Patients With Cancer: Experiences of Medication Management

1
Patients With Cancer Experiences of Medication
Management

• Marilyn Smith-Stoner, PhD, RN, CHPN
• Mikel W. Hand, EdD, RN, OCN, NE-BC

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Introduction and Background

• Medication management is a complex skill for
  patients and their care givers.
• Those suffering from from end stage cancer are no
  exception, but rather at the forefront of the
  problem.
• As a result, patients and their care givers may
  deviate from the prescribed mediation regimen.

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Introduction and Background (Cont)

• Numerous causes of deviation
• Cost of medications
• Side effects
• Inconvenience of the dosing regimen
• Lack of patient/caregiver understanding
• Deviations do not come without consequences

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Introduction and Background

• Numerous strategies reported in the literature to
  promote adherence.
• Meta-analysis of randomized controlled trials
  have failed to produce a best intervention to
  promote adherence.
• (Peterson Finley, 2003)

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Why do they Deviate

• Primarily due to patient/care giver strain.
• Secondarily due to a perceived negative response
  on the part of the patient.
• (Travis et al. 2006)

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The Critical Gap

• A plethora of literature exists related to
  medication safety and administration
• A critical gap in the literature exists in
  relation to patients specific experience of
  medication management and how these impact their
  safety and overall quality of life

7
Significance

• Effective medication management is crucial
• For patient safety
• Effective symptom management
• Overall Quality of life

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Purpose

• To gain an understanding of the process of
  medication management from the perspective of the
  late state cancer patient
• Specific aims
• 1. Describe the experience.
• 2. Explore responses to ongoing changes in the
  regimen
• 3. Examine barriers that these patients faced.

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Key Research Question

• How do patients with late stage cancer describe
  their experience of medication management,
  response to medication changes, and the barriers
  they experience in the process?

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Sample

• Purposive sample of 11 elderly patients
• Each was diagnosed with end stage cancer
• Each was being seen in the same rural oncology
  center

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Method and Data Collection

• Descriptive phenomenology was chosen
• Data was collected via tape recorded interviews
• These were transcribed and reviewed for accuracy
  by the Principle Investigator.
• A brief semi structured script was used to avoid
  participant fatigue.

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Model and Actions of Analysis

• Independent and Simultaneous Acts
• Dwelling in the data (A singular independent act
  done simultaneously by 2)
• Independent coding by the 2 researchers
  (Independent and simultaneous)
• Collective and Collaborative Acts
• Discussion and reflection
• Uncovering similar meanings
• Consensus

13
Results and Implications

• 4 themes
• Surrender
• I let the doctor tell me if I need more blood
  pressure medication.I mean I am going to a lot
  of doctors and they take my blood pressure all
  the time. I dont check my blood sugar, the
  doctors do when I see them.
• I dont think it matters if I track the
  medication. Especially since my cancer
  returned.

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Themes

• Lack of system for comprehensively managing
  medications
• Daily tracking of medication
• I keep them in my head. I take the medications I
  want, as I think I should take them. I live
  alone and some days I forget if I have taken them
  or not.
• Obtaining refills
• I try to catch it before I run out. Sometimes I
  run out.
• Discontinuing medication
• .the system we have is to put it aside until we
  need to have it refilled.
• Physician monitoring of medication profile
• I see him all the time and assume he is going to
  tell me if I need some lab tests for my thyroid.
• The nurse asked me to take my counts (heart rate)
  when taking these medications, but I don't
  usually do it. I rely on the doctors is to
  adjust the medication when they take my pulse

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Themes

• Medication labeling
• Labels are difficult to readconsistent theme
• The print needs to be larger
• The print is so small. I can barely read it. I
  would like it larger.
• Labels lack identifying information for the
  purpose of the medication
• There is no identifying information about the
  purpose of the medication over time, as
  medications change the patient may forget the
  action of the medication
• Caregivers find it confusing to help track
  correct medications, especially when there are
  more than one
• Changes in functional status and caregiver
  support add to the confusion about the purpose of
  each medication
• There has to be a system, that not only the
  patient can use but the family that is helping
  the patient. Several of us care for my mother
  and we dont always get a chance to talk to each
  other. So it is really important for everyone to
  understand what the medications are used for and
  how to recognize a problem, if one arises

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Themes

• Accessing resources limited use
• Limited use of pharmacist
• Reading pack inserts or pharmacy supplied
  material-done only by one person
• Reliance on health care workers to know and
  educate synthesize information for personal
  relevance

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Limitations

• Number of participants
• Frail physical condition and ease of fatigue

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Directions for Future Research

• Comprehensive medication management research need
  to include late stage or terminal patients
• Medication management research needs to include
  caregivers
• Care givers may be episodic and not one specified
  caregiver
• Labeling is needed to be able accommodate
  different structures of caregiving

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References

• Peterson, A.M. Takiya, L. Finley, R. (2003).
  Meta-analysis of trials of interventions to
  improve medication adherence. American Journal of
  Health Systems Pharmacists,60, 657-664.
• Travis, S. et al. (2006). Differences in the ways
  family caregivers experience medication
  administration hassles. Journal of Aging and
  Pharmacology,13, 35-51.