title: Lack of congruence between patients' and health professionals' perspectives of adherence to imatinib therapy in treatment of chronic myeloid leukemia: A qualitative study.
abstract: OBJECTIVE
  Consistent use of imatinib is critical for treatment success in chronic myeloid leukemia, yet perfect adherence to the prescribed clinical regimen is reported to be as low as 14%. This study aimed to understand patients' experiences of chronic myeloid leukemia with a qualitative approach, including identified facilitators and barriers to adherence, drawing on patients' and health professionals' perspectives, recording comments made by patients and health professionals involved with the same treatment team.
  
  
  METHODS
  We recruited patients with chronic myeloid leukemia prescribed imatinib therapy and health professionals involved in their treatment from a specialized cancer center. Semi-structured qualitative interviews were recorded, transcribed, and manually analyzed using interpretive phenomenological analysis. Recruitment ceased upon saturation, with 16 patients and 10 health professionals (hematologists n = 4, nurses n = 3, pharmacists n = 3).
  
  
  RESULTS
  Twelve patients reported at least one instance of nonadherence. Reasons for unintentional nonadherence included forgetfulness related to variations of routine and doctor-patient communication issues. Reasons for intentional nonadherence included desires to reduce dose-dependent side effects and insufficient support. Patients who reported higher nonadherence rates felt complacent following periods of sustained disease control or had received conflicting advice regarding nonadherence. Health professionals had difficulty in accurately evaluating medication adherence due to a lack of reliable measures, utilizing patient self-report and manifestations of suboptimal disease control to guide assessments.
  
  
  CONCLUSIONS
  Adherence issues persist throughout the course of treatment. While high patient-reported nonadherence rates were recorded, health professionals were often unaware of the complex causes, compounded by an inadequacy of adherence assessment tools. Some patients reported nonadherence events because of insufficient education or lack of access to prompt medical guidance. These issues should be addressed to improve clinical practice.
authors: Department of Cancer Experiences Research, Peter MacCallum Cancer Center, East Melbourne, Victoria,Australia.
authors: Simon
authors: S
authors: Wu
authors: Department of Cancer Experiences Research, Peter MacCallum Cancer Center, East Melbourne, Victoria,Australia.
authors: Desmond
authors: D
authors: Chee
authors: Department of Cancer Experiences Research, Peter MacCallum Cancer Center, East Melbourne, Victoria,Australia.
authors: Anna
authors: A
authors: Ugalde
authors: Department of Psychology,The University of Sydney,Sydney, New South Wales,Australia.
authors: Phyllis
authors: P
authors: Butow
authors: Faculty of Medicine, Dentistry and Health Sciences,The University of Melbourne,Parkville, Victoria,Australia.
authors: John
authors: J
authors: Seymour
authors: Department of Cancer Experiences Research, Peter MacCallum Cancer Center, East Melbourne, Victoria,Australia.
authors: Penelope
authors: P
authors: Schofield
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D000068877:Imatinib Mesylate / Q000008:administration & dosage* / Q000009:adverse effects; D007407:Interviews as Topic; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010817:Physician-Patient Relations; D036301:Qualitative Research; D012307:Risk Factors
chemical_list: D000970:Antineoplastic Agents; D000068877:Imatinib Mesylate
keywords: Imatinib