Determinants of Therapeutic Compliance in an Ambulatory Palliative Care Setting: An Observational Study

Non-adherence to pharmacotherapy in an ambulatory palliative care setting can negatively affect therapeutic outcomes. Only a limited number of studies have explored the determinants of therapeutic compliance in the Indian palliative care context. This study aims to evaluate therapeutic compliance, assess attitudes toward medication adherence, and the factors influencing it among patients accessing an ambulatory palliative care service in a tertiary care hospital in India.

One hundred and five adult patients accessing the ambulatory palliative care service and prescribed palliative pharmacotherapy for at least 1 month participated in this observational study. Data were collected using a study questionnaire that included socio-demographic details, the Morisky-Green test and a validated 17-item Likert scale assessing attitudes towards medication adherence. Statistical analysis comprised descriptive statistics, chi-square tests, Fisher's exact test and logistic regression.

Adherence to palliative pharmacotherapy was significantly associated with age, with older individuals (>60 years) showing greater compliance with medications compared to the young (p = 0.041, adjusted odds ratio [AOR] = 2.48, confidence interval [CI]: 1.04-5.95). Individuals with lower literacy levels demonstrated greater compliance than those with higher levels of education (p = 0.049, adjusted odds ratio [AOR] = 3.23, CI: 1.01-10.42). Furthermore, women were more compliant towards palliative pharmacotherapy compared to men (p = 0.017, adjusted odds ratio [AOR] = 3.03, CI: 1.22-7.56). Although other factors such as forgetfulness, affordability and assistance to take medications correlated with medication adherence, these were not found to be statistically significant.

In the context of Indian palliative care, older age, female gender and lower literacy levels were associated with increased adherence to palliative pharmacotherapy; these demographic associations with compliance with palliative pharmacotherapy warrant further exploration.