appraisal Skills Programme and subjected to a narrative analysis. This process assisted the development to emerging themes. Four themes were developed: patient barriers, health professional involvement, and health related outcomes and formation giving. CONCLUSIONS The salient findings of the review infer that there is no clear definition of non-adherent behaviour. Quantitative interventions fail to assess patient choice in relation to medication taking. Pharmacist-driven interventions are resource intensive. Health care outcomes and clinical effectiveness are seldom addressed in interventions. Among the many difficulties encountered when attempting to use interventions to promote adherence with medication in older people is their perceptions and beliefs, the appropriateness of the medicines prescribed as well as the impact of lifestyle patterns: smoking, alcohol and diet. Many intervention studies are of poor quality and do not include a theoretical framework to underpin the interventions being used. More focused research is needed to improve understanding of the theoretical knowledge that underpins the complexities of adherence with medication in older people. In-depth qualitative studies can be used to develop such theory. In addition, the quality of intervention research can be improved by the inclusion of a research framework such as the Medical Research Council model.

Older people and adherence with medication: A review of the literature

BACKGROUND Older people represent a sizeable population of the UK. Many older people receive drug treatment for long-term conditions. Adherence with medication is therefore an important clinical, financial and resource intensive concern. OBJECTIVES This review aimed to examine patients beliefs, perceptions and views in relation to adherence with medication. DESIGN A comprehensive search of the literature was undertaken using numerous approaches. The search of revealed 30 research papers. FINDINGS Articles were initially evaluated using Critical Appraisal Skills Programme principles to identify those relevant to the review. Relevant studies were then subjected to a narrative analysis to assist the development of relevant themes. Four themes were identified; experience of adherence; perceptions and attitudes to medication adherence and non-adherence; patients acceptance of their illness and impact on medication taking behaviour and shared decision making. CONCLUSIONS The findings of this review imply that there is a need for more emphasis on shared decision making between the older patient and the prescriber. Using this approach, adherence with medication may improve. There is also a need to develop a standardized measure of medication adherence.

Employment and breast cancer: A meta-ethnography

The purpose of this synthesis is to examine the qualitative evidence on the lived experience of breast cancer survivors in relation to return to work. An in-depth search of the literature was undertaken from 1999 until July 2010. Ten relevant papers emerged that reflected the aims of the synthesis. A meta-ethnographic approach was used to synthesise papers. Four concepts emerged that reflected the return to work, these included influencing factors, sickness absence, work ability and work-related problems and experiences of return to work. Further synthesis of concepts led to the development of four final interpretations. These included breast cancer and employment, treatment-induced physical impairment, employer comprehension of breast cancer and fear of work-related failure. These interpretations indicate that employers need to be educated on the work capabilities of cancer survivors post treatment. Improved support facilities are needed for cancer survivors which are supported by European employment legislation and guidance offered by company occupational health departments. Moreover, health care professionals could become more involved in the education of breast cancer patients with regard to the timing of returning to work.BANNING M. (2011) European Journal of Cancer Care20, 708–719 Employment and breast cancer: a meta-ethnography The purpose of this synthesis is to examine the qualitative evidence on the lived experience of breast cancer survivors in relation to return to work. An in-depth search of the literature was undertaken from 1999 until July 2010. Ten relevant papers emerged that reflected the aims of the synthesis. A meta-ethnographic approach was used to synthesise papers. Four concepts emerged that reflected the return to work, these included influencing factors, sickness absence, work ability and work-related problems and experiences of return to work. Further synthesis of concepts led to the development of four final interpretations. These included breast cancer and employment, treatment-induced physical impairment, employer comprehension of breast cancer and fear of work-related failure. These interpretations indicate that employers need to be educated on the work capabilities of cancer survivors post treatment. Improved support facilities are needed for cancer survivors which are supported by European employment legislation and guidance offered by company occupational health departments. Moreover, health care professionals could become more involved in the education of breast cancer patients with regard to the timing of returning to work.

The impact of culture and sociological and psychological issues on Muslim patients with breast cancer in Pakistan.

Breast cancer is the most common form of cancer in Muslim women in Pakistan. The impact of the initial diagnosis, culture, religion, and psychosocial and psychological aspects of the disease is not well established. This qualitative study examined the experience and coping strategies used by patients with breast cancer in relation to its impact on their physical, mental health, religious, and family issues. Thirty patients with breast cancer were interviewed. Data were analyzed using thematic analysis. The patients experience of breast cancer focused on the range of emotions felt throughout the illness trajectory, the importance of religion and family support on coping strategies used to manage the adverse effects of chemotherapy, and also the financial concerns. This is the first study to examine Pakistani Muslim womens views on the lived experience of breast cancer. This article provides clarification of the voiced experiences of women with breast cancer. The data not only highlight the role of religion and family support as essential coping strategies but also emphasize the issues of isolation, aggression, and anger as common responses to chemotherapy. Unique features of this study are womens need to seek spiritual support for their illness and the overriding innate characteristic of maternal responsibility. These cultural features require further analysis and research.

Topical diclofenac: clinical effectiveness and current uses in osteoarthritis of the knee and soft tissue injuries

Background: Diclofenac is a commonly used non-steroidal anti-inflammatory drug (NSAID) for symptom control in osteoarthritis (OA) of the knee and soft tissue injuries. Although treatment with oral diclofenac is associated with serious adverse effects involving both the gastrointestinal and renal systems, these adverse effects are thought to be limited with topical diclofenac formulations without loss of efficacy. Objective: The aim of this review is to explore the available evidence in relation to the pharmacokinetics, efficacy and reported adverse effects of the topical diclofenac formulations available. Results/conclusions: In the majority of studies examined, topical diclofenac formulations with sodium lotion, lecithin or epolamine gel, patch or plaster were either superior or equivalent to oral diclofenac formulations or placebo. Topical diclofenac significantly reduced pain and morning stiffness and improved physical function and patient global assessment without major adverse effects reported in patients with OA of the knee; and provided significant pain relief in patients with sports and soft tissue injuries involving the ankle, knee or shoulder. In the majority of studies, the predominant adverse effect involved pruritus or rash at the site of application, or nausea. The principle outcome of these studies is that topical diclofenac is a safe and practical alternative as a method of treatment in OA of the knee or as an alternative treatment for sports and soft tissue injury.

Black women and breast health: A review of the literature

AIM In the UK, it is known that screening inequalities exist involving ethnic minority groups such as Black women (Patnick, 2009). To date, there is limited UK data on Black British women and breast health awareness. Black British women appear to be an underrepresented group in breast cancer studies (Breast Cancer Care, 2004, 2005). This literature review aimed to explore Black womens perceptions of breast health and factors that influence breast cancer screening practices. METHODS A literature search for the period 1994 to September 2009 was undertaken using BNI, CINAHL, PubMed, OSH-ROM, PsyInfo, Google scholar, and Scopus databases. Key words used included: breast cancer, breast health, African American women, Black British women, black women, breast cancer screening, qualitative studies. Hand-searching was also done, and reference lists of papers were examined for relevant studies. RESULTS Black women hold a variety of views and perceptions on the risk that breast cancer poses. These perceptions are strongly related to existing knowledge, related stigmatization, spiritual and religious beliefs, all of which can adversely influence motivation to engage in self-breast examination and breast cancer screening. CONCLUSION US based studies identified several influential factors: religion, educational awareness of breast cancer screening, breast health awareness. Breast health interventions and research are needed to increase breast health awareness in Black British women.

Cultural interrelationships and the lived experience of Pakistani breast cancer patients.

AIM There is a paucity of British and international literature on the psychological, sociological and cultural correlates of breast health in ethnic minority women. METHODS This two centre qualitative study was part of a larger study that aimed to examine the influence of culture on the lived experience of Pakistani Muslim breast cancer patients. Thirty six patients attending hospital out-patient breast cancer clinics in Lahore, Pakistan and London, UK were recruited to the study. Women were predominantly married, 20-76 years of age with an average of three children. Semi-structured interviews were undertaken. Interview data were analysed using thematic analysis. RESULTS Five themes emerged: Discovery and reaction to the disease; disclosure to family; developing emotions; emerging reality; long term uncertainty. CONCLUSIONS Data infer that irrespective of city of residence, the cultural attributes of women, breast health awareness and reactions to the diagnosis and treatment are similar. To raise awareness, more focused health education interventions are needed.

Living with advanced breast cancer: perceptions of Pakistani women on life expectations and fears.

Background: Pakistan has the highest rate of breast cancer in Asia. Many women delay seeking heath advice and treatment for breast cancer, and between 50% and 70% of women will present when the disease in is in an advanced, aggressive form, particularly young women. The psychological impact of breast cancer is challenged by the negative public perception of cancer. Objectives: This qualitative study explored the psychological impact of advanced breast cancer in women receiving follow-up care in an oncology hospital in Pakistan. Methods: This qualitative study used semistructured interviews to explore women’s experiences of living with advanced breast cancer and the impact that this had on their lives as women, mothers, and wives. Twenty-one women were interviewed. Data were analyzed using thematic analysis. Results: The majority of 21 women interviewed were diagnosed between 1 and 11 years, and 15 women had a history of metastases. Four themes emerged from the data. These were reaction to the diagnosis, change in outlook, living life positively, and motivating factors. Conclusion: Women acknowledged the significance of their illness on their health and longevity. Their individual cancer journey was multilayered and imbued with the hope of cure, remission, and an emotional catalog of feelings. All married women wished for sufficient time to visualize their children reach adulthood and marry. Single women wished to care for their mothers and families. Implications for Practice: Through education and support, nurses can provide women with advanced breast cancer and their families educational, spiritual, and psychological care.

Managing the illness experience of women with advanced breast cancer: hopes and fears of cancer-related insecurity

The cultural significance of a diagnosis of advanced breast cancer is important in Pakistan particularly due to the high incidence in women, limited breast cancer screening, healthcare resources and cancer educational programmes in Pakistan. The psychological impact of breast cancer is therefore an important concern for women. This qualitative study explored the psychological impact of advanced breast cancer in Pakistani women. Twenty-one women with advanced breast cancer were interviewed. Women acknowledged feelings related to the insecurity of health, resistance to cancer, the impact of their illness on their physical and emotional well-being and marital relationships and emotions related to cultural discrimination. The majority of women had metastatic spread to bone, liver or lungs. More effort is needed to educate women on the aetiology of cancer, breast self-examination and mammographic screening to ensure that all Pakistanis are educated that cancer is not a communicable disease or one that is transmitted by personal contact.

Perceptions of breast health awareness in Black British women

PURPOSE Breast cancer is a global concern. Published studies indicate that 43% of Black and ethnic minority women interviewed have reported that they did not practice breast awareness because they did not know the relevant breast changes that occur in breast cancer. Black women are also more likely to receive a diagnosis of breast cancer when it is in an advanced stage. This pilot study aimed to address the views of Black British women on breast health awareness and breast health screening practices. METHODS AND SAMPLE In this qualitative study I used semi-structured interviews were used to investigate breast health perceptions, practices and education in a pilot sample of ten women. KEY RESULTS Women held numerous perceptions of breast cancer which ranged from no knowledge to well informed through receiving extensive education. Two out of ten women were relatively uneducated with regard to breast self examination (BSE). The remaining eight women participated in a variety of screening routines which varied from undertaking BSE everyday to once every few months. Womens experience of breast health education was also variable. One woman, younger woman, had not received any health education advice in relation to breast health awareness or BSE. The remaining nine women had received some health advice following visit to their General Practitioners, Medical consultant, media information or as a result of participating in mammographic screening. CONCLUSIONS Black British women require health education that focuses on breast cancer and its associated risk factors, technique of BSE, and national breast cancer screening recommendations.