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. Because
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 (Timmers et al 2017, Kav, 2017, Kimura et
al, 2014, Feiten et al, 2016, Mathes et al,
2014). 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 29.2% 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 the treatment
procedure of the oncologist and do not like to talk with anyone apart from
their oncologist. They have kept more trust on doctor. 63.4% of total
population believes taking medicine was not a trouble. For above instances
sufficient adherence were acquired. But it is better if adherent population can
be increased further through counselling.
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 considerable amount of factors affect for
the adherence of the other factors too. Therefore this type of factors should
be given a priority when enhancing adherence.
As discussed earlier
questionnaire 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 comparatively high average percentage for full adherence
had acquired by patient intentional and patient’s unintentional factors. Patient’s
intentional non adherence occur due to capacity and resource limitations (jimmy
et al,2011). Here majority of population showed full adherent to
the intentional factors and that’s a good sign of adherence. It was clear that
when discussing with them they were given more attention to avoid
unintentionally occurring non-adherent factors.
Full adherence was not
achieved in a sufficient level by medication related and health care system
related barriers. That may be due to lack of knowledge about the medications
and miscommunication about the treatment plan. Therefore it’s necessary to
arrange counselling sections for the patients in order to overcome medication
and health care system related factors giving more information about
medications they are currently taking and guiding them to communicate with the
oncologist whenever they are in a confusion related to the disease. Thus it
leads to enhance the adherence.
Significantly low level
of adherence obtained for patient attitudes. This adherence issue can be
overcome if proper adherence to treatment is needed. Because patient’s 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.
For this population
sufficient level of adherence had achieved. Adherent percentage is 72.04%.
Majority of the population adherent to the treatment. But this adherent
population can further lead for a well adherent population by arranging
counselling sections, having separate programs to discuss their problems with
health care professionals and by introducing adherent agents like calendars and
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.