Administration of chemotherapy drugs has shifted dramatically in the past 15 years from parenteral to oral administration. This change requires patients to self-manage their chemotherapy. Patients need to understand important medication administration tasks: right dose, right time, right route, and right drug. Patients must also be able to safely handle medications, recognize adverse effects, and know when to report adverse effects to their oncology team.
When patients were in the infusion room, nurses could actively monitor their levels of understanding and adherence. Not so today, when nurses send patients out with a prescription, pages of information, and a bit of education, hoping for the best. As a result, nurses may be justifiably concerned regarding efficacy of their teaching, adherence to the regimen, and patient safety.
According to the evidence, what works well in promoting adherence to oral chemotherapy?
Practice good communication. “One of the most important aspects of medication adherence is creating and maintaining a good relationship between the oncology team and the patient and family, in which open communication is encouraged.” The message should be simple, and patients or caregivers should teach back to verify comprehension.
Simplify the regimen. Create a medication schedule requiring fewer daily doses or tying administration times with existing activities, such as, “Right before you watch the morning news, take your pill.” Every effort should be made to decrease the total number of medications taken each day. Use reminder tools such as pill boxes and adherence apps whenever possible.
Education is essential. Patients are often overwhelmed, and directions are easily misunderstood. Provide written instructions and calendars. Make reminder phone calls, or just call patients once a week to see how it’s going.
Ensure patients’ ability to obtain medications. Assess financial ability and refer patients for financial counseling or assistance programs (Roop & Wu, 2014). It may be necessary to change to an IV regimen with a lower out-of-pocket cost. Speak up; be your patient’s advocate. Discuss logistics: how and when will it be delivered, whether they need to be home for delivery, and what to do when there are delivery issues.
Reasons for nonadherence to oral chemotherapy are different for each patient. Using evidence regarding oral chemotherapy, nurses play an essential role in identifying the reasons for and promoting adherence to oral chemotherapy. Be your patient’s advocate.