Does a Nursing Intervention Improve Adherence to Oral Chemotherapies in the Outpatient Cancer Treatment Setting?
調査の概要
詳細な説明
The purpose of this study is to investigate which nursing intervention will help to improve adherence in adult patients who are receiving oral chemotherapy. This study will identify the barriers to adherence, interventions that will increase patients' adherence, and the role of nursing in promoting oral chemotherapy adherence. Oral chemotherapy adherence is important in the setting of cancer care as many new chemotherapy medications being approved for use are oral chemotherapies. Nursing responsibility in this study is to help promote interventions that would improve adherence. The literature shows that the best intervention to promote adherence to oral chemotherapy is education that patients receive prior to them starting their treatment. The interventions such as the MEMS system, AVR, and the generic diary were studied and found to be somewhat effective in improving adherence, but not reliable. The literature supports the use of individualized and personalized education for patients. The education should be in terms that they can understand and absorb, and it should be information that they need related to their treatment.
Oral chemotherapy has emerged as the growing treatment of choice in the cancer treatment specialty; accounting for a quarter of the 400 anticancer medications currently under development (Simchowitz et al., 2010). There are now more than 20 oral antineoplastic agents approved for use in the United States alone; and dozens more under development (Ruddy, Mayer, & Partridge, 2009). Chemotherapy treatments are moving in the direction of conveniences for patients. Oral chemotherapies can be given to patients to take home and be administered in the convenience of their homes. This process works for some patients, but not all.
One of the biggest issues that health care providers find with oral chemotherapy is the non-adherence with the regimens. Without nursing education and follow up interventions, adherence is even more difficult to obtain. Although some patients want to experience having the same care and intervention as a patient receiving intravenous chemotherapy, the mindset of receiving oral chemotherapy is that it is just a pill and not taken seriously by some patients. In a study conducted at Dana Farber, most patients would prefer oral chemotherapy to intravenous (IV) chemotherapy for its convenience, ease of use, and painless administration (Simchowitz et al., 2010). Although most patients realize the importance of taking their medication and adhering to the regimen, they are still non-adherent and suffer unneeded side effects due to that non-adherence. Not to mention that they do not get the full therapeutic effect of the oral chemotherapy regimen.
The standard process for treatment with oral chemotherapy agents start with the providers request for the agent via prescription. Once patient has received approval and has the drug available, the patient will call the cancer center to set up a formal educational appointment with an oncology certified chemotherapy nurse (OCN). The OCN meets with the patient to review potential side effects, how to manage those side effects, and how to properly take the oral chemotherapy. It will be at this education appointment that, the patient will be approached for interest in the study.
Subjects will be identified as any patient that has an oral chemotherapy prescribed that meets the inclusion criteria (please see inclusion/exclusion criteria list later in this document). If the patient expresses interest informed consent process will begin.Once patient has given informed consent, the OCN will confirm eligibility. Once consented and eligibility verified, they will be randomized to either the control group (no intervention, standard of care [SOC]) or to the study group (the intervention group). The initial sample size is 60. All eligible patients' prescribed oral chemotherapy will be approached until sample size of 60 participants has been reached. An interim analysis will be completed after 60 patients have completed the study to assess adequacy of the sample size.
If randomized to the study arm, the OCN will follow-up with that patient at week one, two, three via phone,. At week four, follow-up will occur at the patients routinely scheduled medical oncology visit. For the control group, data will be collected at initial education visit and again at the 4 week physician visit. At the initial education visit both the study group and the control group will receive the standard chemotherapy education, and complete a QOL questionnaire. For the study group, at the initial education visit, a time for each phone call that is convenient for the patient will be scheduled. At each phone call, the OCN will get a pill count and discuss reasons for missed doses if applicable; grade any adverse events (AE's) experienced and interventions for those side effects; and answer any questions or concerns that they patient may be having.
The control group will not receive contact by the OCN at week 1, 2 and 3. At week four, both the control group and the study group will have a complete physical, pill count, QOL completion and document any AE experienced.
The quality of life (QOL) survey tool will be a questionnaire that is self-reported by the patient. This will be done at the initial education session and again at the four week follow up session, for both the control and the intervention group. The sample size will be 60 participants, 30 for the control group and 30 for the intervention group.
研究の種類
入学 (実際)
段階
- 適用できない
連絡先と場所
研究場所
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New York
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Cooperstown、New York、アメリカ、13326
- Bassett Healthcare Network
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- Must be >= 18 years of age
- Have a diagnosis of Cancer that will require an oral chemotherapy
- Be treated at Bassett Medical Center Cancer Center
- Must not be receiving radiation or infusional chemotherapy concomitantly with their oral chemotherapy
Exclusion Criteria:
- Being treated at satellite sites
- Receiving radiation and/or infusional chemotherapy concurrently with oral chemotherapy
- Due to impairment or other reasons, patient unable to provide consent or comply with survey.
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:支持療法
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:なし(オープンラベル)
武器と介入
参加者グループ / アーム |
介入・治療 |
---|---|
アクティブコンパレータ:Control Arm
This is a "usual care" group.
Patients in this arm will receive the standard pre-drug initiation training and 4 week clinic follow up visit.
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The control group will receive the standard chemotherapy education and will return for the standard 4 week follow up clinic visit.
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実験的:Intervention arm
Patients in this arm will also receive the standard pre-drug initiation training followed by telephone follow up by an oncology certified chemotherapy nurse (OCN) at week one, two, and three.
Patients will then have the standard 4 week follow up clinic visit.
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For the study group, at the initial education visit, a time for each phone call that is convenient for the patient will be scheduled.
At each phone call, the OCN will get a pill count and discuss reasons for missed doses if applicable; grade any AE's experienced and interventions for those side effects; and answer any questions or concerns that they patient may be having.
Patients will then return for the standard 4 week clinic visit.
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Oral chemotherapy compliance
時間枠:4 weeks
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A 4 week pill count will be completed on all participants to measure drug compliance.
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4 weeks
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協力者と研究者
スポンサー
捜査官
- 主任研究者:Kristina Loeffler, RN、Bassett Healthcare
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (実際)
研究の完了 (予想される)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。
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