Patient Preference and Adherence (Nov 2023)
Barriers and Facilitators of Adherence to Oral Anticancer Medications Among Women with Breast Cancer: A Qualitative Study
Abstract
Deborah Obehi Onwusah,1 Elizabeth Bolanle Ojewole,1 Tawanda Manyangadze,2,3 Moses John Chimbari2,4 1Discipline of Pharmaceutical Sciences, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa; 2Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa; 3Geosciences, School of Geosciences, Disasters and Sustainable Development, Faculty of Science and Engineering, Bindura University of Science Education, Bindura, Mashonaland Central, Zimbabwe; 4Department of Public Health, School of Medical and Health Sciences, Great Zimbabwe University, Masvingo, ZimbabweCorrespondence: Deborah Obehi Onwusah, Discipline of Pharmaceutical Sciences, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, KwaZulu-Natal, 4000, South Africa, Email [email protected]: Despite the life-saving benefits of oral anticancer medications (OAMs) to women with breast cancer (BC), adherence remains suboptimal and, in many cases, not well documented. The study examined barriers and facilitators of adherence to OAMs among women receiving BC treatment in Nigeria.Patients and Methods: The study was framed within the World Health Organization (WHO) Multidimensional Model of Adherence. We conducted qualitative in-depth interviews of 16 purposively sampled women in two tertiary hospitals in Southern Nigeria. The interviews were audio-recorded and transcribed verbatim. The interview data were analyzed using the Framework Method.Results: The key barriers to OAM adherence mentioned were socioeconomic factors (high cost of medication) and therapy-related factors (medication side effects). The key facilitating mechanisms for adherence to OAMs mentioned included; (i) patient-related psychosocial factors such as self-encouragement and self-discipline in sticking to the prescription, taking the medication at a particular time each day, receiving practical support from family members; and (ii) healthcare team/system factors such as obtaining an adequate supply of the medication at the pharmacy.Conclusion: Barriers and facilitators to OAM adherence are multidimensional. The study findings highlight the potential benefit of a multifaceted intervention (such as patient education and monitoring or strategies promoting cost-containment and side effects management) to optimize adherence. Therefore, our findings may inform the designing and evaluating of context-specific adherence measures and multifaceted intervention strategies targeting key barriers and approaches that enable adherence to enhance patient outcomes.Keywords: medication adherence, oral antineoplastic agents, breast cancer, women’s experiences
