Wednesday 18 September, 12-1 pm
Treatment for hepatitis C: staying strong and staying on! Facilitators and barriers to treatment adherence and completion
Ms Victoria Sublette, PhD candidate in Health Psychology, The University of Sydney
Location: Room 119, John Goodsell Building.
Map reference F20.
With the predicted rise in morbidity and mortality from chronic hepatitis C over the next decade, there is an urgent need to increase rates of treatment uptake and adherence. Most research to date has focused on the medical and physiological predictors of treatment outcomes, but these factors alone cannot predict patients’ adherence and completion of treatment. This study aims to identify the barriers to, and facilitators of, hepatitis C treatment adherence and completion. We hypothesise that the perceptions, attitudes, and experiences of patients
with hepatitis C, and the healthcare professionals who treat them, will affect treatment adherence and completion.
Semi-structured interviews were conducted with 20 healthcare professionals and 20 patients, from liver clinics throughout NSW and Victoria. The factors leading to improved treatment adherence and completion were explored, from both the healthcare professionals’ and patients’ perspectives.
Support was a dominant theme raised by both groups throughout the interviews. In particular, the quality, type and source of support were felt to be critical to treatment adherence. Healthcare professional participants reported a range of innovative, instrumental support strategies that doctors and nurses implemented to assist patient adherence. These were patient advocacy, problem solving, clinical feedback regarding patients' treatment progress, and emotional support during treatment. Instrumental support from health professionals was integral to
engaging patients in treatment, enhancing their outlook, and reinforcing their commitment to treatment. Patients and healthcare professionals agreed that such support strategies could help motivate patients to complete treatment.
Instrumental support provided by healthcare professionals assists patients from unsupported environments to complete treatment. However, to meet the social and emotional needs of patients who are at risk of terminating treatment early, many clinicians are finding they must expand their roles as medical professionals to perform as psychologists and social workers. This extra burden on the already heavy workloads of most doctors and nurses could be alleviated by increasing the numbers of social workers and counsellors in tertiary hepatitis C clinics. Better
allocation of staffing resources and a true multidisciplinary model of health care is essential to increasing uptake of treatment and improving adherence and completion rates in patients with hepatitis C.
Sublette, VA1,3, Hopwood, M2, George, J3, Smith, SK4, Nicholson Perry, K5, McCaffery, K6, & Douglas, MW3,7
1 Westmead Clinical School, University of Sydney
2 National Centre in HIV Social Research, The University of New South Wales
3 Storr Liver Unit, Westmead Millennium Institute, University of Sydney and Westmead Hospital
4 Prince of Wales Clinical School, Psychosocial Research Group, University of New South Wales
5 University of Western Sydney, Centre for Health Research & School of Social Sciences and Psychology
6 School of Public Health, University of Sydney
7 Centre for Infectious Diseases and Microbiology, Sydney Emerging Infections and Biosecurity Institute, University of Sydney and Westmead Hospital.
Victoria Sublette is a third year PhD candidate in Health Psychology at The University of Sydney. Her research on the psychosocial aspects of hepatitis C treatment includes a systematic review of the predictors of hepatitis C treatment outcomes (in press), a qualitative study of the barriers and facilitators of hepatitis C treatment adherence and completion, and the development of a screening tool to assist clinicians with assessing patient eligibility for hepatitis C treatment.