Tensions in caring for chronic patients' medication adherence: A qualitative study in Cyprus.

Medication adherence (MA) to recommended treatment is a multi-faceted problem and an ongoing challenge for healthcare providers (HCPs) to monitor. This qualitative study with 10 HCPs in Cyprus aims to explore HCPs' perceptions and strategies used on addressing medication non-adherence (MNA) in patients with chronic conditions. Two main themes emerged from the analysis reflecting the ways that HCPs described their reactions to MNA of their patients: (1) "Relying on information provision to improve MA" and (2) "Trying to understand patients' perspective." HCPs reported empathizing with patients and engaging in discussions to understand patients' perspective and reasons for MNA, so as to explore alternative solutions. Simultaneously, some HCPs reflected that the techniques used to improve MA are solely centered around information on medication and side-effects. HCPs experienced an internal conflict between providing patient-centered care versus using directive approaches to improve MA. Findings suggest how HCPs could thoroughly address patients' individual barriers.

A Scoping Review of Methods Used to Assess Medication Adherence in Patients with Chronic Conditions.

BACKGROUND: Medication nonadherence of patients with chronic conditions is a complex phenomenon contributing to increased economic burden and decreased quality of life. Intervention development relies on accurately assessing adherence but no "gold standard" method currently exists. PURPOSE: The present scoping review aimed to: (a) review and describe current methods of assessing medication adherence (MA) in patients with chronic conditions with the highest nonadherence rates (asthma, cancer, diabetes, epilepsy, HIV/AIDS, hypertension), (b) outline and compare the evidence on the quality indicators between assessment methods (e.g., sensitivity), and (c) provide evidence-based recommendations. METHODS: PubMed, PsycINFO and Scopus databases were screened, resulting in 62,592 studies of which 71 met criteria and were included. RESULTS: Twenty-seven self-report and 10 nonself-report measures were identified. The Medication Adherence Report Scale (MARS-5) was found to be the most accurate self-report, whereas electronic monitoring devices such as Medication Event Monitoring System (MEMS) corresponded to the most accurate nonself-report. Higher MA rates were reported when assessed using self-reports compared to nonself-reports, except from pill counts. CONCLUSIONS: Professionals are advised to use a combination of self-report (like MARS-5) and nonself-report measures (like MEMS) as these were found to be the most accurate and reliable measures. This is the first review examining self and nonself-report methods for MA, across chronic conditions with the highest nonadherence rates and provides evidence-based recommendations. It highlights that MA assessment methods are understudied in certain conditions, like epilepsy. Before selecting a MA measure, professionals are advised to inspect its quality indicators. Feasibility of measures should be explored in future studies as there is presently a lack of evidence.

Psychological Inflexibility in Pain Scale: Greek adaptation, psychometric properties, and invariance testing across three pain samples.

The success of acceptance and commitment therapy (ACT) in improving life functioning among chronic pain patients is followed by an interest in investigating mechanisms of action via which it unfolds and validating measures to assess its key constructs. The Psychological Inflexibility in Pain Scale (PIPS-II) assesses pain avoidance and fusion. This is the first study to examine the measurement models of this instrument's Greek adaptation (G-PIPS-II) in patients with different pain localizations (i.e., chronic and headache). A community heterogeneous sample of chronic pain sufferers (N = 156) and two clinical samples comprising treatment-seeking chronic pain patients (N = 149) and treatment-seeking headache patients (N = 89) were recruited from nongovernmental chronic pain support organizations and primary care centers. Exploratory and confirmatory factor analyses demonstrated an acceptable model fit of the G-PIPS-II yielding a two-factor model: avoidance (8 items) and cognitive fusion (4 items). Moderate to high correlations with theoretically related measures supported its construct validity; reliability was high for the total scale and the Avoidance subscale and medium for the Cognitive Fusion subscale. Weak measurement invariance was established across the three pain groups, suggesting that regardless of pain localization, chronic pain and headache patients understand the two latent factors in a similar way. G-PIPS-II is a psychometrically sound instrument assessing two constructs targeted for change within ACT and is deemed a conceptually meaningful scale with items having similar meanings for patients with different pain localization. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Construct validity of the G-CPAQ and its mediating role in pain interference and adjustment.

The Chronic Pain Acceptance Questionnaire (CPAQ) is a measure of pain acceptance comprised of pain willingness (PW) and activity engagement (AE; McCracken et al., 2004). Concerns about the factorial structure of the CPAQ exist, as it is not yet clear whether PW and AE constitute 2 independent constructs or 1, pain acceptance. Concerns also exist about the internal and predictive validity of test score interpretations of this measure. This study also presents that the choice of predictor variables has contributed to theoretical confusion regarding the impact of pain acceptance on pain-related adjustment. The purpose of this study was: (a) to examine the psychometric properties of both the long (20 items) and short (8 items) versions of the Greek-Chronic Pain Acceptance Questionnaire (G-CPAQ); (b) to examine the utility of a 2-factor solution in predicting psychosocial adjustment to pain using confirmatory factor analysis; and (c) to explore the mediating effects of pain acceptance and cognitive defusion, comprising the "open" response style to pain, between pain interference and pain related outcomes. One hundred and sixty chronic pain patients completed a questionnaire packet including pain indexes, pain acceptance, cognitive fusion, avoidance, and emotional distress. Confirmatory factor analyses supported the 2-factor solution, though a general good model fit was achieved only for the short G-CPAQ version. Structural equation modeling showed that PW and AE coupled with cognitive defusion partially mediated the influence of pain interference on pain severity, emotional distress, and avoidance of pain. (PsycINFO Database Record

The impact of experiential avoidance on the relations between illness representations, pain catastrophising and pain interference in chronic pain.

OBJECTIVE: The aim of this study was to examine the effects of experiential avoidance (EA) on the indirect relationship of chronic pain patients' illness representations to pain interference, through pain catastrophising Design and main outcome measure: The sample consisted of 162 patients diagnosed with an arthritis-related or a musculoskeletal disorder. The effects of EA on the pathway between illness representations, pain catastrophising and pain interference were examined with PROCESS, a computational tool for SPSS Results: After controlling for patient and illness-related variables and pain severity, the 'illness representations-pain catastrophising-pain interference' pathway was interrupted at the higher levels of EA. The reason was that, at the high levels of EA, either the relation of illness representations to pain catastrophising or the relation of pain catastrophising to pain interference was not statistically significant. CONCLUSION: The findings indicate that EA is not a generalised negative response to highly aversive conditions, at least as far as the factors examined in this study are concerned. EA may rather reflect a coping reaction, the impact of which depends on its specific interactions with the other aspects of the self-regulation mechanism. At least in chronic pain, EA should become the focus of potential intervention only when its interaction with the illness-related self-regulation mechanism results in negative outcomes.