An exploration of the patients' lived experience with antineoplastic medicines for colorectal cancer in Malta.

Cancer is a global health problem, with colorectal cancer being the third most common cancer worldwide. Antineoplastic medicines are considered the backbone of treatment for colorectal cancer, administered with the intent to relieve symptoms and achieve cure or prolong life. Consequently, patients have to cope with the burden of this treatment in addition to the symptoms of a life-threatening illness. This can be challenging and is poorly understood. The overall aim of this research was to explore the patients' lived experience with antineoplastic medicines for colorectal cancer in Malta. This research involved three phases. Phase I consisted of a systematic review to appraise, synthesise and present the available evidence of patients' lived experience with antineoplastic medicines prescribed for the management of malignant solid tumours. This review of ten studies showed the dynamic processes and socio-cultural influences that affected the patients' beliefs, practice and burden with antineoplastic medicines. Despite the lack of longitudinal qualitative studies, patients were still noted to undergo a continuous process of reinterpretations about their treatment along its journey. As this review captured almost all aspects mentioned in the original conceptual model of patients' lived experience with medicines (PLEM) for any acute and chronic illness (Mohammed, Moles and Chen 2016), it was likely to be transferable to the oncology setting with minor modifications. Phase II involved a longitudinal qualitative study which explored the perceptions and experiences of 16 patients receiving a six month cycle of antineoplastic medicines (FOLFOX or XELOX) for the management of colorectal cancer. In parallel, another longitudinal qualitative study was conducted for Phase III by interviews with significant others nominated by patients participating in Phase II. This phase aimed to explore the significant others' perspective on the patients' lived experience with antineoplastic medicines. All interviews were audio-recorded and transcribed verbatim, with data analysed using Interpretative Phenomenological Analysis for Phase II and Framework Analysis for Phase III. Five themes were generated from the analyses: (1) perceptions and knowledge of the illness and treatment; (2) the healthcare system in relation to the illness and treatment; (3) patient's involvement in treatment decision-making and their experience of medicine-taking; (4) medicine and illness-related impact on patients and (5) personal support structure. The longitudinal analysis of these themes supported inferences relevant to development in these areas along the treatment trajectory. Whilst patients faced the prospect of the treatment journey with fear, they had high expectations to achieve cure irrespective of treatment intent. Almost all patients passively consented to the oncologist's recommendations but still criticised the lack of provision of specific treatment information. Patients praised the personalised service of the nurse navigator particularly upon encountering difficulties in between cycles. To mitigate the substantial impact of treatment on their everyday life, patients sought refuge in spirituality and religion in addition to self-regulation coping strategies. Support was crucial for patients as they sought to develop a personal support network, mainly involving their significant other as from initiation of treatment. In conclusion, this doctoral research showed that the patients' lived experience with antineoplastic medicines is complex and remained challenging long-term. It also highlighted that the patients' needs go beyond the provision of medicines. Despite improvements made in the local healthcare system, further specific patient-tailored interventions are warranted such as the introduction of buddy system and the provision of specific information at appropriate timepoints in the treatment journey. Further research is required to explore their potential implementation and adoption into practice

Overview of the pathogenesis and management of postmenopausal osteoporosis

Postmenopausal osteoporosis is a silent systemic progressive disease characterised by a decrease in bone mass per unit volume, compromising the physical strength of the skeleton and enhancing susceptibility to fractures on minor trauma. The progressive loss of bone tissue occurs as a result of an imbalance between bone formation and bone resorption subsequent to oestrogen deficiency. The aim of this overview is to shed light on the pathophysiology, aetiology and diagnostic techniques for this metabolic bone disorder. It demonstrates current treatment options and evaluates the emerging pharmacological therapies in the management of postmenopausal osteoporosis.peer-reviewe

Drug information bulletin

Objective: To develop and implement an online bulletin intended to provide information on locally available medicinal products undergoing variation in their Summary of Product Characteristics (SmPC) and inclusions of medicinal products in the Government Formulary List (GFL) and to evaluate the usefulness of the bulletin among healthcare professionals and students. Method: Lists of locally available medicines that had undergone variations and medicinal products added to the GFL during a 6-month time frame were compiled. Additional information was obtained from regulatory authorities and local agents. A concise article was written on each drug, reviewed by a panel of experts and subsequently published in the online bulletin. Following completion of the contents and layout, the material was uploaded on the website of the Department of Pharmacy, University of Malta. A pilot study was carried out to identify shortcomings in the online bulletin design. The launch of the online bulletin started the promotional process which was mainly focused on electronic mail marketing. The data obtained from the validated questionnaire was coded and analysed using SPSS® v.20 and Microsoft® Excel Vista®. Key findings: Sixty seven per cent (n=223) of the respondents returned the questionnaire. The online bulletin was evaluated by 27 medical practitioners, 34 pharmacists, 37 medical students and 51 pharmacy students; of which 35% (n=52) were male and 65% (n=97) were female. The respondents agreed that the bulletin was up-to-date, clear and concise (91%, n=136), user-friendly (97%, n=144), useful (95%, n=142), well-designed (91%, n=136) and easy to access (87%, n=130). Ninety seven per cent (n=145) of the respondents stated that the information present in the bulletin was new to them, whilst 97% (n=144) agreed that the bulletin helped to keep them informed. Conclusion: The online bulletin provided an accessible means to deliver unbiased information about the introduction of recent medicinal products on the GFL and variations in SmPCs of products available on the local market. It was positively received by both healthcare professionals and students.peer-reviewe

Patients' lived experiences of cytotoxic medications prescribed for the management of malignant solid tumours: a systematic review.

The aim of the systematic review is to critically appraise, synthesise and present the available evidence of patients' lived experiences of cytotoxic medications prescribed for the management of malignant solid tumours. In relation to the patients pharmacological treatment journey for the management of malignant solid tumours: What are the patients' lived experience? What is the medication related burden? What are the medication related beliefs? What is the medication taking practice? What is the relationship between the lived experience and medication related burden, medication related beliefs and medication taking practice

Hospital pharmacy...where do we stand?

Hospital pharmacy is a specialised field of pharmacy within the healthcare service which entails the procurement, storage, compounding and dispensing of medications and medical devices. It also involves advising healthcare professionals and patients on their safe, effective and efficient use. In accordance to the European Association of Hospital Pharmacists (EAHP), the mission of each hospital pharmacist is to enhance the safety and quality of all medicine-related processes affecting patients whilst ensuring that the seven “rights” are respected: right patient, right dose, right route, right time, right drug with the right information and right documentation. Being part of the medication management within a hospital, each hospital pharmacist must strive to optimise the use of medicines such as ensuring the correct dosage regimen and promote adherence to prescribed treatment by patients.peer-reviewe

Patients' lived experiences with antineoplastic medicines for the management of malignant solid tumours: a systematic review.

Background: Antineoplastic medicines affect the patients’ physical and psychosocial well-being posing challenges for patients, caregivers and healthcare professionals. However, little is known about the patients’ lived experience with medicines (PLEM) for antineoplastic treatment. It is the lived experience that gives meaning to each individual’s perception of a particular phenomenon which is influenced by internal and external factors relevant to the individual. Objectives: To critically appraise, synthesise and present the available evidence of patients’ lived experience with antineoplastic medicines prescribed for the management of malignant solid tumours. Method: A systematic literature search was conducted in six electronic databases for articles published in English with no date restrictions. The search terms were related to beliefs, practice and burden in relation to patient, antineoplastic medicines, tumours and lived experience. Study selection, quality assessment and data extraction were performed independently by 2 reviewers. Research findings were analysed using narrative and meta-synthesis approaches. Results: The search retrieved 31,004 articles with only 10 studies satisfying the inclusion and exclusion criteria. These studies were published between 2005 and 2016 in Europe (n=6), America (n=3) and Asia (n=1). Nine themes were identified to contribute to the patients’ lived experience with antineoplastic medicines. These were (a) influence from family members, healthcare professionals, media and culture, (b) general attitude towards medicine, (c) accepting medicine, (d) modifying or altering medicine regimen or dose, (e) medicine characteristics, (f) medicine routine, (g) medicine adverse events, (h) medicine and social burden and (i) healthcare associated medicine burden. Patients tend to undergo a continuous process of reinterpretations of their experience with medicines throughout their treatment journey. Conclusion: The use of antineoplastic medicines has a profound effect on the patients’ lives. Further longitudinal in-depth studies are required to provide deeper insight into PLEM and support patients in their treatment journey

Exploring perspectives of significant others on patients' experiences of cancer services.

The aim of this research is to explore the perspectives of significant others regarding cancer care experiences of patients receiving antineoplastic medicines for colorectal cancer. Globally, there has been growing concern that patients are not receiving appropriate cancer care based on their needs. Efforts were made towards better quality of care to meet patients' needs and expectations. Despite this, healthcare systems are required to operate with decreasing resources as a consequence of the overall economic context. This poster was selected for the Poster Discussion Forum Session at the conference (PDF 2.10) and was the Winner of this category

Patients’ lived experiences of cytotoxic medications prescribed for the management of malignant solid tumours : a systematic review

The aim of the systematic review is to critically appraise, synthesise and present the available evidence of patients’ lived experiences of cytotoxic medications prescribed for the management of malignant solid tumours. In relation to the patients’ pharmacological treatment journey for the management of malignant solid tumours: • What are the patients’ lived experience? • What is the medication related burden? • What are the medication related beliefs? • What is the medication taking practice? • What is the relationship between the lived experience and medication related burden, medication related beliefs and medication taking practice?peer-reviewe

Patients’ experiences of medicines on initiation of antineoplastic agents for the treatment of colorectal cancer: a qualitative study.

Objective To explore the patients' experiences on initiation of treatment with antineoplastic medicines for colorectal cancer. Design A qualitative study using semistructured, face-to-face interviews based on the adapted patients' lived experience with medicines conceptual model was conducted. Ethics approval was granted. Interviews took place while eligible patients were receiving their first cycle of antineoplastic medicines, audiorecorded and transcribed verbatim. Interpretative phenomenological analysis was used. Setting National oncology hospital in Malta. Participants Adult patients over 18 years, newly diagnosed with colorectal cancer and initiating treatment with 5-fluorouracil/folinic acid and oxaliplatin (FOLFOX) or capecitabine plus oxaliplatin (XELOX) between October 2018 and September 2019 were recruited. Patients were included if fully aware of their diagnosis and the treatment being received. A purposive sample of 16 patients participated in the study. Results Five themes emerged from our analysis: (1) beliefs and knowledge on cancer and treatment; (2) healthcare system in relation to treatment; (3) medicine-taking practice; (4) medicine-related impact and (5) personal support structure. In addition, 16 subthemes were identified to describe the interplay of all aspects of the patients' experiences on initiation of treatment with antineoplastic medicines. Conclusion This qualitative study illustrated that the patients find themselves in a complex situation on initiation of treatment with antineoplastic medicines. The patients' knowledge on their specific treatment and active participation in making an informed decision need to be addressed. The healthcare system should develop tailored patient-centred services that specifically address the lack of patient empowerment and patient's concern about treatment specific information