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: 8542605
• 负责人: Gertraud Stadler
• 金额: $ 7.52万
• 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 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8542605
• 关键词: Acute; Address; Adherence; Adult; Aftercare; Allogenic; Behavioral; Cancer Patient; Cell Transplants; Clinical Data; Complex; Data; Electronic drug monitoring; Electronics; Feasibility Studies; Graft Rejection; HIV; Health; Health Care Costs; Hematopoietic stem cells; Homologous Transplantation; Hospital Mortality; Immunosuppressive Agents; Infection; Intervention; Interview; Lead; Link; Low income; Lymphoid; Malignant Neoplasms; Measures; Medical; Mental Depression; Methods; Minority; Minority Groups; Modeling; Monitor; Morbidity - disease rate; Motivation; Organ Transplantation; Outcome; Participant; Patient Self-Report; Patients; Pattern; Persons; Pharmaceutical Preparations; Plasma; Population; Process; Questionnaires; Recommendation; Recording of previous events; Regimen; Research; Research Personnel; Risk; Risk Factors; Sampling; Social support; Solid; Stem cell transplant; Sum; Testing; Theoretical model; Transplant Recipients; Transplantation; Visit; base; blood treatment; chronic graft versus host disease; compliance behavior; ethnic minority population; follow-up; hospital readmission; information model; innovation; medication compliance; monitoring device; mortality; prevent; public health relevance; satisfaction; skills; theories; treatment center

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 an allogeneic HSCT, patients typically take more than a dozen medications to prevent rejection of the transplanted cells and to fend off infections. This medication regimen is both complex and requires rigorous adherence, usually extending for at least 6 months after transplantation. Clinical data suggest that medication non-adherence places patients at risk for increased morbidity and mortality, requiring hospital readmissions that lead to increased personal and healthcare costs. No systematic studies are available on HSCT patients' medication adherence after transplant, despite the fact that non-adherence can have severe consequences. Therefore, predictors of non-adherence in HSCT patients are poorly understood. Theoretical models of adherence and research with solid organ transplant patients delineate possible risk factors, such as having a history of non-adherence, lack of social support, and depression. These factors are more prevalent among low-income and ethnic minority patients for whom post-transplant mortality and morbidity are higher in comparison to majority groups. In sum, there is clearly a need to study (1) medication adherence in allogeneic HSCT patients, (2) the link between adherence and transplant outcomes, and (3) predictors of HSCT patients' adherence, including the effects of low-income and minority status. To address this scientific need, the study will assess medication adherence in 60 allogeneic HSCT patients, including 30 minority patients, during the first six months post treatment. In addition, the study will use a multi- method approach to examine adherence predictors and strategies 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 regimen; and 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 regimens who are at risk for non-adherence, including 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。同种异体HSCT之后，患者通常服用十几种药物来防止移植细胞排斥并抵御感染。 该药物治疗方案既复杂又需要严格的依从性，通常在移植后至少延伸6个月。临床数据表明，不遵守药物使患者处于发病率和死亡率增加的风险，需要医院再入院 导致个人和医疗保健费用增加。尽管不遵守可能会带来严重的后果，但在移植后没有针对HSCT患者的药物依从性进行系统研究。因此，对HSCT患者不遵守的预测因素知之甚少。与固体器官移植患者依从性和研究的理论模型描述了可能的危险因素，例如具有不遵守历史，缺乏社会支持和抑郁症。这些因素在低收入和少数民族患者中更为普遍，而后者死亡率和发病率与多数群体相比更高。总而言之，显然需要研究（1）同种异体HSCT患者的药物依从性，（2）（2）依从性与移植结局之间的联系，以及（3）HSCT患者依从性的预测指标，包括低收入和少数族裔状况的影响。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60名同种异体HSCT患者（包括30名少数患者）的药物依从性。此外，该研究将使用多种方法来检查定性患者访谈和标准问卷的依从性预测因子和策略。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 遵守复杂的药物治疗方案； 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患有不依从性（包括少数族裔患者）风险的复杂药物治疗方案患者的依从性的策略。

项目成果

Patient-generated strategies for strengthening adherence to multiple medication regimens after allogeneic stem cell transplantation: a qualitative study.

患者制定的加强同种异体干细胞移植后多种药物治疗方案依从性的策略：一项定性研究。

• DOI: 10.1038/s41409-022-01727-1
• 发表时间: 2022
• 期刊: Bone marrow transplantation
• 影响因子: 4.8
• 作者: Song,Yaena;Chen,Stephanie;Roseman,Julia;Scigliano,Eileen;Allegrante,JohnP;Stadler,Gertraud
• 通讯作者: Stadler,Gertraud