Optimizing Adherence to Oral Anticancer Agents: Results from an Implementation Mapping Study

TL;DR

This study develops and evaluates strategies to improve patient adherence to oral anticancer medications in real-world settings.

Contribution

A novel implementation mapping approach co-developed practical strategies for improving adherence to oral anticancer agents.

Findings

EHR templates and SOPs were rated most feasible and acceptable for improving adherence.

Leadership buy-in and incremental implementation were emphasized as critical for success.

KPIs were valued for tracking outcomes, but resource constraints and workload were noted as challenges.

Abstract

Clinical trials inform cancer care, yet real-world outcomes often diverge due to patient-related factors, like age, organ dysfunction, and nonadherence to oral anticancer agents (OAAs). While oncology organizations emphasize patient support programs, practical guidance on designing and implementing these programs is limited. We conducted a two-phase, mixed-methods study to enhance the adoption, implementation, and sustainability of an OAA adherence program (OAP). In phase 1, we used implementation mapping (IM) with a multidisciplinary expert panel to develop six strategies: (1) memorandum of understanding (MOU), (2) data-driven presentation, (3) standard operating procedures (SOPs), (4) motivational interviewing (MI) training, (5) electronic health record (EHR) templates, and (6) key performance indicators (KPIs). In phase 2, oncology professionals (n = 34) completed surveys, and a subset (n = 10) participated in interviews to assess feasibility, acceptability, and appropriateness. EHR templates and SOPs were rated as the most feasible and acceptable strategies, while MI training and formal agreements received moderate ratings. Interviews highlighted the importance of leadership buy-in, incremental implementation, and clear documentation. Participants valued KPIs for tracking adherence and outcomes but noted resource constraints and staff workload as challenges. Using IM, we co-developed strategies to activate OAA adherence-focused clinical programs. Tools standardizing care, like EHR templates and SOPs, were highly endorsed. Future work will test these strategies in a hybrid trial to improve real-world oncology outcomes.

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