Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Patient-generated strategies for strengthening adherence to multiple medication regimens after allogeneic stem cell transplantation: a qualitative study

Bone Marrow Transplantation volume 57, pages 1455–1457 (2022)Cite this article

Subjects

Adherence to the multiple medication regimen typically prescribed after allogeneic cell transplant (alloHCT) can be difficult for patients, and studies report inconsistent adherence rates [1, 2]. These regimens are complicated and the new learning and behavioral tasks required following alloHCT are challenging, despite the assistance of caregivers [3, 4]. As a first step towards developing theory- and evidence-based interventions for alloHCT patients, we utilized the IMB (Information-Motivation-Behavioral Skills model) [5] and qualitative research methods to develop an understanding of adherence challenges and strategies employed by patients who have been prescribed multiple medications.

The study was reviewed and approved by the local IRB (HS# 12-00453) and followed qualitative research guidelines (see Supplementary Material 1). Patients in the hematology and oncology department were invited to participate by healthcare providers during preparation for their first transplant and were followed for six months after their first post-transplant hospital discharge. Eligible participants included adults 18 years or older with leukemia or lymphoma cancers who spoke English, Spanish or Mandarin, and received alloHCT for the first time. Patients were typically prescribed a multiple medication regimen of 18 or more different medications with 24 or more pills per day as a part of the post-discharge self-care regimen, which also included frequent hospital visits, following strict dietary and hydration requirements, hygiene practices and social distancing [3]. We conducted individual, semi-structured in-depth interviews to allow participants to fully describe their post-transplant experiences. This approach involves the elicitation of information from participants to identify specific needs [6]. The interviews covered a wide range of questions about home care, adherence to medication and other recommended behaviors, information, skills, social motivation, and strategies (see Supplementary Material 2 for interview guide). Participants were scheduled for interviews 3–6 months after their first hospital discharge. We conducted interviews face-to-face during hospital visits or by telephone depending on the schedule and health status of participants. Two interviewers facilitated a conversational experience: one focused on conducting the interview, while the other took notes and recorded the interview. The interview lasted 40–60 min, and all interviews were audio recorded, stored in a password-secured computer drive, and transcribed.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Data availability

The Supplementary Materials contain detailed information related to the data supporting the findings of the study and the raw data supporting the findings of the study are available from the corresponding author upon reasonable request.

References

  1. Lehrer J, Brissot E, Ruggeri A, Dulery R, Vekhoff A, Battipaglia G, et al. Medication adherence among allogeneic hematopoietic stem cell transplant recipients: a pilot single-center study. Bone Marrow Transpl. 2018;53:231–3.

    Article  CAS  Google Scholar 

  2. Morrison CF, Martsolf DM, Wehrkamp N, Tehan R, Pai AL. Medication adherence in hematopoietic stem cell transplantation: a review of the literature. Biol Blood Marrow Transpl. 2017;23:562–8.

    Article  Google Scholar 

  3. Tomblyn M, Chiller T, Einsele H, Gress R, Sepkowitz K, Storek J, et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transpl. 2009;15:1143–238.

    Article  CAS  Google Scholar 

  4. Posluszny DM, Bovbjerg DH, Agha ME, Hou J-Z, Raptis A, Boyiadzis MM, et al. Patient and family caregiver dyadic adherence to the allogeneic hematopoietic cell transplantation medical regimen. Psychooncology. 2018;27:354–8.

    Article  Google Scholar 

  5. Fisher JD, Fisher WA, Amico RK, Harman JJ. An information-motivation-behavioral skills model of adherence to antiretroviral therapy. Health Psychol. 2006;25:462–73.

    Article  Google Scholar 

  6. Fisher JD, Fisher WA. Changing AIDS-risk behavior. Psychol Bull. 1992;111:455–74.

    Article  CAS  Google Scholar 

  7. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.

    Article  Google Scholar 

  8. Chou WS, Hamel LM, Thai CL, Debono D, Chapman RA, Albrecht TL, et al. Discussing prognosis and treatment goals with patients with advanced cancer: a qualitative analysis of oncologists’ language. Health Expect. 2017;20:1073–80.

    Article  Google Scholar 

  9. Mifsud M, Molines M, Cases A-S, N’Goala G. It’s MY health care program: enhancing patient adherence through psychological ownership. Soc Sci Med. 2019;232:307–15.

    Article  Google Scholar 

  10. Song Y, Chen S, Roseman J, Scigliano E, Redd WH, Stadler G. It takes a team to make it through: the role of social support for survival and self-care after allogeneic hematopoietic stem cell transplant. Front Psychol. 2021;12:821.

    Google Scholar 

  11. Warner LM, Schüz B, Aiken L, Ziegelmann JP, Wurm S, Tesch-Römer C, et al. Interactive effects of social support and social conflict on medication adherence in multimorbid older adults. Soc Sci Med. 2013;87:23–30.

    Article  Google Scholar 

  12. Park CL. Making sense of the meaning literature: an integrative review of meaning making and its effects on adjustment to stressful life events. Psychol Bull. 2010;136:257–301.

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank Luis Isola, Shakira Riley, Rita Jakubowski, William Redd, and all the staff members of the Bone Marrow Transplant service at the Mount Sinai Hospital for their generous support of this study. We would also like to thank the research team at Columbia University, including Laura Guttentag, Marie Chesaniuk, and Alexandra Yogman, for their support. Finally, we also thank Louise Locock at University of Aberdeen for her invaluable advice on qualitative research.

Author information

Authors and Affiliations

  1. Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA

    Yaena Song

  2. Teachers College, Columbia University, New York, NY, USA

    Yaena Song, Stephanie Chen & John P. Allegrante

  3. Charité – Universitätsmedizin, Berlin, Germany

    Julia Roseman & Gertraud Stadler

  4. Mount Sinai Hospital, New York, NY, USA

    Eileen Scigliano

  5. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Eileen Scigliano

  6. Mailman School of Public Health, Columbia University, New York, NY, USA

    John P. Allegrante

  7. Graduate School of Arts and Sciences, Columbia University, New York, NY, USA

    Gertraud Stadler

  8. University of Aberdeen, Aberdeen, UK

    Gertraud Stadler

Authors
  1. Yaena Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephanie Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Julia Roseman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eileen Scigliano
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John P. Allegrante
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gertraud Stadler
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

GS designed the research project. ES and JA advised with designing the study and ES also helped conduct the study. YS and GS developed the research questions. YS, SC, and GS collected and analyzed data. YS wrote the initial draft of manuscript. YS, SC, JR, JA and GS contributed to writing and revising the manuscript. YS, JA, and GS revised the manuscript for the final submission. All authors have contributed, reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Yaena Song.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Song, Y., Chen, S., Roseman, J. et al. Patient-generated strategies for strengthening adherence to multiple medication regimens after allogeneic stem cell transplantation: a qualitative study. Bone Marrow Transplant 57, 1455–1457 (2022). https://doi.org/10.1038/s41409-022-01727-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41409-022-01727-1

Search

Advanced search

Quick links