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Lack of congruence between patients' and health professionals' perspectives of adherence to imatinib therapy in treatment of chronic myeloid leukemia: A qualitative study

Published online by Cambridge University Press:  13 February 2014

Simon Wu ,
Desmond Chee ,
Anna Ugalde ,
Phyllis Butow ,
John Seymour  and
Penelope Schofield
Simon Wu
Affiliation:
Department of Cancer Experiences Research, Peter MacCallum Cancer Center, East Melbourne, Victoria, Australia Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
Desmond Chee
Affiliation:
Department of Cancer Experiences Research, Peter MacCallum Cancer Center, East Melbourne, Victoria, Australia Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
Anna Ugalde
Affiliation:
Department of Cancer Experiences Research, Peter MacCallum Cancer Center, East Melbourne, Victoria, Australia Center for Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
Phyllis Butow
Affiliation:
Department of Psychology, The University of Sydney, Sydney, New South Wales, Australia
John Seymour
Affiliation:
Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia Department of Hematology, Peter MacCallum Cancer Center, East Melbourne, Victoria, Australia
Penelope Schofield*
Affiliation:
Department of Cancer Experiences Research, Peter MacCallum Cancer Center, East Melbourne, Victoria, Australia Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
*
Address correspondence and reprint requests to: Penelope Schofield, Peter MacCallum Cancer Center, Locked Bag 1, A'Beckett Street, Victoria, 8006, Australia. E-mail: penelope.schofield@petermac.org.
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Abstract

Objective:

Consistent use of imatinib is critical for treatment success in chronic myeloid leukemia, yet perfect adherence to the prescribed clinical regimen is reported to be as low as 14%. This study aimed to understand patients' experiences of chronic myeloid leukemia with a qualitative approach, including identified facilitators and barriers to adherence, drawing on patients' and health professionals' perspectives, recording comments made by patients and health professionals involved with the same treatment team.

Method:

We recruited patients with chronic myeloid leukemia prescribed imatinib therapy and health professionals involved in their treatment from a specialized cancer center. Semi-structured qualitative interviews were recorded, transcribed, and manually analyzed using interpretive phenomenological analysis. Recruitment ceased upon saturation, with 16 patients and 10 health professionals (hematologists n = 4, nurses n = 3, pharmacists n = 3).

Results:

Twelve patients reported at least one instance of nonadherence. Reasons for unintentional nonadherence included forgetfulness related to variations of routine and doctor–patient communication issues. Reasons for intentional nonadherence included desires to reduce dose-dependent side effects and insufficient support. Patients who reported higher nonadherence rates felt complacent following periods of sustained disease control or had received conflicting advice regarding nonadherence. Health professionals had difficulty in accurately evaluating medication adherence due to a lack of reliable measures, utilizing patient self-report and manifestations of suboptimal disease control to guide assessments.

Significance of Results:

Adherence issues persist throughout the course of treatment. While high patient-reported nonadherence rates were recorded, health professionals were often unaware of the complex causes, compounded by an inadequacy of adherence assessment tools. Some patients reported nonadherence events because of insufficient education or lack of access to prompt medical guidance. These issues should be addressed to improve clinical practice.

Keywords

CancerAdherenceChronic myeloid leukemiaQualitativeImatinib
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 2 , April 2015 , pp. 255 - 263
Copyright
Copyright © Cambridge University Press 2014 

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