Adherence is defined as
the extent to which a person’s behavior of taking medication corresponds with
agreed recommendations from a health care providers (WHO, 2003). Especially
adherence is important in chronic conditions rather than for acute conditions.
As it enhances patient’s safety and increases the effectiveness of the
treatment. Therefore it’s clear that it plays a major role for the long-term treatment
Several studies have been
conducted in various regions of the world to explore the adherence to OACA by
cancer outpatients (citations). These studies have investigated different
medication adherence rates in the different countries. For example, adherence
rate of outpatients were 64% in a study conducted in Japan by “Kimura et
al, 2014” and were 84% in a study conducted in Germany by “Feiten et
al, 2016”. According to the present study 72.04% of population are
adhered to the oral chemotherapy.
Usually most of the patients
forget to take medications. “Jimmy et al” stated that 49.6% of
patients told that forgetfulness is a great unintentional barrier for medication
adherence. It is amazing that this population do not face such forgetting
problems much because 80.2% of them adherent to the treatment. Only 19.8%
non-adherent to the treatment. Majority of the population even do not show
carelessness when handling with medications too. Among them 87.6% adherent to
Attitude and belief about
health condition plays a major role on adherence. Study conducted by “Bender et
al, 2014” stated that presence of negative mood effect adherence in a negative
manner. Therefore having a positive attitude towards the disease condition and
belief of them that they were in good condition significantly effect on
adherence. Because it can cause interest in patients to follow appropriate
procedures. Majority of the population believe they are in good health (88.2%)
and 77.2% a positive attitude towards the disease.
Normally patients take
medications when only they feel sick, stopping medications if they didn’t cure
soon or stopping medicines as soon as they get cured. This practice have become
a trend for most of the disease conditions. But it’s amazing that among this
population those incidents were appeared rarely. It’s significant that full
adherence option was selected by the majority of the population for above mentioned
factors. Usually some may try to stop medications thinking that it’s unnatural
for them to be controlled by medications. But for this population majority do
not think like that. Here 78.20% showed adherence to the treatment.
Meeting the clinician is
the most suitable thing that should be done when side effects appear. Here
majority of them do the right thing and 92.6% adhere to the treatment. This
population have a proper knowledge what to do during such condition.
the current treatment, explanations given by oncologist about the disease
condition usually considered as factors that have an impact on adherence. “Martin
et al, 2005” had stated in their study that more than 40% of patients’ non
adherent to the treatment due to misunderstandings, forgetting or ignoring
health care advice. But here 78.2% of population do not having misunderstanding
about the current treatment and 86.1% of population showed adherent to the
explanations given by the oncologist bout the disease condition. Therefore
majority of the population adherent to the treatment.
Sri Lanka is a middle
income country and patients face transport problems due to lack of income and
no one to care them when reaching the hospitals. Although they face such
transport problems they said that they try their best to overcome those issues
to attend clinics. Here 80.2% of population adhered to the treatment. Nearly
1/5 of the population non adherent to this factor, so it is better if funds can
be given to them even to cover their traveling cost.
Understanding the current
therapy and believing the therapy effectiveness are important positive effects
on adherence as it can lead to the success of treatment. Because when they had
understand what to do and seen the effectiveness of treatment then they adhere
to the treatment willingly. This population showed a 77.3% of adherence
regarding the understanding of therapy and 85.7% of adherence regarding the
believing the therapy is effective.
If patient see dosing time
as complex then they won’t get adhere to treatment. Here majority of the
population (70.3%) adhered to the treatment. While 29.7% of the population non
adherent and they must be guided for how to adjust the dosing time by
discussing with the oncologist.
Trust upon the medication
have a positive effect on adherence. They depend on medication thinking that it
will lead to cure or improve the quality of the life. Most of the patients
adhere (75.2%) to the treatment hoping that medication will cure or improve the
quality of life.
Above mentioned factors
had shown significant adherence percentages. Majority are adherent to the
treatment. Some factors which are addressed by questions 32, 13, 20, 22, 9, 31,
15 are comparatively acquired less percentages for the adherence.
As significantly less
percentage was acquired for question 32, special considerations should be taken
to improve the adherence. Other factors emphasized by questions mentioned above
should also considered well to gain sufficient adherence.
There were 22.8% in the
case of interest to obtain more information about medicine and 70.8% were not
eager to do so. It implies that lack of interest to gain more information means
they are not adherent to the treatment. They are not well aware about the medication
with great attention. So awareness programs should be implemented in order to
induce interest to obtain more information about medication.
70.8% were rejected to
answer for the further ways of obtaining information about medication. Adherent
percentage for this acquired only 22.8%.Therefore necessary steps should be
taken to develop the attitude of gaining information through reliable sources.
48.5% of total patients
were adherent to discussion about the dosing schedule with physician. Especial
attention should be pay for this fact. Because nearly half of the population do
not talk for adjustment of dosing schedule with the physician. If they are
talking about this matter and adjust according to their schedule, it will be
helpful to avoid missing doses and getting trouble to follow the treatment
In the case of worrying
side effects 51.4% adherent to the treatment. Nearly half of population had an
issue regarding worrying about side effects. So proper program should be
implemented to aware the population regarding importance of having medications
than worrying about side effects. Not only that but also have to inform
majority of side effects are reversible and no need to worry.
From the total population
64.3% do not need someone to talk further about medications as they well
informed about medicine. They were readily accepted to follow whatever the
doctor said and do not like to talk with anyone. They have kept more trust on
doctor. 63.4% of total population believes taking medicine is not a
trouble. For above instances sufficient adherence were acquired. But it is
better if adherent population can be increased further through
Special attention should
be taken on factors that already affect adherence and as well as effecting on
other factors that affect adherence too. According to the above chi square
tests, it has explored that there are some factors affect for the adherence of
the other factors too. It has explored that (lack of) counselling with the
pharmacist and explanations given by the oncologists about the disease
condition have an impact on misunderstanding about the current treatment
policy. Misunderstanding about the treatment policy have an impact on understanding
about the current treatment policy and agreeing with the current treatment
Careless nature when
handling medicines and dosing time complexity have an effect on forgetting
nature to take medications. Living condition of the patient have an impact on
having transport problems. Therefore this type of factors should be given a
priority when enhancing adherence.
As discussed earlier
questionnaire (appendix) composed of mainly 6 components of demographic data,
questions related to medication factors, healthcare system related factors,
patient’s unintentional factors, patient’s intentional factors and patient’s
attitude. Among those factors high average percentage for full adherence had
acquired by patient intentional and patient’s unintentional barriers related factors.
Full adherence was not achieved in a sufficient level by medication related and
health care system related barriers. Therefore it’s necessary to arrange
counselling sections for the patients in order to improve adherence. Significantly
low level of adherence obtained for patient beliefs, expectation and attitudes.
This adherence barrier must be overcome if proper adherence to treatment is
needed. Because patient belief, expectation attitude play major role in curing
the disease. If they following the treatment procedures by their own
willingness then definite cure can be obtained. Therefore patients must be
encouraged to overcome this barrier through proper counselling sections that
build their self-confident.
In summary, although majority
of this population shows a good adherence to oral chemotherapy by cancer
outpatients but factors that effect on adherence in a negative manner should
not be taken as diminutive. Those factors must be given a proper attention to
enhance the adherence in a favorable manner.