title: The relationship between patient activation, confidence to self-manage side effects, and adherence to oral oncolytics: a pilot study with Michigan oncology practices.
abstract: The Michigan Oncology Quality Consortium (MOQC) is a continuous quality improvement collaborative seeking to improve oncology care in Michigan, including for patients taking oral chemotherapy. The aim of this study was to assess the relationship between patient activation, confidence to self-manage side effects, and adherence to oral oncolytics to inform future oncology care.
  
  
  
  A multicenter cross-sectional observational study was conducted using an online survey to examine patient activation (patient activation measure, PAM), health literacy, symptom burden (Edmonton Symptom Assessment System, ESAS), confidence to self-manage side effects (fatigue, nausea, and diarrhea), and adherence to oral oncolytics. Inclusion criteria were patients taking an oral oncolytic for at least 1 month. Bivariate analyses and logistic regression were performed to evaluate relationships between the variables.
  
  
  
  A total of 125 respondents, mean (SD) age 66.2 (13.6), 57.7% female, and 95.1% Caucasian completed the survey. The mean (SD) PAM score was 65.0 (18.0). Confidence to manage fatigue, nausea, and diarrhea was associated with higher activation, and confidence to self-manage fatigue and diarrhea were associated with higher health literacy. About 30% of participants reported some level of non-adherence to oral oncolytics, and those who experienced side effects (Fisher's exact test p = 0.033) and with shorter length of therapy (t test p = 0.027) were significantly more likely to be non-adherent.
  
  
  
  These findings show that there is room for improvement across practices involved with MOQC with regard to supporting patients taking oral oncolytics. Patients will need to improve their activation levels, and oncology clinics will need to create new workflows in order to enhance self-care management ability for patients taking oral oncolytics.
authors.affiliation: University of Michigan College of Pharmacy, 428 Church St., Ann Arbor, MI, USA.|Michigan Oncology Quality Consortium, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd., SPC 2800, Building 14, G210-30, Ann Arbor, MI, 48109, USA.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Salgado
authors.affiliation: Michigan Oncology Quality Consortium, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd., SPC 2800, Building 14, G210-30, Ann Arbor, MI, 48109, USA. estunteb@umich.edu.
authors.forename: Emily
authors.initials: E
authors.lastname: Mackler
authors.affiliation: Michigan Oncology Quality Consortium, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd., SPC 2800, Building 14, G210-30, Ann Arbor, MI, 48109, USA.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Severson
authors.affiliation: Michigan Oncology Quality Consortium, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd., SPC 2800, Building 14, G210-30, Ann Arbor, MI, 48109, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Lindsay
authors.affiliation: University of Michigan College of Pharmacy, 428 Church St., Ann Arbor, MI, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Batra
authors.affiliation: Michigan Oncology Quality Consortium, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd., SPC 2800, Building 14, G210-30, Ann Arbor, MI, 48109, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Petersen
authors.affiliation: University of Michigan College of Pharmacy, 428 Church St., Ann Arbor, MI, USA.|Michigan Oncology Quality Consortium, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd., SPC 2800, Building 14, G210-30, Ann Arbor, MI, 48109, USA.
authors.forename: Karen B
authors.initials: KB
authors.lastname: Farris
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008824:Michigan; D010358:Patient Participation / Q000379:methods*; D010865:Pilot Projects; D012648:Self Care / Q000379:methods*; D011795:Surveys and Questionnaires
chemical_list: D000970:Antineoplastic Agents
keywords: Adherence; Oral chemotherapy; Quality improvement; Self-management