1473P - Patient preference, adherence and outcomes in oncology: development of a theoretical model

Date 01 October 2012
Event ESMO Congress 2012
Session Poster presentation III
Topics Psychosocial Aspects of Cancer
Presenter Sarah Shingler
Authors S.L. Shingler1, B. Bennett1, J. Cramer2, C. Twelves3, A. Towse4, A.J. Lloyd1
  • 1Patient Reported Outcomes, Oxford Outcomes, An ICON plc Company, OX1 1LE - Oxford/UK
  • 2School Of Medicine, Yale University, 06510 - New Haven/US
  • 3Leeds Institute Of Molecular Medicine & St James’s Institute Of Oncology, St James’s University Hospital, LS9 7TF - Leeds/UK
  • 4Health Economics, Office of Health Economics, SW1E 6QT - London/UK



A patient's preference may guide their behaviour and influence their treatment outcomes. However, the importance of understanding patient preferences within oncology is unclear. The present study was designed to review the literature regarding preferences, adherence and their link to outcomes specifically in the oncology setting and to propose a theoretical model.


Published data examining patient preference, adherence and outcomes, specific to oncology, from 1982 to 2012, was searched for in Embase, Medline and Cochrane Library databases. Articles were then reviewed independently by two researchers and rated on their relevance and quality. Information from the retrieved literature and discussion with experts in the fields of oncology and patient preference, informed the development of the theoretical model.


The search yielded 2359 abstracts, of which 93 were reviewed in detail after de-duplication and abstract review. Evidence from the highest quality and most relevant articles (n = 19) were included in the development of the theoretical model. Relationships between patient preference, adherence and clinical outcomes/HRQoL were found to exist. Adverse effects (AEs) were found to have a strong relationship with adherence. Patient beliefs and values were also identified as having a moderating effect on adherence.


This review identified external and cognitive variables related to patient preference, adherence behaviour and outcome, which are included in the theoretical model. Specifically, external variables have an impact on adherence behaviour. However, this relationship is moderated by cognitive variables. Central to the theoretical model is the dynamic influence of AEs. AEs are proposed as having an impact on clinical outcomes and HRQoL, directly and indirectly through adherence behaviour, as well as impacting on external factors and may influence cognitive variables. Improving patient preference may improve clinical outcomes/HRQoL in oncology patients. The proposed theoretical model provides the opportunity to identify such hypotheses for further research with a view to improving adherence and clinical outcomes in oncology.


S.L. Shingler: Oxford Outcomes were paid a fixed fee for conducting this research project. B. Bennett: Oxford Outcomes were paid a fixed fee to conduct this research project. J. Cramer: Prof Cramer was paid a fixed honorary payment for her expert input on this study. C. Twelves: Prof Twelves was paid a fixed honorary fee for his expert input into this study. A. Towse: Prof towse was paid a fixed honorary fee forhis expert input into the study. A.J. Lloyd: Oxford Outcomes were paid a fixed fee for conducting this research project.