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PloS One 2020Little is known of acupuncture patients' experiences and opinions of clinical trials, and what may influence their compliance when participating in an acupuncture trial.
INTRODUCTION
Little is known of acupuncture patients' experiences and opinions of clinical trials, and what may influence their compliance when participating in an acupuncture trial.
OBJECTIVES
To explore the potential factors that influence patients' choice and determinants to participate in acupuncture clinical trials.
METHODS
Ten qualitative, in-depth interviews were conducted with patients from acupuncture clinics in Beijing, who had previously participated in acupuncture clinical trials.
RESULTS
Four main themes emerged from the interview data: effectiveness of the treatment, convenience of participating in a trial, doctor-participant communication, and participant acceptance of the treatment (or the trial). Effectiveness of acupuncture in treating the health condition was the most important factor for participant adherence. Pragmatics of treatment schedules, travel and attendance burden, together with confidence in the doctor's ability additionally influenced trial and treatment compliance.
CONCLUSIONS
In-depth interviews suggest that treatment effectiveness, the pragmatics of attending treatment sessions, and the expertise and attitudes of acupuncturists are determining factors of participation and compliance in acupuncture clinical trials. Participants' confidence in, and expectation of, acupuncture may facilitate compliance, while their fear of acupuncture and negative perceptions of the trial's purpose may reduce treatment compliance. Compliance may be facilitated by enhanced doctor-patient communication, personalized treatment programs, and feedback on treatment outcomes.
Topics: Acupuncture Therapy; Adult; Aged; Beijing; Female; Humans; Male; Middle Aged; Patient Compliance; Patient Satisfaction; Physician-Patient Relations; Treatment Outcome
PubMed: 32298368
DOI: 10.1371/journal.pone.0231780 -
Headache May 2014To review and critically evaluate the extant research literature pertaining to adherence in youth and adults with headache and to provide recommendations for future... (Review)
Review
OBJECTIVE
To review and critically evaluate the extant research literature pertaining to adherence in youth and adults with headache and to provide recommendations for future research.
BACKGROUND
This article provides the first systematic review of pediatric headache adherence and updates a previous review of treatment adherence in adults with headache.
DESIGN
Systematic review of empirical literature.
METHODS
A literature search with no date restriction was conducted using PubMed and PsycINFO electronic databases and bibliographies of relevant articles.
RESULTS
Adherence rates in adults with headache range considerably from 25% to 94% across treatment, assessment method, and definition of adherence utilized. Methods to assess adherence included retrospective prescription claims data, paper or electronic diaries, follow-up appointment attendance, written and verbal self-report of general adherence, verbal self-report of adherence over a specific amount of time via in person interview or telephone, validated adherence measures, adherence questionnaires without validation, and counselor ratings of homework. Each methodology and assessment tool demonstrated strengths and weaknesses. No studies have systematically examined medication adherence in children with headache, and the few available studies examining adherence to behavioral treatment have documented adherence rates ranging from 52% to 86%.
CONCLUSIONS
Adherence research in adults with headache is growing, but studies demonstrate a number of methodological shortcomings. Adherence research in children with headache, and adherence intervention research in both adults and children, is scant. Future research should use objective measures of adherence, consider over-the-counter medications and medication overuse, examine demographic, psychological, and behavioral correlates of adherence, assess adherence to botulinum toxin type A, and examine the efficacy of adherence interventions in individuals with headache.
Topics: Databases, Bibliographic; Headache; Humans; Medication Adherence; Patient Compliance
PubMed: 24750017
DOI: 10.1111/head.12353 -
British Medical Journal May 1980
Topics: Epilepsy; Humans; Patient Compliance; Physician-Patient Relations
PubMed: 7388481
DOI: 10.1136/bmj.280.6225.1228-a -
Clinical Journal of Oncology Nursing Apr 2008Many factors contribute to the success or failure of adjuvant therapy, but perhaps one of the most critical is treatment adherence. Patients do not adhere to prescribed... (Review)
Review
Many factors contribute to the success or failure of adjuvant therapy, but perhaps one of the most critical is treatment adherence. Patients do not adhere to prescribed therapy for a variety of reasons, and each one should be uncovered and addressed or managed accordingly to maintain therapeutic levels and give patients the best chance for positive outcomes. Nurses are well positioned to play a central role in promoting adherence by ensuring that patients understand the need for treatment and by identifying any underlying causes of nonadherence to therapy. When the issues are identified and addressed effectively, patients' chances for successful clinical outcomes are greatly improved. This article summarizes the issues surrounding adherence, paying specific attention to adjuvant endocrine therapy for breast cancer, and outlines strategies to reduce nonadherence that nurses can incorporate into clinical practice.
Topics: Administration, Oral; Antineoplastic Agents, Hormonal; Aromatase Inhibitors; Breast Neoplasms; Chemotherapy, Adjuvant; Clinical Competence; Communication; Female; Humans; Motivation; Nurse's Role; Nurse-Patient Relations; Oncology Nursing; Patient Compliance; Patient Education as Topic; Risk Factors
PubMed: 18390458
DOI: 10.1188/08.CJON.213-221 -
BMJ (Clinical Research Ed.) Jul 2006To evaluate the relation between adherence to drug therapy, including placebo, and mortality. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the relation between adherence to drug therapy, including placebo, and mortality.
DESIGN
Meta-analysis of observational studies.
DATA SOURCES
Electronic databases, contact with investigators, and textbooks and reviews on adherence. Review methods Predefined criteria were used to select studies reporting mortality among participants with good and poor adherence to drug therapy. Data were extracted for disease, drug therapy groups, methods for measurement of adherence rate, definition for good adherence, and mortality.
RESULTS
Data were available from 21 studies (46,847 participants), including eight studies with placebo arms (19,633 participants). Compared with poor adherence, good adherence was associated with lower mortality (odds ratio 0.56, 95% confidence interval 0.50 to 0.63). Good adherence to placebo was associated with lower mortality (0.56, 0.43 to 0.74), as was good adherence to beneficial drug therapy (0.55, 0.49 to 0.62). Good adherence to harmful drug therapy was associated with increased mortality (2.90, 1.04 to 8.11).
CONCLUSION
Good adherence to drug therapy is associated with positive health outcomes. Moreover, the observed association between good adherence to placebo and mortality supports the existence of the "healthy adherer" effect, whereby adherence to drug therapy may be a surrogate marker for overall healthy behaviour.
Topics: Drug Therapy; Epidemiologic Methods; Humans; Patient Compliance; Prognosis; Randomized Controlled Trials as Topic
PubMed: 16790458
DOI: 10.1136/bmj.38875.675486.55 -
Psychological Assessment Mar 2013Fidelity measurement is critical for testing the effectiveness and implementation in practice of psychosocial interventions. Adherence is a critical component of... (Review)
Review
Fidelity measurement is critical for testing the effectiveness and implementation in practice of psychosocial interventions. Adherence is a critical component of fidelity. The purposes of this review were to catalogue adherence measurement methods and assess existing evidence for the valid and reliable use of the scores that they generate and the feasibility of their use in routine care settings. A systematic literature search identified articles published between 1980-2008 reporting studies of evidence-based psychosocial treatments for child or adult mental health problems, including mention of adherence or fidelity assessment. Coders abstracted data on the measurement methods and clinical contexts of their use. Three hundred forty-one articles were reviewed, in which 249 unique adherence measurement methods were identified. These methods assessed many treatment models, although more than half (59%) assessed cognitive behavioral treatments. The measurement methods were used in studies with diverse clientele and clinicians. The majority (71.5%) of methods were observational. Information about psychometric properties was reported for 35% of the measurement methods, but adherence-outcomes relationships were reported for only 10%. Approximately 1/3 of the measures were used in community-based settings. Many adherence measurement methods have been used in treatment research; however, little reliability and validity evidence exists for the use of these methods. That some methods were used in routine care settings suggests the feasibility of their use in practice; however, information about the operational details of measurement, scoring, and reporting is sorely needed to inform and evaluate strategies to embed fidelity measurement in implementation support and monitoring systems.
Topics: Humans; Mental Disorders; Patient Compliance; Psychometrics; Treatment Outcome
PubMed: 22888981
DOI: 10.1037/a0029715 -
Current Pain and Headache Reports Jan 2019In other disease states, adherence to behavioral therapies has gained attention, with a greater amount of studies discussing, defining, and optimizing adherence. For... (Review)
Review
PURPOSE OF REVIEW
In other disease states, adherence to behavioral therapies has gained attention, with a greater amount of studies discussing, defining, and optimizing adherence. For example, a meta-analysis formally discussed adherence in 25 studies of CBT for 11 different disorders, with only 6 of the 25 omitting addressing or defining adherence. Many studies have discussed the use of text messages, graph-based adherence rates, and email/telephone reminders to improve adherence. This paper examined the available literature regarding adherence to behavioral therapy for migraine as well as adherence to similar therapies in other disease states. The goal of this research is to apply lessons learned from adherence to behavioral therapy for other diseases in better understanding how we can improve adherence to behavioral therapy for migraine.
RECENT FINDINGS
Treatment for migraine typically includes both pharmacologic and non-pharmacologic therapies, including progressive muscle relaxation (PMR), cognitive behavioral therapy (CBT), and biofeedback. Behavioral therapies have been shown to significantly reduce headache frequency and intensity, but high attrition rates and suboptimal adherence can undermine their efficacy. Traditionally, adherence to behavioral therapy has been defined by self-report, including paper headache diaries and assignments. In person attendance has also been employed as a method of defining and monitoring adherence. With the advent of personal electronics, measurements of adherence have shifted to include electronic-based methods such as computer-based programs and mobile-based therapies. Furthermore, some studies have taken advantage of electronic methods such as email reminders, push notifications, and other mobile-based reminders to optimize adherence. The JITA-I, a novel method of engaging individual patient adherence, has also been suggested as a possible method to improve adherence by tailoring engagement with a mobile health app-based on patient input. These novel methods may be utilized in behavioral therapy for migraine for further optimizing adherence. Few intervention studies to date have addressed the optimal ways to impact adherence to migraine behavioral therapy. Further research is required regarding adherence with behavioral therapies, specifically via mobile health interventions to better understand how to define and improve adherence via this novel forum. Once we are able to understand optimal methods of tracking adherence, we will be better equipped to understand the role of adherence in shaping outcomes for behavioral therapy in migraine.
Topics: Cognitive Behavioral Therapy; Computers, Handheld; Feasibility Studies; Humans; Internet; Migraine Disorders; Patient Compliance; Wearable Electronic Devices
PubMed: 30661135
DOI: 10.1007/s11916-019-0739-3 -
CA: a Cancer Journal For Clinicians 2009Given the recent significant increase in the use of oral therapies in cancer management, an understanding of patients' adherence to and persistence with oral therapy is... (Review)
Review
Given the recent significant increase in the use of oral therapies in cancer management, an understanding of patients' adherence to and persistence with oral therapy is crucial. Nonadherence and early cessation may be substantial barriers to the delivery of valuable therapies, and may impair health. Potential obstacles to adherence and persistence include personal characteristics, treatment features, and system factors. Techniques for measuring adherence and persistence include self-report, pill counts, microelectronic monitoring systems (MEMS), prescription database analysis, and the assessment of serum or urine drug levels. This review article describes available data regarding adherence and persistence among patients with cancer, as well as studies of interventions to improve adherence. All reports of studies of adherence with oral cancer therapy that the authors could find on PubMed or in the reference sections of these PubMed-located articles were included. Adherence and persistence rates ranged from 16% to 100% with different therapies and different methods of measurement. Studies that included educational, behavioral, and multidimensional interventions to improve adherence were also described.
Topics: Administration, Oral; Adult; Antineoplastic Agents; Child; Clinical Trials as Topic; Evidence-Based Medicine; Health Behavior; Humans; Medication Adherence; Motivation; Neoplasms; Patient Compliance; Patient Education as Topic
PubMed: 19147869
DOI: 10.3322/caac.20004 -
Human Reproduction Update 2013The goal of this systematic review and meta-analysis was to estimate the rate of compliance with assisted reproductive technologies (ART) and examine its relationship... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The goal of this systematic review and meta-analysis was to estimate the rate of compliance with assisted reproductive technologies (ART) and examine its relationship with treatment success rates.
METHODS
Six databases were systematically searched from 1978 to December 2011. Studies were included if they reported data on patient progression through three consecutive standard ART cycles. Compliance was estimated for the first three ART cycles (typical ART Regimen Compliance, TARC) and after the first and the second failed cycles (CAF1, CAF2). Treatment success rates for all patients who started ART and for those who fully complied with the three ART cycles were estimated.
RESULTS
Ten studies with data for 14 810 patients were included. TARC was 78.2% [95% confidence interval (CI) 68.8-85.3%], CAF1 was 81.8% (73.3-88.1%) and CAF2 was 75.3% (68.2-81.2%). The overall success rate was 42.7% (32.6-53.6%) for all patients starting ART and 57.9% (49.4-65.9%) for those who complied with three ART cycles. Compliance rates did not vary according to study quality, but TARC was higher for studies that reported data on doctor-censored patients versus those that did not (84.2% 95% CI 75.5-90.2 versus 70.6% 95% CI 58.3-80.5, P = 0.043). Analysis of funnel plots and the Egger test indicated publication bias for CAF1.
CONCLUSIONS
Findings from this meta-analysis should reassure clinics and patients that most patients are able to comply with three cycles of ART. Compliers could increase their chances of success by as much as 15%. A more detailed assessment of compliance requires monitoring long-term treatment trajectories through the creation of national registries.
Topics: Female; Humans; Infertility; Male; Patient Compliance; Reproductive Techniques, Assisted
PubMed: 23178304
DOI: 10.1093/humupd/dms045 -
BMC Psychiatry Nov 2013Treatment resistance is an omnipresent frustration in eating disorders. Attempts to identify the features of this resistance and subsequently develop novel treatments... (Review)
Review
BACKGROUND
Treatment resistance is an omnipresent frustration in eating disorders. Attempts to identify the features of this resistance and subsequently develop novel treatments have had modest effects. This selective review examines treatment resistant features expressed in core eating disorder psychopathology, comorbidities and biological features. Novel treatments addressing resistance are discussed.
DESCRIPTION
The core eating disorder psychopathology of anorexia nervosa becomes a coping mechanism likely via vulnerable neurobiological features and conditioned learning to deal with life events. Thus it is reinforcing and ego syntonic resulting in resistance to treatment. The severity of core features such as preoccupations with body image, weight, eating and exercising predicts greater resistance to treatment. Bulimia nervosa patients are less resistant to treatment with treatment failure related to greater body image concerns, impulsivity, depression, severe diet restriction and poor social adjustment. For those with binge eating disorder overweight in childhood and high emotional eating predicts treatment resistance. There is suggestive data that a diagnosis of an anxiety disorder and severe perfectionism may confer treatment resistance in anorexia nervosa and substance use disorders or personality disorders with impulse control problems may produce resistance to treatment in bulimia nervosa. Traits such as perfectionism, cognitive inflexibility and negative affect with likely genetic influences may also affect treatment resistance. Pharmacotherapy and novel therapies have been developed to address treatment resistance. Atypical antipsychotic drugs have shown some effect in treatment resistant anorexia nervosa and topiramate and high doses of SSRIs are helpful for treatment of resistant binge eating disorder patients. There are insufficient randomized controlled trials to evaluate the novel psychotherapies which are primarily based on the core psychopathological features of the eating disorders.
CONCLUSION
Treatment resistance in eating disorders is usually predicted by the severity of the core eating disorder psychopathology which develops from an interaction between environmental risk factors with genetic traits and a vulnerable neurobiology. Future investigations of the biological features and neurocircuitry of the core eating disorders psychopathology and behaviors may provide information for more successful treatment interventions.
Topics: Adaptation, Psychological; Emotions; Feeding and Eating Disorders; Humans; Patient Compliance; Psychotherapy
PubMed: 24199597
DOI: 10.1186/1471-244X-13-292