Patient-reported outcome measures for medication-related quality of life: A scoping review.

BACKGROUND: Medication use is common for the prevention and treatment of many health conditions. Understanding the impact of medication-taking on quality of life is important, as it could contribute to better care plans and improve shared decision-making between patients and healthcare providers. OBJECTIVE: To systematically identify and summarize the extent of literature on patient-reported outcome measures (PROMs) for medication-related quality of life (QoL). METHODS: Medline, Embase, PsycINFO, and Health and Psychosocial Instruments databases were searched until May 17, 2021 for peer-reviewed, original research articles that included a PROM for medication-related QoL and reported its psychometric properties. Study selection were completed by pairs with a third reviewer resolving any conflicts. Data were extracted by the study team using a form in Microsoft Excel. Extracted data were summarized descriptively and tabulated numerically. RESULTS: We screened 8,878 records, including 170 full-text articles, of which 86 met the criteria for inclusion. We identified 80 unique PROMs. Over half (n = 53) described measuring treatment satisfaction and less than one quarter measured medication related-QoL more broadly. Most of the included PROMs were targeted towards populations with specific health conditions including cancer (n = 9) and diabetes (n = 8), as well as individuals taking medication for non-specific conditions (n = 7). The most reported psychometric properties were internal consistency (n = 75) and construct validity (n = 77). All PROMs but one (n = 79) assessed physical health but fewer assessed other QoL dimensions (e.g., autonomy, interactions with providers). CONCLUSIONS: We found that the PROMs were designed for condition-specific or medication-specific populations, with few for general medication-related QoL. Future research should focus on assessing medication-related QoL measures for broader populations such as those with disabilities, multimorbidity, or experiencing polypharmacy. There needs to be more guidance on how to implement the use of PROMs in clinical settings, as well as to ensure consistency around terminology related to QoL.

Exploring medication self-management in community-dwelling adults with chronic medication experience: A concept mapping study.

BACKGROUND: People who take medications often experience challenges including making decisions about risks versus benefits and integrating medication management with all aspects of life (e.g., social and work responsibilities). Existing medication self-management frameworks are primarily adherence-focused and lack integrating holistic perspectives. OBJECTIVE: To explore the priorities of people with chronic medication experience (i.e., take at least 1 medication daily for at least 3 months) and what they can contribute to the understanding of medication self-management. METHODS: Concept mapping is a participatory, mixed-methods approach with 3 stages: brainstorming, sorting/rating, and mapping. Group brainstorming discussions were held with participants who generated statements about what mattered to them regarding medications in their everyday lives. In sorting/rating, individual participants grouped statements into thematic piles and rated their importance and feasibility. During mapping, a subset of participants discussed and agreed on a visual map and named the statement clusters. Following mapping, the researchers analyzed rating results, stratified by participant characteristics (gender, age, duration of medication use, number of medications, and chronic conditions). RESULTS: Sixty-three participants generated 1044 statements during 8 brainstorming sessions, which the researchers synthesized into 94 statements. Fifty-four participants individually sorted and rated the statements. Most statements were rated highly on both importance and feasibility, regardless of participant characteristics. Eight participants attended the mapping session. The final map had 9 thematic clusters, which were named by participants as: 1) researching and becoming educated about medications; 2) social support; 3) effectiveness of medication; 4) self-ownership of medication; 5) ease of use; 6) convenience and accessibility; 7) information provided by healthcare provider; 8) personal interactions with healthcare provider; and 9) patient involvement and trust. CONCLUSIONS: Results enhance existing medication management frameworks by providing a more comprehensive perspective. Understanding medication self-management requires more research that incorporates and prioritizes the perspectives of individuals who manage their medications.

Medication Management Frameworks in the Context of Self-Management: A Scoping Review.

PURPOSE: Many individuals take multiple prescribed and unprescribed medications, also known as polypharmacy, which can be problematic. Improving medication self-management is important; however, most medication management frameworks focus on adherence and limit the integration of the core components of self-management. Therefore, the objective of this scoping review was to identify what is reported in the literature on medication management frameworks or models within the context of self-management. METHODS: Electronic databases (Medline, Embase, CINAHL and Cochrane Library) and grey literature (healthcare and government organization websites) were searched for articles that described a framework or model developed or adapted for medication management, included components of self-management and was published from January 2000 to January 2020. During the screening of titles and abstracts, 5668 articles were reviewed, 5242 were excluded and 426 were then assessed at the full-text level. Thirty-nine articles met the eligibility criteria and were included in the review. RESULTS: About half of the frameworks were newly developed (n=20), while the other half were adapted from, or applied, a previous model or framework (n=19). The majority of frameworks focused on medication adherence and most of the self-management domains were categorized as medical management, followed by emotional and role management. CONCLUSION: Medication self-management is a complex process and often impacts multiple areas of an individual's life. It is important for future frameworks to incorporate a comprehensive, holistic conceptualization of self-management that is inclusive of the three self-management domains - medical, emotional and role management.