Monica Schueller

mHealth SMS text messaging interventions and to promote medication adherence: an integrative review

AIMS AND OBJECTIVES This article is an integrative review of the evidence for mobile health Short Message Service text messages as an innovative and emerging intervention to promote medication adherence. Authors completed this review to draw conclusions and implications towards establishing a scientific foundation for use of text messages to promote medication adherence, thus informing clinical practice. BACKGROUND The World Health Organization has identified medication adherence as a priority global problem. Text messages are emerging as an effective means of improving health behaviours and in some diseases to promote medication adherence. However, a gap in the literature indicates lack of evidence in guiding theories and content of text messages, which should be synthesised prior to use in clinical practice. DESIGN Integrative review. METHODS Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBASE, Scopus, the Cochrane Library and PubMed were searched for relevant studies between 2004-2014. Inclusion criteria were (1) implementation of a text-message intervention and (2) medication adherence to a prescribed oral medication as a primary outcome. Articles were assessed for quality of methodology and measures of adherence. An integrative review process was used to perform analysis. RESULTS Thirteen articles meeting the inclusion criteria are included in this review. Nine of 13 studies found adherence rates improved between 15·3-17·8% when using text messages to promote medication adherence. Text messages that were standardised, tailored, one- or two-way and timed either daily to medication regimen, weekly or monthly showed improvement in medication adherence. CONCLUSIONS This review established a scientific basis for text messages as an intervention to improve medication adherence across multiple diseases. Future large rigorous randomised trials are needed to further test text messaging interventions. RELEVANCE TO CLINICAL PRACTICE This review provides clinicians with the state of the science with regard to text messaging interventions that promote medication adherence. A description of intervention components are provided to aid nurses in development of text messages and in translating evidence into practice.

Interventions combining motivational interviewing and cognitive behaviour to promote medication adherence: A literature review

AIMS AND OBJECTIVES This article presents an integrative review of the evidence for combined motivational interviewing and cognitive behavioural interventions that promote medication adherence. We undertook this review to establish a scientific foundation for development of interventions to promote medication adherence and to guide clinical practice. BACKGROUND The World Health Organization has designated medication adherence as a global problem. Motivational interviewing and cognitive behaviour interventions have been found to individually promote medication adherence. However, there is a gap in the literature on the effect of combined motivational interviewing and cognitive behavioural approaches to promote medication adherence. DESIGN Integrative review. METHODS COCHRANE, PubMed and CINAHL were searched to access relevant studies between 2004-2014. Inclusion criteria were interventions combining motivational interviewing and cognitive behavioural therapy with medication adherence as the outcome. Articles were assessed for measures of adherence and methodological rigour. Analysis was performed using an integrative review process. RESULTS Six articles met the inclusion criteria. A randomised controlled trial reported pretreatment missed doses of 5·58 and post-treatment of 0·92 and trended towards significance. Four cohort studies had effect sizes of 0·19-0·35 (p < 0·05). A case study had a pretreatment adherence rate of 25% and post-treatment 77% (p < 0·01). CONCLUSIONS Although there were a limited number of studies on combined motivational interviewing and cognitive behavioural interventions, five out of six were effective at improving medication adherence. Future studies with large rigorous randomised trials are needed. RELEVANCE TO CLINICAL PRACTICE This review provides clinicians with the state of the science in relation to combined motivational interviewing and cognitive behavioural therapy interventions that promote medication adherence. A summary of intervention components and talking points are provided to aid nurses in informing decision-making and translating evidence into practice.

Feasibility of a Text Messaging Intervention to Promote Self-Management for Patients Prescribed Oral Anticancer Agents

PURPOSE/OBJECTIVES To determine proof of concept of a mobile health (mHealth) intervention delivering text messages (texts) to self-manage among patients prescribed oral anticancer agents (OAs) and to examine preliminary efficacy on symptoms and medication adherence. DESIGN A longitudinal randomized, controlled trial. SETTING Two community cancer centers in the midwestern United States and a national specialty pharmacy. SAMPLE 80 adults with cancer who were newly prescribed OAs
. METHODS Adherence and symptoms were assessed weekly for 10 weeks in both groups. The intervention group received daily texts for adherence and weekly for symptoms for 21-28 days, and satisfaction with the intervention was assessed
. MAIN RESEARCH VARIABLES Medication adherence and symptom severity. FINDINGS Mean age was 58.5 years (SD = 10.7 years), 48 participants were female, and 48 were Caucasian. Fewer symptoms were found in the intervention group with a moderate effect size. Adherence was higher in the text group using medical record and prescription data (n = 26) with greater relative dose intensity of moderate to large effect size. Regarding acceptability, 57% (83 of 145) of eligible participants consented, 39 of 40 participants completed the entire intervention, 30 participants read texts all of the time, and 34 participants were satisfied with the intervention.
 CONCLUSIONS Proof of concept and preliminary efficacy of an mHealth intervention using texts to promote self-management for patients prescribed OAs was demonstrated. Patients had high satisfaction with the texts, and adherence and symptoms improved after the intervention. IMPLICATIONS FOR NURSING Texts show promise for patients with cancer who must manage their OAs. Additional research is needed prior to use in practice.

Treatment With Oral Anticancer Agents: Symptom Severity and Attribution, and Interference With Comorbidity Management

PURPOSE/OBJECTIVES To evaluate the prevalence, severity, and attribution of symptoms, as well as the interference with management of comorbidities, in patients who have been prescribed oral anticancer agents (OAs). DESIGN Descriptive exploratory study. SETTING A comprehensive cancer center and two community-based oncology programs in the midwestern United States. SAMPLE 30 adults undergoing OA treatment. METHODS Five phone interviews were conducted during eight weeks. Linear mixed effects and generalized estimating equations were used to examine symptoms and interference over time. MAIN RESEARCH VARIABLES Symptoms and comorbid conditions. FINDINGS The mean age of participants was 65.1 years. Fifteen participants were female, 25 were Caucasian, and 23 had comorbidities. Twenty-one patients had late-stage cancer, and rates of adherence were 90%. Fatigue, sleep disturbance, and numbness or tingling in hands and feet were highly prevalent symptoms. Younger age was associated with higher symptom severity (p < 0.01) and interference (p = 0.01). Patients with more comorbidities tended to report higher symptom severity. Simultaneous IV chemotherapy was not a predictor of symptom severity or interference over age and comorbidity. Symptoms were most frequently attributed to cancer and its treatment. Patients with a greater number of comorbidities were more likely to include comorbidities in symptom attribution and reported interference from the OA with managing comorbid conditions. CONCLUSIONS Symptoms may be more severe in patients prescribed OAs who are younger and have comorbid conditions. More comorbidities and absence of simultaneous IV chemotherapy increased the likelihood of inclusion of chronic conditions in symptom attribution. Patients reported that OA treatment interfered with comorbidity management. IMPLICATIONS FOR NURSING Nurses need to take comorbidities into account when caring for patients prescribed OAs because the chronic conditions may influence symptom severity and the ability to manage symptoms.

A randomized controlled trial of the feasibility and preliminary efficacy of a texting intervention on medication adherence in adults prescribed oral anti-cancer agents: study protocol

AIM The aim of this study was to report a study protocol that examines feasibility, preliminary efficacy and satisfaction of a text message intervention on the outcome of medication adherence in adult patients prescribed oral anti-cancer agents. BACKGROUND Administration of oral anti-cancer agents occurs in the home setting, requiring patients to self-manage the regimen as prescribed. However, many barriers to medication adherence exist: regimens are often complex, with cycling of two or more medications; side effects of treatment; most cancer patients are older with comorbid conditions and competing demands; and cognitive decline and forgetfulness may occur. Research indicates patients miss nearly one-third of the prescribed oral anti-cancer agent dosages. Text message interventions have been shown to improve medication adherence in chronic conditions other than cancer. However, a majority of those patients were less than 50 years of age and most cancer patients are diagnosed later in life. DESIGN A two-group randomized controlled trial with repeated measures. METHODS Seventy-five adult patients newly prescribed an oral anti-cancer agent will be recruited (project funded in April 2013) from community cancer centres and a specialty pharmacy. Participants will be randomized to either a control group (n = 25; usual care) or an intervention group (n = 50; usual care plus text messages timed to medication regimen). Outcome measures include: medication adherence, feasibility and satisfaction with the intervention. Data will be collected over 8 weeks: baseline, weekly and exit. DISCUSSION Standardized text message intervention protocol and detailed study procedures have been developed in this study to improve medication adherence.

A Trial Examining an Advanced Practice Nurse Intervention to Promote Medication Adherence and Symptom Management in Adult Cancer Patients Prescribed Oral Anti-Cancer Agents: Study Protocol

AIM To report a study protocol that refines then examines feasibility, preliminary efficacy and satisfaction of ADHERE, an intervention using motivational interviewing and brief cognitive behaviorial therapy as a mechanism for goal-oriented systematic patient education to promote symptom management and adherence among cancer patients prescribed oral anti-cancer agents. BACKGROUND Cancer treatment with oral anti-cancer agents shifts responsibility for managing treatment from clinicians in supervised cancer centres to patients and their caregivers. Thus, a need exists to standardize start-of-care to support patient self-management of care at home. DESIGN A two-phase quasi-experimental sequential design with repeated measures. METHODS Sixty-five adult patients newly prescribed an oral anti-cancer agent will be recruited from three community cancer centres. Phase 1 will enrol five patients to refine the ADHERE intervention prior to testing. After completion, Phase 2 will enrol 30 patients who receive usual care. Advanced practice nurses will then be trained. Thirty patients will be then enrolled in the intervention group and provided ADHERE, a 4-week intervention using semi-structured interactions (initial face-to-face session and once a week phone sessions over 3 weeks) and a Toolkit to promote self-management of care. Outcome measures include: oral anti-cancer agents adherence rate, symptom presence and severity, feasibility and satisfaction with ADHERE. This protocol was approved January 2014. DISCUSSION This nurse-led intervention has the potential to standardize the start-of-care training for the patients to self-manage when oral anti-cancer agents for treatment were prescribed.

A Health Belief Messaging Framework and a Randomized Controlled Trial of an SMS-Based Intervention for Cancer Patient Outcomes

Cancer is on the rise, and the effectiveness of oral anticancer agent (OA) treatment depends heavily on adherence to the prescribed regimen. Adherence, however, is a significant problem with 42% of patients missing OA doses due to poor memory recall, lack of knowledge, incompatible beliefs, and depressive symptoms. Short Message Service (SMS) messaging may provide a feasible, low-cost approach to promote adherence and lead to improved patient outcomes when compared to other strategies that have had disappointing results. Through our Health Belief Messaging Framework, we propose that SMS message development may be informed by adherence antecedents, namely Perceived Benefits, Perceived Barriers, and Cues to Action. Through a 2-group, 80-patient, randomized controlled trial of a tailored, daily SMS intervention for 21 days, an improved adherence trend, and a statistically significant effect on the number of symptoms and physical function was observed, patient satisfaction with the SMS messaging was also reported.

Oral Anticancer Agents: An Intervention to Promote Medication Adherence and Symptom Management

&NA; Symptom burden and poor adherence to oral anticancer agents remain significant clinical problems. This study examined feasibility, preliminary efficacy, and satisfaction with ADHERE, a nurse practitioner intervention that promotes symptom management and adherence among patients prescribed oral agents. The intervention group (which received one semistructured, face‐to‐face session followed by three weekly telephone sessions using motivational interviewing, brief cognitive‐behavioral therapy, and a toolkit to promote self‐management) had significantly lower symptom severity postintervention. Self‐reported adherence was high and did not differ by group. Patients reported being highly satisfied with the ADHERE intervention. AT A GLANCENo known standard of care exists for patients newly prescribed oral anticancer agents.Many patients with cancer treated with oral anticancer agents have difficulty managing side effects of treatment, which may lead to difficulty with adherence to the medication regimen, or adverse events.The intervention improved symptom severity compared to the control group.

FEASIBILITY OF TEXT MESSAGING TO IMPROVE ORAL ANTI-CANCER ADHERENCE IN OLDER CANCER PATIENTS

BACKGROUND More than 50 oral chemotherapy agents in pill form are on the market, with projections that in 3 years, 25% of cancer treatment will be in pill form. For oral agents to achieve a therapeutically effective level for cancer treatment, patients must strictly adhere to the regimen. However, adherence is often less than 80%, which may be inadequate for treating the cancer. There are more than 285 million wireless subscribers in the US with an estimated 67.5% of adults owning cell phones and 98% of those phones having text messaging capability. A recent review of 12 trials on interventions for disease prevention or management found that text messaging improved health behaviors. PURPOSE There are multiple mobile applications and smart phone products to prompt medication adherence, however, few have examined if these prompts improve medication adherence. Adherence is critical among cancer patients who are older and less likely to text message. The cancer medications can be costly, as much as

Proof of Concept of a Mobile Health Short Message Service Text Message Intervention That Promotes Adherence to Oral Anticancer Agent Medications: A Randomized Controlled Trial

800 per pill, and only effective if taken as prescribed. Adherence is complicated by complexity of the dosing and the duration of the prescriptions. Therefore, the purpose of this study is to test the feasibility, usability, and satisfaction with text messages to improve symptoms from side effects of treatment and adherence to oral chemotherapy agents. METHODS A 10-week, 2-group, prospective trial will enroll 76 patients from cancer centers to examine a 3week text message intervention to promote oral agent adherence and management of symptoms from side effects of treatment. Descriptive statistics, generalized linear modeling, and generalized estimating equations will be used for analysis.