title: Disease acceptance and adherence to imatinib in Taiwanese chronic myeloid leukaemia outpatients.
abstract: BACKGROUND
  The launch of imatinib has turned chronic myeloid leukaemia (CML) into a chronic illness due to the dramatic improvement in survival. Several recent studies have demonstrated that poor adherence to imatinib may hamper the therapeutic outcomes and result in increased medical expenditures, whilst research on exploring the reasons for non-adherence to imatinib is still limited.
  
  
  OBJECTIVE
  This study aimed to explore the experience of patients as they journey through their CML treatments and associated imatinib utilisation in order to understand the perceptions, attitudes and concerns that may influence adherence to imatinib treatment.
  
  
  METHODS
  This study was conducted at oncology outpatient clinics in a medical centre in southern Taiwan.
  
  
  METHODS
  CML patients who regularly attended the oncology outpatient clinics to receive imatinib treatment from October 2011 to March 2012 were invited to participate in the study. Semi-structured face-to-face interviews were used to explore patients' experiences and views of their treatment, their current CML status and CML-related health conditions, their concerns about imatinib treatment and imatinib-taking behaviours. Patient interviews were recorded, transcribed verbatim and thematically analysed using the constant comparison approach.
  
  
  METHODS
  Themes related to patients' views of the disease and health conditions, worries and concerns influencing imatinib utilisation behaviours are reported.
  
  
  RESULTS
  Forty-two CML patients participated in the interviews. The emerging themes included: acceptance of current disease and health status, misconceptions about disease progression, factors associated with adherence to imatinib, concerns and management of adverse drug effects. Participants regarded CML as a chronic disease but had misconceptions about disease progression, therapeutic monitoring, resistance to imatinib and symptoms of side effects. Participants were generally adherent to imatinib and favoured long-term prescriptions to avoid regular outpatient visits for medication refills. Experiencing adverse effect was the main reason influencing adherence and led to polypharmacy. Most participants altered medicine-taking behaviours to maintain long-term use of imatinib.
  
  
  CONCLUSIONS
  Taiwanese CML patients are adherent to imatinib but report changing their medication-taking behaviour due to adverse drug effects and associated polypharmacy. Patients' misconceptions of the disease and medication suggests that it is necessary to improve communication between patients and healthcare professionals. Routinely providing updated information as part of the patient counselling process should be considered as a means of improving this communication.
authors.affiliation: Division for Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, East Drive, University Park, Nottingham, NG7 2RD, UK, li-chia.chen@nottingham.ac.uk.
authors.forename: Li-Chia
authors.initials: LC
authors.lastname: Chen
authors.forename: Teng-Chou
authors.initials: TC
authors.lastname: Chen
authors.forename: Yaw-Bin
authors.initials: YB
authors.lastname: Huang
authors.forename: Chao-Sung
authors.initials: CS
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001549:Benzamides / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D000068877:Imatinib Mesylate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000523:psychology*; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology; D010879:Piperazines / Q000009:adverse effects / Q000627:therapeutic use; D011743:Pyrimidines / Q000009:adverse effects / Q000627:therapeutic use; D013624:Taiwan; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate