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Title: "It's a wonderful poison" : towards a system approach of understanding behaviour, theory and measurements relating to patient adherence to oral anticancer drugs
Author: Eliasson, Lina Linnéa
ISNI:       0000 0004 2703 6302
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2011
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Oral anticancer drugs are increasingly prescribed and are often preferred to intravenous treatments by patients. With the introduction of new efficient drugs, cancer is becoming more like a chronic disease that can be managed at home. However, nonadherence to oral anticancer treatments exists and increased prescription of oral therapy prompts further opportunities for nonadherence. The aims of this thesis were to understand the medication-taking behaviours of chronic myeloid leukaemia (CML) patients prescribed imatinib; to explore the usefulness of the Accident Causation Framework (ACF) in explaining nonadherence; and to develop a self-report diagnostic adherence scale (DAS). Interviews were conducted with 21 patients whose adherence rates had previously been monitored using MEMS. Analysis was first conducted according to the constant comparison aspect of grounded theory. Subsequently, a framework analysis guided by the ACF was performed. Three pilot studies tested the validity and reliability of the DAS. Patients commonly missed doses to reduce side-effects or because of forgetting. Surprisingly, many patients did not think missing "the odd dose" mattered and expressed their assurance of this based on communication with health care professionals (HCPs). The ACF could explain reasons for nonadherence and strategies for facilitating adherence. The pilots of the DAS were promising. Causes of nonadherence should be addressed to improve care and clinical outcomes of CML patients. Patients should be made aware of the dangers of treatment interruptions and of missing relatively few doses. HCPs should avoid using unclear language such as "the odd dose" when discussing adherence issues. Different patterns of nonadherence were revealed, which exposed limitations of using MEMS without self-report measures to support interpretation. A system perspective, based on the ACF, contributed further understanding of medication- taking behaviours; highlighted causes of nonadherence external to the patient and the need for appropriate adherence monitoring; and may direct strategies to reduce nonadherence.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available