title: Supporting adherence to oral anticancer agents: clinical practice and clues to improve care provided by physicians, nurse practitioners, nurses and pharmacists.
abstract: Healthcare provider (HCP) activities and attitudes towards patients strongly influence medication adherence. The aim of this study was to assess current clinical practices to support patients in adhering to treatment with oral anticancer agents (OACA) and to explore clues to improve the management of medication adherence.
  
  
  
  A cross-sectional, observational study among HCPs in (haemato-)oncology settings in Belgium and the Netherlands was conducted in 2014 using a composite questionnaire. A total of 47 care activities were listed and categorised into eight domains. HCPs were also asked about their perceptions of adherence management on the items: insight into adherence, patients' communication, capability to influence, knowledge of consequences and insight into causes. Validated questionnaires were used to assess beliefs about medication (BMQ) and shared decision making (SDM-Q-doc).
  
  
  
  In total, 208 HCPs (29% male) participated; 107 from 51 Dutch and 101 from 26 Belgian hospitals. Though a wide range of activities were reported, certain domains concerning medication adherence management received less attention. Activities related to patient knowledge and adverse event management were reported most frequently, whereas activities aimed at patient's self-efficacy and medication adherence during ongoing use were frequently missed. The care provided differed between professions and by country. Belgian physicians reported more activities than Dutch physicians, whereas Dutch nurses and pharmacists reported more activities than Belgian colleagues. The perceptions of medication adherence management were related to the level of care provided by HCPs. SDM and BMQ outcomes were not related to the care provided.
  
  
  
  Enhancing the awareness and perceptions of medication adherence management of HCPs is likely to have a positive effect on care quality. Care can be improved by addressing medication adherence more directly e.g., by questioning patients about (expected) barriers and discussing strategies to overcome them, by asking for missed doses and offering (electronic) reminders to support long-term medication adherence. A multidisciplinary approach is recommended in which the role of the pharmacist could be expanded.
authors.affiliation: Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. l.timmers@vumc.nl.
authors.forename: Lonneke
authors.initials: L
authors.lastname: Timmers
authors.affiliation: Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: Christel C L M
authors.initials: CC
authors.lastname: Boons
authors.affiliation: University Centre of Nursing and Midwifery, Department of Public Health, Ghent University, Ghent, Belgium.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Verbrugghe
authors.affiliation: Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands.|Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Bart J F
authors.initials: BJ
authors.lastname: van den Bemt
authors.affiliation: University Centre of Nursing and Midwifery, Department of Public Health, Ghent University, Ghent, Belgium.
authors.forename: Ann
authors.initials: A
authors.lastname: Van Hecke
authors.affiliation: Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.|The EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Jacqueline G
authors.initials: JG
authors.lastname: Hugtenburg
mesh_terms: D000284:Administration, Oral; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001530:Belgium; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D009726:Nurses / Q000706:statistics & numerical data*; D010595:Pharmacists / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016903:Drug Monitoring
chemical_list: D000970:Antineoplastic Agents
keywords: Adherence management; Clinical practice; Healthcare providers; Medication adherence; Multidisciplinary care; Nurse; Nurse practitioner; Oral anticancer agents; Pharmacist; Physician