Data extraction.

Background
Treatment nonadherence in cancer patients remains high with most interventions having had limited success. Most studies omit the multi-factorial aspects of treatment adherence and refer to medication adherence. The behaviour is rarely defined as intentional or unintentional.
Aim
The aim of this Scoping Review is to increase understanding of modifiable factors in treatment nonadherence through the relationships that physicians have with their patients. This knowledge can help define when treatment nonadherence is intentional or unintentional and can assist in predicting cancer patients at risk of nonadherence and in intervention design. The scoping review provides the basis for method triangulation in two subsequent qualitative studies: 1. Sentiment analysis of online cancer support groups in relation to treatment nonadherence; 2. A qualitative validation survey to refute / or validate claims from this scoping review. Thereafter, framework development for a future (cancer patient) online peer support intervention.
Methods
A Scoping Review was performed to identify peer reviewed studies that concern treatment / medication nonadherence in cancer patients—published between 2000 to 2021 (and partial 2022). The review was registered in the Prospero database CRD42020210340 and follows the PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Searches. The principles of meta-ethnography are used in a synthesis of qualitative findings that preserve the context of primary data. An aim of meta-ethnography is to identify common and refuted themes across studies. This is not a mixed methods study, but due to a limited qualitativevidence base and to broaden findings, the qualitative elements (author interpretations) found within relevant quantitative studies have been included.
Results
Of 7510 articles identified, 240 full texts were reviewed with 35 included. These comprise 15 qualitative and 20 quantitative studies. One major theme, that embraces 6 sub themes has emerged: ‘Physician factors can influence patient factors in treatment nonadherence’. The six (6) subthemes are: 1. Suboptimal Communication; 2. The concept of Information differs between Patient and Physician; 3.Inadequate time. 4. The need for Treatment Concordance is vague or missing from concepts; 5. The importance of Trust in the physician / patient relationship is understated in papers; 6. Treatment concordance as a concept is rarely defined and largely missing from studies.
Line of argument was drawn
Treatment (or medication) nonadherence that is intentional or unintentional is often attributed to patient factors—with far less attention to the potential influence of physician communication factors. The differentation between intentional or unintentional nonadherence is missing from most qualitative and quantitative studies. The holistic inter-dimensional / multi-factorial concept of ‘treatment adherence’ receives scant attention. The main focus is on medication adherence / nonadherence in the singular context. Nonadherence that is unintentional is not necessarily passive behaviour and may overlap with intentional nonadherence. The absence of treatment concordance is a barrier to treatment adherence and is rarely articulated or defined in studies.
Conclusion
This review demonstrates how cancer patient treatment nonadherence is often a shared outcome. An equal focus on physican and patient factors can increase understanding of the two main types of nonadherence (intentional or unintentional). This differentation should help improve the fundamentals of intervention design.

背景
癌症患者的治疗不依从现状仍居高不下，且多数干预措施收效甚微。现有多数研究忽略了治疗依从性的多维度成因，仅聚焦于药物依从性范畴，且极少将此类行为明确区分为有意或无意两类。

研究目的
本项范围综述（Scoping Review）旨在通过剖析医患关系，深化对癌症患者治疗不依从性可干预影响因素的认知。该认知可用于明确治疗不依从行为的有意/无意属性，辅助识别存在不依从风险的癌症患者，并为干预方案设计提供参考。本范围综述将为后续两项质性研究的方法三角验证奠定基础：1. 针对在线癌症支持社群中与治疗不依从相关内容的情感分析（Sentiment analysis）；2. 用于验证/驳斥本范围综述结论的质性验证问卷。后续还将据此开发面向癌症患者的在线同伴支持干预框架。

研究方法
本研究开展范围综述，检索2000年至2021年（含部分2022年）发表的、针对癌症患者治疗/药物不依从性的同行评议研究。本综述已在Prospero数据库（注册号：CRD42020210340）完成注册，并遵循PRISMA-S：系统检索文献报告的PRISMA扩展声明（PRISMA-S）规范。本研究采用元民族志（meta-ethnography）的原则对质性研究结果进行整合，以保留原始数据的情境信息；元民族志的核心目标之一是识别不同研究中共通与相悖的研究主题。本研究并非混合方法研究，但鉴于现有质性证据基础较为薄弱，为拓展研究结论的广度，本研究纳入了相关定量研究中包含的质性要素（即作者的解读内容）。

研究结果
本研究初检出7510篇文献，经筛选后对240篇全文进行审阅，最终纳入35项研究，其中15项为质性研究，20项为定量研究。本研究提炼出1个核心主题及6个子主题：「医师因素可通过影响患者因素进而导致治疗不依从」。6个子主题分别为：1. 沟通欠佳（Suboptimal Communication）；2. 医患双方对“信息”的认知存在差异；3. 问诊时间不足；4. 研究中未明确提及或模糊化了治疗协同（Treatment Concordance）的必要性；5. 现有研究对医患关系中信任的重要性阐述不足；6. 研究中极少对“治疗协同”这一概念进行明确定义，且该概念整体上未得到足够关注。

论证思路
现有研究常将有意或无意的治疗（或药物）不依从行为归因于患者自身因素，却极少关注医师沟通行为的潜在影响。多数质性与定量研究均未对有意与无意的不依从行为进行明确区分；“治疗依从性”的整体性多维度/多因素概念未得到足够重视，主流研究仅聚焦于单一维度的药物依从/不依从行为。无意的不依从行为并非必然是被动行为，且可能与有意不依从行为存在重叠。治疗协同的缺失会阻碍治疗依从性的维持，但现有研究极少对该问题进行阐述或明确定义。

研究结论
本范围综述表明，癌症患者的治疗不依从行为通常是医患双方共同作用的结果。若能同时同等关注医师与患者两方面的影响因素，将有助于加深对两类主要不依从行为（有意与无意）的认知。明确区分这两类行为，可助力优化干预方案的基础设计。