{"id":3650,"date":"2016-05-03T16:26:28","date_gmt":"2016-05-03T21:26:28","guid":{"rendered":"http:\/\/kbicblog.com\/blog\/pharmacy\/?p=3650"},"modified":"2016-09-14T18:36:23","modified_gmt":"2016-09-14T23:36:23","slug":"motivational-interviewing-can-improve-adherence-to-oral-cancer-agents","status":"publish","type":"post","link":"https:\/\/kbicblog.com\/pharmacy\/industry-news\/motivational-interviewing-can-improve-adherence-to-oral-cancer-agents\/","title":{"rendered":"Motivational Interviewing Can Improve Adherence to Oral Cancer Agents"},"content":{"rendered":"

Motivational Interviewing Can Improve Adherence to Oral Cancer Agents<\/h2>\n

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By Kate O’Rourke<\/strong><\/p>\n

Dallas, TX\u00a0| Posted May 3, 2016<\/strong><\/p>\n

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Do you have patients who are nonadherent to their oral cancer therapy? Have you tried motivational interviewing, which has been most widely used for patients with substance abuse?<\/p>\n

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\u201cThere is a lot of information out there showing that motivational interviewing can be applied to everything, including medication adherence,\u201d said Jenny Van Amburgh, PharmD, a clinical professor and the residency program director at Northeastern University School of Pharmacy, in Boston. She presented a primer on the topic during a talk at the 2015 annual conference of the Hematology\/Oncology Pharmacy Association.<\/p>\n

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A variety of intrinsic and extrinsic factors can affect adherence to medication, including lack of symptoms, bothersome side effects and high medical costs (Table). First described in 1983, the concept of motivational interviewing sprang from the recognition that problem drinkers who eventually went sober experienced the same six cycles of change (Am Psychol <\/em>2009;64[6]:527-537). The first is precontemplation, of which a person does not intend to change anytime soon, followed by contemplation, when a person can be strongly inclined to change a behavior but doesn\u2019t know how to begin. In the preparation stage, a person intends to act in the near future. In the action stage, a person takes steps toward making a change. In the maintenance stage, the new behavior has been sustained over a period of time, and then there is the possibility of a sixth stage, relapse.<\/p>\n

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Table. Factors That Affect Medication Adherence<\/td>\n<\/tr>\n
Health system<\/td>\n\n
    \n
  • Relationship with health care team<\/li>\n
  • High medical costs<\/li>\n
  • Long wait times<\/li>\n
  • Missed appointments<\/li>\n
  • Restricted formularies<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Social\/economic<\/td>\n\n
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  • Limited English proficiency<\/li>\n
  • Lack of family\/social support<\/li>\n
  • Medication costs<\/li>\n
  • Cultural\/lay beliefs<\/li>\n
  • Limited access to resources<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Therapy related<\/td>\n\n
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  • Complexity of treatment<\/li>\n
  • Social stigma<\/li>\n
  • Interference with lifestyle<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Patient related<\/td>\n\n
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  • Visual, hearing, cognitive, swallowing<\/li>\n
  • Dexterity<\/li>\n
  • Motivation\/confidence<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Condition related<\/td>\n\n
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  • Lack of symptoms<\/li>\n
  • Severity of disease<\/li>\n
  • Depression<\/li>\n
  • Other chronic conditions<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Source: American College of Preventive Medicine (www.acpm.org\/?MedAdherTT_ClinRef<\/a>).<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n
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Motivational interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. A variety of skills can be used to help move individuals through the stages of change. \u201cWhen you are using motivational interviewing skills, you need to have open-ended questions, affirmations that are sincere and true, and active listening and reflection. It is a learned process. It takes time,\u201d Dr. Van Amburgh said. \u201cYou are letting the patient do all of the talking, and you are listening to what the patient is saying and trying to figure out how to move them into action.\u201d<\/p>\n

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You might say, \u201cIt must be difficult to take your medication every day if it makes you feel worse. About how many times per week would you say you miss your medication?\u201d Dr. Van Amburgh typically tells patients that she has difficulty remembering her daily vitamin, as a way of relating to patients.<\/p>\n

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Clinicians can reflect on words and body language. \u201cYou can say, \u2018I noticed when we were discussing these new medications, you appeared upset and frustrated. What are you thinking about?\u2019\u201d Dr. Van Amburgh said.<\/p>\n

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Sometimes just getting patients into the clinic can get them to buy in, if clinicians can follow up with something such as, \u201cI\u2019m glad you came into the clinic today for another appointment, and I appreciate your honesty about how you take your medications.\u201d You are affirming that your patients shared their problems with you, but you are not passing judgment and are engaging them to tell you more, she noted.<\/p>\n

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Providing quick summaries at the end of a conversation can be very helpful, such as, \u201cWe discussed a couple ways to help you take your medication; which would you be most interested in trying?\u201d Dr. Van Amburgh said. \u201cThe difference is I am not telling the patient; the patient is leading the conversation. Motivational interviewing is about having patients be their own advocate and making them more in control of what they are doing. The more they are in control, the more they are likely to do it.\u201d<\/p>\n

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Prompting Change<\/strong><\/div>\n
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Dr. Van Amburgh discussed a few of the motivational interviewing principles of change: rolling with resistance, expressing empathy, developing discrepancy and supporting self-efficacy. To roll with resistance and express empathy, you might say, \u201cTaking medications can be difficult, especially when they make you feel worse. Let me suggest an idea that you could consider to see if it would help. If it works, then great, but if not, feel free to let me know so we can think about something else.\u201d<\/p>\n

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To develop discrepancy, clinicians can evoke the patient\u2019s own reason for and against change, such as, \u201cWhat difficulties have you encountered when trying to take your medications every day?\u201d<\/p>\n

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Pharmacists can support self-efficacy using importance\/confidence scales. \u201cHow important is it to you to take all your medications every day on a scale of 1 to 10, with 0 being not important and 10 being very important? How confident are you that you can take your medications every day using the same scale? What would it take to move you from 7 to 8 on the scale, and what do you think you would need to do it?\u201d Dr. Van Amburgh said.<\/p>\n

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Dr. Van Amburgh pointed out that she had only covered the very tip of the iceberg of motivational interviewing. \u201cYou can take courses for weeks on motivational interviewing,\u201d she said, noting that it takes time to implement in practice.<\/p>\n

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The use of motivational interviewing for cancer patients is growing. The Oncology Nursing Society includes motivational interviewing techniques in their Oral Adherence Toolkit (www.ons.org\/practice-resources\/clinical-practice\/ons-toolkit-helps-patients-adhere-oral-therapies-cancer). According to Stephanie Wheeler, PhD, an assistant professor of health policy and management at University of North Carolina Gillings School of Global Public Health, in Chapel Hill, who studies medication adherence, motivational interviewing is a promising technique for addressing many types of behavior change in cancer patients or survivors, including diet, exercise, smoking cessation and cancer-related stress.<\/p>\n

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Source:\u00a0http:\/\/www.pharmacypracticenews.com\/Clinical\/Article\/04-16\/Motivational-Interviewing-Can-Improve-Adherence-to-Oral-Cancer-Agents\/35979<\/a><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Motivational Interviewing Can Improve Adherence to Oral Cancer Agents                     By Kate O’Rourke Dallas, TX\u00a0| Posted May 3, 2016 Do you have patients who are nonadherent to their oral cancer therapy? Have you tried motivational interviewing, which has been most widely …<\/p>\n","protected":false},"author":26,"featured_media":3651,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"ngg_post_thumbnail":0,"footnotes":""},"categories":[319,54,318],"tags":[41,8,10,87,85,86,34,15,6,22,25,23,59],"class_list":["post-3650","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-education","category-industry-news","category-management","tag-healthcare","tag-kayebassman-international-corp","tag-kayebassman-www-kbic-comblog","tag-motivational-interviewing","tag-motivational-interviewing-can-improve-adherence-to-oral-cancer-agents","tag-patients","tag-pharmaceutical-industry","tag-pharmacists","tag-pharmacy","tag-pharmacy-jobs","tag-pharmacy-news","tag-pharmacy-recruitment","tag-pharmd","column","threecol","has-thumbnail"],"yoast_head":"\nPharmacy Recruiting<\/title>\n<meta name=\"description\" content=\"Motivational Interviewing Can Improve Adherence to Oral Cancer Agents. 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