How APRNs Can Support Patients During Oral Agent Treatment
Oral agents offer many patient benefits, one of which is the freedom to take the medication at home, allowing them to keep their daily routine and gain additional time and independence they would have spent traveling to the clinic for treatment.
However, with that freedom comes additional patient responsibilities, and preparation from advanced practice RNs (APRNs) is necessary to ensure patients can self-manage symptoms and adhere to administration regimens. Research shows (https://doi.org/10.1188/17.CJON.157-160) that patients experience severe symptoms on oral agents that may cause them to miss as many as one-third of the prescribed doses. How can APRNs empower patients to adhere to the treatment plan and ensure safe symptom self-management at home?
Right Therapy, Right Patient
The first step is to decipher the right therapy for the right patient. Motivational interviewing, patient-focused interventions, and patient education may help prevent most causes of nonadherence and delayed reporting of adverse reactions by helping APRNs ensure that the right patient is getting the right therapy for their situation—and to promptly intervene if needed.
Motivational interviewing helps providers and patients to partner in decision making. It allows the space to discuss therapy options, expected barriers, and strategies for adherence and self-symptom management. Figure 1 shows how motivational interviewing compares with more traditional counseling methods.
Brush Up on the Facts
It’s also important for APRNs to have a clear understanding of oral adherence and the factors most likely to interfere with treatment. The ONS Oral Adherence Toolkit (http://www.ons.org/sites/default/files/ONS_Toolkit_ONLINE.pdf) strategies and resources APRNs can use to facilitate and monitor adherence among patients with cancer related to:
- Safety concerns (e.g., drug-drug and food-drug interactions, adverse effects)
- Pharmacy and reimbursement or financial resources
- Monitoring for adherence
- Motivational interviewing and counseling
- Change theory and helping patients to change nonadherence into adherence
Patient Education
Patient involvement in goal setting, interventions, and their own education acknowledges that they are a participant in their own care. ONS offers patient- and caregiver-centered tools curated specifically for oral agents.
- The Oral Chemotherapy Guide (http://www.onsoralchemoguide.com/) is a video series that helps patients and families understand the importance of safe treatment administration in the home and how to manage the side effects of oral anticancer agents.
- Oral Chemotherapy Education (http://www.oralchemoedsheets.com/) offers medication-specific, easy-to-use, printable sheets that outline the dose and schedule, storage and handling, drug or food interactions, and possible side effects with management recommendations.