P09.31 Adherence to Treatment Recommendations from Multidisciplinary Tumor Boards

Abstract Background: Adherence to nonmedication recommendations is typically low, as seen in various health populations. Because literature on adherence to treatment recommendations made after neuropsychological testing in multiple sclerosis (MS) is lacking, this study evaluated adherence and reasons for nonadherence. Relationships between adherence to recommendations and various other factors in patients with MS were also evaluated. Methods: Of 66 adult patients seen for neuropsychological testing at an MS center, 55 were eligible for this study. Forty-five patients (mean age, 43.4 years; 75.6% women) were reached by phone, and all agreed to an interview involving questions regarding adherence to treatment recommendations. Other information was obtained through retrospective medical record review. Results: Overall self-reported adherence to recommendations made from neuropsychological testing was 38%. Adherence rates varied by recommendation type: psychopharmacological management had the highest rate (80%), and referrals for cognitive rehabilitation had the lowest (6.5%). Reasons for nonadherence included needing more information and wanting to speak with one's physician regarding the recommendations. Adherence was associated with patients' ability to spontaneously recall at least some of their recommendations and with receiving both a written report and a phone call with test results. Conclusions: Adherence to recommendations made after neuropsychological testing for patients with MS is low. Points of intervention may be to give directed feedback for each recommendation and to provide both a written report and a phone call with results and recommendations. Asking patients to repeat back the recommendations may be a simple and efficient way to increase understanding and improve adherence.

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Real-world experience of treatment decision-making in carotid stenosis in a neurovascular board

Neurology ◽

10.1212/wnl.0000000000004151 ◽

2017 ◽

Vol 89 (4) ◽

pp. 399-407 ◽

Cited By ~ 3

Author(s):

David Leander Rimmele ◽

Axel Larena-Avellaneda ◽

Anna C. Alegiani ◽

Michael Rosenkranz ◽

Nils Ole Schmidt ◽

...

Keyword(s):

Decision Making ◽

Carotid Artery ◽

Medical Management ◽

Treatment Strategies ◽

Treatment Decision ◽

Treatment Recommendations ◽

Adherence To Treatment ◽

Treatment Decision Making ◽

Time Period ◽

Ica Stenosis

Objective:To describe our experience with consensus-based decision-making for treatment of internal carotid artery (ICA) stenosis by neurologists, interventional neuroradiologists, vascular surgeons, and neurosurgeons in a multidisciplinary neurovascular board and to study adherence to treatment recommendations in the context of uncertainty with respect to the best treatment option.Methods:We established a multidisciplinary neurovascular board meeting twice a week with structured documentation of consensus decisions. Over a time period of 53 months, 614 cases with ICA stenosis were discussed, with 285 (46%) symptomatic and 279 (45%) asymptomatic cases.Results:Recommendation for symptomatic ICA stenosis was revascularization in 76%, medical management alone in 8%, and further diagnostics in 16%. For asymptomatic ICA stenosis, recommendation was randomization in a clinical trial in 29%, revascularization in 27%, medical management alone in 23%, and further diagnostics in 22%. Treatment recommendations were followed in 94% of symptomatic ICA stenosis and 69% of asymptomatic ICA stenosis. Patients in whom carotid artery stenting was recommended for revascularization were younger and showed a higher rate of severe (≥70%) ICA stenosis.Conclusions:Interdisciplinary board decisions are a helpful and transparent tool to assure adherence to guideline recommendations, and to provide consensus-based individualized treatment strategies in clinical practice in the absence of unequivocal evidence.

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Can we increase adherence to treatment recommendations of the consultation psychiatrist working in a general hospital? A systematic review

Journal of Psychosomatic Research ◽

10.1016/j.jpsychores.2009.07.006 ◽

2010 ◽

Vol 68 (3) ◽

pp. 303-309 ◽

Cited By ~ 18

Author(s):

Albert F.G. Leentjens ◽

Annette D. Boenink ◽

Christina M. van der Feltz-Cornelis

Keyword(s):

Systematic Review ◽

General Hospital ◽

Treatment Recommendations ◽

Adherence To Treatment

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Comparison of Treatment Recommendations by Molecular Tumor Boards Worldwide

JCO Precision Oncology ◽

10.1200/po.18.00098 ◽

2018 ◽

pp. 1-14 ◽

Cited By ~ 2

Author(s):

Damian T. Rieke ◽

Mario Lamping ◽

Marissa Schuh ◽

Christophe Le Tourneau ◽

Neus Basté ◽

...

Keyword(s):

Treatment Strategies ◽

Treatment Recommendations ◽

Tumor Board ◽

Precision Oncology ◽

Genomic Information ◽

Specific Patient ◽

Rational Decision Making ◽

Copy Numbers ◽

Tumor Boards ◽

Molecular Profiles

Purpose Precision oncology holds the promise of improving patient outcome. It is based on the idea that the testing of genomic biomarkers can lead to the recommendation of a treatment option tailored to the specific patient. To derive treatment recommendations from molecular profiles, interdisciplinary molecular tumor boards (MTBs) have been established recently in many academic institutions. The recommendation process in MTBs, however, has not been well defined, which limits applicability to larger clinical trials and patient populations. Methods We created four fictional patients on the basis of recent real cases with genomic information on mutations, fusions, copy numbers, and gene expression. We identified 29 tumor boards from nine countries worldwide and asked them to provide treatment recommendations for the sample patients. In addition, a questionnaire regarding the setup and methods used by MTBs was circulated. Results Five MTBs from four countries provided treatment recommendations and answered the questionnaire. For one patient, three tumor board treatment recommendations were identical, and two tumor boards had identical treatment strategies for the other three patients. There was heterogeneity in the interpretation of tumor and germline aberrations as well as in standards of prioritization. Conclusion Differences in the interpretation and recommendation process contribute to heterogeneity in MTB recommendations. Additional comparative analyses of recommendations could help improve rational decision making and lead to standardization.

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Predictors of treatment adherence in patients with chronic disease using the Multidimensional Adherence Model: unique considerations for patients with haemophilia

The Journal of Haemophilia Practice ◽

10.17225/jhp00152 ◽

2020 ◽

Vol 7 (1) ◽

pp. 92-101

Author(s):

Karen Strike ◽

Anthony Chan ◽

Alfonso Iorio ◽

Monica R. Maly ◽

Paul W. Stratford ◽

...

Keyword(s):

Chronic Disease ◽

Objective Measure ◽

Treatment Recommendations ◽

World Health ◽

Related Factor ◽

Haemophilia A ◽

Adherence To Treatment ◽

Subjective Report ◽

Explanatory Variables ◽

Home Infusion

AbstractIntroductionAdherence to treatment recommendations in patients with chronic disease is complex and is influenced by numerous factors. Haemophilia is a chronic disease with reported levels of adherence ranging from 17–82%.AimBased on the theoretical foundation of the World Health Organization Multidimensional Adherence Model, the objective of this study was to identify the best combination of the variables infusion frequency, annualised bleed rate, age, distance to haemophilia treatment centre (HTC) and Haemophilia Joint Health Score (HJHS), to predict adherence to treatment recommendations in patients with haemophilia A and B on home infusion prophylaxis in Canada.MethodsA one-year retrospective cohort study investigated adherence to treatment recommendations using two measures: 1) subjective report via home infusion diaries, and 2) objective report of inventory ordered from Canadian Blood Services. Stepwise regression was performed for both measures.ResultsEighty-seven patients with haemophilia A and B, median age 21 years, were included. Adherence for both measures was 81% and 93% respectively. The sample consisted largely of patients performing an infusion frequency of every other day (34%). Median scores on the HJHS was 10.5; annualised bleed rate was two. Distance to the HTC was 51km. Analysis of the objective measure weakly supported greater infusion frequency as a treatment-related factor for the prediction of lower adherence, however the strength of this relationship was not clinically relevant (R2=0.048). For the subjective measure, none of the explanatory variables were significant.ConclusionAdherence is a multifaceted construct. Despite the use of theory, most of the variance in adherence to treatment recommendations in this sample of patients with haemophilia remains unknown. Further research on other potential predictors of adherence, and possible variables and relationships within factors of the MAM is required.

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