Current nursing practice for patients on oral chemotherapy: a multicenter survey in Japan.
BACKGROUND
With a paradigm shift toward a chronic care model in cancer, the issue of adherence is becoming increasingly important in oncology.


METHODS
We mailed two self-reported surveys on current nursing practices for patients on oral chemotherapy to all 309 designated cancer centers and 141 large general hospitals in Japan. The first survey was based on a nurse-based questionnaire containing 40 items concerning nurse's characteristics, nurse staffing at workplace, general nursing care for new patients on oral chemotherapy and those with refilled prescriptions, follow-up, and system-based approach. The second survey was based on a patient-based questionnaire containing 10 items about patient characteristics and adherence-related nursing practice for 249 patients taking oral chemotherapy of 903 systematically sampled. We used multivariate logistic regression to identify factors that were associated with adherence-related nursing practices.


RESULTS
A total of 62 nurses (mean age: 41.5 years) from 62 hospitals who consented participated in the both nurse-based survey and patient-based survey about 249 patients. The results of nurse-based survey indicated that practices varied, but nurses were less likely to ask adherence-related questions of patients with refilled prescriptions than of new patients. The results of patient-based survey found that questions on side effects, discussions about barriers to achieving balance between treatment and daily life activities, and medication management were all significantly related to the question about unused medicines. Logistic regression revealed that adherence-related nursing practices were associated with the nurse's background, type of treatment, and healthcare system-related factors. Patient orientation on oral chemotherapy, interdisciplinary learning, and having a system-based approach for detecting prescription errors were identified as healthcare system-related factors.


CONCLUSIONS
A more systematic approach must be developed to ensure patients receive safe and effective oral chemotherapy, while nurses should play significant roles in patient education and monitoring.
Faculty of Nursing and Medical Care, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. hkomatsu@sfc.keio.ac.jp.
Hiroko
H
Komatsu
Kaori
K
Yagasaki
Kimio
K
Yoshimura
D000203:Activities of Daily Living; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D002173:Cancer Care Facilities; D004993:Ethics, Nursing; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000523:psychology*; D009726:Nurses / Q000523:psychology*; D063046:Patient Medication Knowledge; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016903:Drug Monitoring
D000970:Antineoplastic Agents