People with advanced cancer are often prescribed complex medication regimens. This makes the process of medicines management (incorporating prescribing, dispensing, adherence and medication review) challenging for this patient population. The overall aim of this thesis was to determine how effectively medicines are managed in the home setting and to explore how medicines management may be optimised in this patient population, from the perspectives of healthcare professionals, patients and those involved in caring for people with advanced cancer (carers, family members and relevant others).
Qualitative and quantitative methodologies were used throughout the four studies described in this thesis. The first qualitative study employed face-to-face semistructured interviews with patients with advanced cancer and their carers to explore the main issues in managing medications in the home setting. A quantitative questionnaire study was undertaken to investigate medication adherence and beliefs about medication in community-dwelling patients with advanced cancer. A systematic review was undertaken to determine the effectiveness of interventions in improving medication adherence in community-dwelling patients with cancer. Finally, a mixed method study, using postal questionnaires and semi-structured interviews, was conducted with pharmacists to explore their approaches to caring for people with advanced cancer approaching the end of life. All qualitative studies were analysed using thematic analysis.
Patients with advanced cancer and their carers struggled with the daily task of managing medications. Analysis of textual data revealed four core themes; medication management, medication adherence, medication review and pharmacy involvement. Patients had varying opinions of how much medication-related information they needed, however carers all expressed a need for further information. Furthermore medication non-adherence appears to be an issue in this population. A more in depth look at medication adherence found that medication adherence in this population is sub-optimal, with full adherence reported by only 20% of participants. Younger adults (aged 45-54 years) exhibited the lowest rate of medication adherence (p= 0.004). The systematic review identified a lack of good-quality research to inform answers to the question of how to improve medication adherence in community-dwelling patients with cancer. None-the-less, complex interventions combining patient education and intensified patient care may be beneficial in enhancing medication adherence as all four of the studies that incorporated patient education in conjunction with intensified patient care led to significantly better medication adherence. Analysis of the interviews conducted with community pharmacists revealed three core themes; the current and future roles of community pharmacy, lack of integration and communication and beliefs about confidence, knowledge and training. This study found that pharmacists play an important role in providing care for patients with advanced cancer and their carers, particularly describing their emotional role, which often extended into providing support in a family’s bereavement. In some cases, despite feeling embedded in the community, pharmacists felt isolated from other healthcare professionals. However the emerging role of the general practice-based pharmacist appears to be improving communication between GPs and community pharmacists. Pharmacists expressed a desire for a more enhanced role in provision of care to patients. However, the absence of financial incentives and adequate training and education to support pharmacists are currently hindering this role.
The findings demonstrate that medicines management for community-dwelling patients with advanced cancer is a complex issue. Further training, education and support for patients, carers and healthcare professionals are required to optimise the use of medications in this growing patient population.
|Date of Award||Dec 2020|
|Sponsors||Northern Ireland Department for the Economy|
|Supervisor||Carole Parsons (Supervisor) & Martin Dempster (Supervisor)|