Barriers and facilitators associated with implementing interventions to support oral anticancer agent adherence in academic and community cancer center settings.

Purpose: The goal of this study is to determine barriers and facilitators to the implementation of medication adherence interventions to support cancer patients taking novel, targeted oral anticancer agents (OAAs).
Methods: We conducted qualitative interviews using a semi-structured guide from the Consolidated Framework for Implementation Research (CFIR). We used purposive sampling to identify clinicians (physicians, pharmacists, nurse practitioners, nurses) and administrators (leadership from medicine, pharmacy, and nursing) who delivered care and/or oversee care delivery for patients with chronic leukemia prescribed an OAA.
Results: A total of 19 individuals participated in an interview (12 clinicians and 7 administrators), with 10 primarily employed by an academic cancer center; 5 employed by the community cancer center; and 4 employed by the integrated health-system specialty pharmacy. Barriers identified included low awareness of adherence interventions, difficulty in adherence measurement, complexity of designing and implementing a structured adherence intervention, and competing priorities. Facilitators identified included support of hospital administrators, value for pharmacists, and willingness to embrace change. Participants also made recommendations moving forward including standardizing workflow, designating champions, iterating implementation strategies, and improving communication between clinicians and with patients.
Conclusion: Individual and system level factors were identified as determinants of implementation effectiveness of medication adherence interventions. A multidisciplinary advisory panel will be assembled to design comprehensive and actionable strategies to refine and implement a structured intervention to improve medication adherence in cancer patients.
Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Benyam Muluneh is a consultant for Servier and his spouse is employed by Novartis; Michele Muir *and JB Collins are* a post-doctoral fellow with GlaxoSmithKline, Emily Mackler has research funding with Astra Zeneca; William Wood has research funding with Genentech and Pfizer; Leah Zullig has research funding with Proteus Digital Health, PhRMA Foundation and is a consultant for Novartis and Pfizer;
(Copyright: © 2023 Muluneh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)