Multi-Method Study of Cancer Patients' Medication Adherence After Allogeneic HSCT

癌症患者同种异体造血干细胞移植后药物依从性的多方法研究

• 批准号: 8655314
• 负责人: Gertraud Stadler
• 金额: $ 3.94万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-08 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8655314
• 关键词: Multi; Method; Study; Cancer; Patients

DESCRIPTION (provided by applicant): Hematopoietic stem-cell transplants (HSCT) are commonly used in the treatment of blood and lymphoid cancers. In an allogeneic transplant, the transplanted cells come from a donor. After such an allogeneic HSCT, patients must take a variety of medications, to prevent rejection of the transplanted cells and to fend off infections due to severe immunosuppression. This medication regime is complex and requires rigorous adherence, usually extending for at least 6 months after transplant. Clinical data suggest that medication nonadherence places patients at risk for increased morbidity and mortality, requiring hospital readmissions with increased medical and economic costs. No systematic studies are available on HSCT patients' medication adherence after transplant. Predictors of nonadherence in HSCT patients are not well understood. Possible risk factors, such as history of nonadherence, lack of social support, and depression, are more prevalent among low-income minority groups for which post- transplant mortality and morbidity are higher than among majority groups. In sum, there is clearly a need to study (1) medication adherence, (2) the link between adherence and transplant outcomes, and (3) predictors of adherence and nonadherence in HSCT patients including low-income and minority patients. To address this scientific need, the study will assess medication adherence in 40 allogeneic HSCT patients (including 20 minority patients) during the first six months after treatment. In addition, the study will use a multi-method approach to examine predictors and processes related to medication adherence through qualitative patient interviews and standard questionnaires. The proposed research is innovative in three distinct ways: 1) It will address the understudied problem of medication adherence in HSCT patients. 2) It will use daily electronic monitoring, drug plasma levels, and self-report to assess adherence with a complex medication regime. 3) It will apply an established empirically supported theory of adherence model (the Information-Motivation-Behavioral Skills Model) to this population. We anticipate that the proposed study will identify strategies to promote adherence in patients with complex medication regimes who are at risk for nonadherence, including low-income and minority patients.

描述（由申请人提供）：造血干细胞移植（HSCT）通常用于治疗血液和淋巴癌。在同种异体移植中，移植细胞来自供体。在这种同种异体HSCT之后，患者必须服用多种药物，以防止移植细胞排斥并因严重的免疫抑制而抑制感染。这种药物制度很复杂，需要严格的依从性，通常在移植后至少延伸6个月。临床数据表明，药物不遵守使患者处于发病率和死亡率增加的风险，需要增加医疗和经济成本的医院再入院。在移植后，没有针对HSCT患者的药物依从性的系统研究。 HSCT患者不遵守的预测因素尚不清楚。在低收入少数群体中，可能的危险因素（例如不遵守历史，缺乏社会支持和抑郁）更为普遍，而后载体死亡率和发病率高于多数群体中的少数群体。总而言之，显然需要研究（1）药物依从性，（2）依从性与移植结局之间的联系，以及（3）包括低收入和少数族裔患者在内的HSCT患者的依从性和不遵守性的预测指标。为了满足这一科学需求，该研究将在治疗后的头六个月内评估40名同种异体HSCT患者（包括20名少数患者）的药物依从性。此外，该研究将使用多方法方法来检查与药物依从性有关的预测因素和过程，并通过定性的患者访谈和标准问卷调查。拟议的研究以三种不同的方式具有创新性：1）它将解决HSCT患者的药物依从性问题。 2）它将使用每日电子监测，药物等离子体水平和自我报告来评估复杂的药物制度的依从性。 3）它将将既定的依从性模型理论（信息动机 - 行为技能模型）应用于该人群。我们预计，拟议的研究将确定促进有不依从风险的复杂药物制度患者（包括低收入和少数族裔患者）的依从性的策略。