Identified barriers and potential solutions.

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.

研究目的
本研究旨在明确针对服用新型靶向口服抗肿瘤药物（oral anticancer agents，OAAs）的癌症患者，实施服药依从性干预措施的障碍因素与促进因素。

研究方法
本研究采用基于综合实施研究框架（Consolidated Framework for Implementation Research, CFIR）的半结构化访谈指南开展质性访谈。通过目的抽样法，招募为开具OAAs的慢性白血病患者提供诊疗服务或监管诊疗流程的临床医护人员（包括医师、药师、执业护士、护士）及行政管理人员（来自医学、药学、护理领域的管理者）。

研究结果
共计19名受访者参与访谈，其中12名为临床医护人员，7名为行政管理人员；10名供职于学术癌症中心，5名供职于社区癌症中心，4名供职于整合医疗系统专科药房。本次研究识别出的障碍因素包括：对服药依从性干预措施认知不足、依从性评估难度较大、设计并实施结构化依从性干预措施的流程复杂、存在优先级冲突。识别出的促进因素包括：医院行政管理层的支持、药师岗位价值得到认可、愿意接纳变革。受访者同时提出了后续推进建议，包括标准化工作流程、指定实施倡导者、迭代优化实施策略，以及加强医护人员间沟通与医患沟通。

研究结论
个体与系统层面的因素被确定为影响服药依从性干预措施实施效果的决定性因素。后续将组建多学科咨询小组，设计全面且可落地的策略，以优化并实施结构化干预措施，改善癌症患者的服药依从性。