Oral Chemotherapy Adherence

In the past, chemotherapy has been given predominantly intravenously, which allowed for multiple nursing therapeutic interactions. Currently oral chemotherapy is increasing in use at a rate of 40%, with an escalating increase occurring rapidly.  In order to ensure adherence to these oral  medications, an in-depth synthesis of the literature was performed, with the gained knowledge being used for the development of a quality project. This evidenced based practice project has been implemented in a large oncology-hematology practice, which includes one central urban facility and five rural sites. 

The following people are at a higher risk for decreased compliance: newly diagnosed/overwhelmed, older age, high co-morbidities, financial issues, decreased symptom management, poor education, and low understanding of why the medications are necessary; therefore our quality project has adequately covered these issues. 

The follorwing is a descriptions of this project. Each patient who is beginning oral chemotherapy is given an initial educational teaching session with a nurse practitioner. A clear understanding of the medications is taught with a review of the side effects, safety factors, medication interactions, dosage, cost, why the medication is necessary, and where/when the medication should arrive at their home. This session is taped verbally, with written instructions and appropriate educational booklets given, so the patients and their care givers can refer to this information as necessary. During this session, the patient and their care givers are given a spread sheet of the medications, explaining exactly when and how the medications are to be given. After this session, the nurses then schedule a telephone call to the patients two weeks after the start of these medications. During these telephone interviews, the patient's understanding of why they are taking their medications is assessed, along with a review of any problems, such as: side effects, costs, compliance, knowledge, and safety issues. When problems are found, a reminder is sent through our electronic medical records (EMR), to the providers. If there are issues, along with the reminder, the patients are also made appointments in our nurse-run clinic or with their providers. If there are no problems, they continue to receive calls every four weeks thereafter, with interventions as necessary. 

An oral chemotherapy questionaire is completed after these calls and recorded in our EMR. The overall information from these calls is tracked through the questionaires in the EMR. The tracking is monitored in control charts; when issues are found, changes are made. 

The project implementation process included multiple employee educational meetings. Due to the involvment of varying departments these classes included: physicians, administration, nursing, scheduling, financial, and information technology. The success was contingent upon the employees understanding of why this project was so important. Through the employees new understanding, they promptly agreed to participate in this endeavor.

We have found through careful use of the evidence, nurses are able to continue their therapeutic interactions with patients, even if this is through a different form of action than with the intravenous chemotherapy. The success of this project is being shared to help other practices have the opportunity to adopt a similar project.