0
No votes yet
Journal Club
Open Access Article

Adherence to Oral Chemotherapy in Childhood Acute Lymphoblastic Leukemia: An Evolutionary Concept Analysis

Wendy Landier
ONF 2011, 38(3), 343-352 DOI: 10.1188/11.ONF.343-352

Purpose/Objectives: To clarify the concept of adherence to daily oral chemotherapy in children with acute lymphoblastic leukemia (ALL), to examine its implications for clinical practice, and to provide a foundation for further research and knowledge development.

Data Sources: Published literature identified through the MEDLINE®, CINAHL®, PsycINFO, and ERIC databases.

Data Synthesis: Identified attributes of adherence to oral chemotherapy in childhood ALL included motivation, persistence, collaboration, mindfulness, cognitive capacity, flexibility, active participation, and identification of key participants in the process. Identified antecedents included a diagnosis of leukemia, the perceived value of adherence, and patient, family, and healthcare system-related factors. Identified consequences included the potential for maintaining optimal drug levels and improving disease outcome, as well as increased patient and caregiver esteem through active participation in the process. Adherence in the context of childhood ALL is defined as the active self-care behavior of taking (or having the responsibility for administering) daily oral chemotherapy, in collaboration with and according to the instructions of the healthcare provider over a defined, prolonged treatment period.

Conclusions: Adherence to oral chemotherapy in childhood ALL is a complex, multidimensional behavior that involves not only a willingness to follow the prescribed regimen over a prolonged period, but also the cognitive capacity and psychomotor skills to carry out the process.

Implications for Nursing: Nurses should recognize the importance of clear communication of medication instructions, reinforcement of adherence-related behaviors, and assistance with common issues such as pill-swallowing skills and reminder systems in caring for children with ALL.

References 

Anderson, C. A., & Collier, J. A. (1999). Managing very poor adherence to medication in children and adolescents: An inpatient intervention. <i>Clinical Child Psychology and Psychiatry, 4</i>, 393-402. http://dx.doi.org/10.1177/1359104599004003009

Aplenc, R., & Lange, B. (2004). Pharmacogenetic determinants of outcome in acute lymphoblastic leukaemia. <i>British Journal of Haematology, 125</i>, 421-434. http://dx.doi.org/10.1111/j.1365-2141.2004.04932.x

Babbitt, R. L., Parrish, J. M., Brierley, P. E., & Kohr, M. A. (1991). Teaching developmentally disabled children with chronic illness to swallow prescribed capsules. <i>Journal of Developmental and Behavioral Pediatrics, 12</i>, 229-235. http://dx.doi.org/10.1097/00004703-199108000-00003

Baker, L. H., Jones, J., Stovall, A., Zeltzer, L. K., Heiney, S. P., Sensenbrenner, L., … Zook, D. (1993). American Cancer Society workshop on adolescents and young adults with cancer. Workgroup #3: Psychosocial and emotional issues and specialized support groups and compliance issues. <i>Cancer, 71</i>, 2419-2422. http://dx.doi.org/10.1002/1097-0142(19930401)71:7<2419::AID-CNCR28207107...

Betz, C. L. (2006). Self-management and adherence of children and youth with special healthcare needs: Implications for pediatric nursing practice. <i>Journal of Pediatric Nursing, 21</i>, 253-255. http://dx.doi.org/10.1016/j.pedn.2006.04.003

Butz, A. M. (2006). Evidence-based practice: What is the evidence for medication adherence in children? <i>Journal of Pediatric Health Care, 20</i>, 338-341. http://dx.doi.org/10.1016/j.pedhc.2006.05.003

Charron-Prochownik, D., Becker, M. H., Brown, M. B., Liang, W. M., & Bennett, S. (1993). Understanding young children's health beliefs and diabetes regimen adherence. <i>Diabetes Educator, 19</i>, 409-418. http://dx.doi.org/10.1177/014572179301900508

Costello, I., Wong, I. C., & Nunn, A. J. (2004). A literature review to identify interventions to improve the use of medicines in children. <i>Child: Care, Health and Development, 30</i>, 647-665.

Cromer, B. A., & Tarnowski, K. J. (1989). Noncompliance in adolescents: A review. <i>Journal of Developmental and Behavioral Pediatrics, 10</i>, 207-215. http://dx.doi.org/10.1097/00004703-198908000-00010

Cunningham, P. B., Naar-King, S., Ellis, D. A., Pejuan, S., & Secord, E. (2006). Achieving adherence to antiretroviral medications for pediatric HIV disease using an empirically supported treatment: A case report. <i>Journal of Developmental and Behavioral Pediatrics, 27</i>, 44-50. http://dx.doi.org/10.1097/00004703-200602000-00009

Davies, H. A., Lennard, L., & Lilleyman, J. S. (1993). Variable mercaptopurine metabolism in children with leukaemia: A problem of non-compliance? <i>BMJ, 306</i>, 1239-1240. http://dx.doi.org/10.1136/bmj.306.6887.1239

Davies, H. A., & Lilleyman, J. S. (1995). Compliance with oral chemotherapy in childhood lymphoblastic leukaemia. <i>Cancer Treatment Reviews, 21</i>, 93-103. http://dx.doi.org/10.1016/0305-7372(95)90022-5

Deatrick, J. A. (1990). Developing self-regulation in adolescents with chronic conditions. <i>Holistic Nursing Practice, 5</i>(1), 17-24.

de Lemos, M. L., Hamata, L., Jennings, S., & Leduc, T. (2007). Interaction between mercaptopurine and milk. <i>Journal of Oncology Pharmacy Practice, 13</i>, 237-240. http://dx.doi.org/10.1177/1078155207080802

de Oliveira, B. M., Viana, M. B., Zani, C. L., & Romanha, A. J. (2004). Clinical and laboratory evaluation of compliance in acute lymphoblastic leukaemia. <i>Archives of Disease in Childhood, 89</i>, 785-788. http://dx.doi.org/10.1136/adc.2003.030775

Dervieux, T., Brenner, T. L., Hon, Y. Y., Zhou, Y., Hancock, M. L., Sandlund, J. T., … Evans, W. E. (2002). De novo purine synthesis inhibition and antileukemic effects of mercaptopurine alone or in combination with methotrexate in vivo. <i>Blood, 100</i>, 1240-1247. http://dx.doi.org/10.1182/blood-2002-02-0495

Dimatteo, M. R. (2004). The role of effective communication with children and their families in fostering adherence to pediatric regimens. <i>Patient Education and Counseling, 55</i>, 339-344.

Dracup, K. A., & Meleis, A. I. (1982). Compliance: An interactionist approach. <i>Nursing Research, 31</i>, 31-36.

Duncan, C., Cloutier, J. D., & Bailey, P. H. (2007). Concept analysis: The importance of differentiating the ontological focus. <i>Journal of Advanced Nursing, 58</i>, 293-300. http://dx.doi.org/10.1111/j.1365-2648.2007.04277.x

Evangelista, L. S. (1999). Compliance: A concept analysis. <i>Nursing Forum, 34</i>(1), 5-11. http://dx.doi.org/10.1111/j.1744-6198.1999.tb00230.x

Festa, R. S., Tamaroff, M. H., Chasalow, F., & Lanzkowsky, P. (1992). Therapeutic adherence to oral medication regimens by adolescents with cancer. I. Laboratory assessment. <i>Journal of Pediatrics, 120</i>, 807-811. http://dx.doi.org/10.1016/S0022-3476(05)80256-2

Fielding, D., & Duff, A. (1999). Compliance with treatment protocols: Interventions for children with chronic illness. <i>Archives of Disease in Childhood, 80</i>, 196-200. http://dx.doi.org/10.1136/adc.80.2.196

Fiese, B. H., & Everhart, R. S. (2006). Medical adherence and childhood chronic illness: Family daily management skills and emotional climate as emerging contributors. <i>Current Opinion in Pediatrics, 18</i>, 551-557. http://dx.doi.org/10.1097/01.mop.0000245357.68207.9b

Fiese, B. H., & Wamboldt, F. S. (2003). Tales of pediatric asthma management: Family-based strategies related to medical adherence and health care utilization. <i>Journal of Pediatrics, 143</i>, 457-462. http://dx.doi.org/10.1067/S0022-3476(03)00448-7

Friedman, I. M., & Litt, I. F. (1987). Adolescents' compliance with therapeutic regimens. Psychological and social aspects and intervention. <i>Journal of Adolescent Health Care, 8</i>, 52-67.

Gale, R. P., & Butturini, A. (1991). Maintenance chemotherapy and cure of childhood acute lymphoblastic leukaemia. <i>Lancet, 338</i>, 1315-1318. http://dx.doi.org/10.1016/0140-6736(91)92604-Z

Garvie, P. A., Lensing, S., & Rai, S. N. (2007). Efficacy of a pill-swallowing training intervention to improve antiretroviral medication adherence in pediatric patients with HIV/AIDS. <i>Pediatrics, 119</i>, E893-E899. http://dx.doi.org/10.1542/peds.2006-1488

Gaynon, P. S. (2006). Treatment adherence and 6-mercaptopurine metabolites. <i>Pediatric Blood and Cancer, 46</i>, 120-121. http://dx.doi.org/10.1002/pbc.20620

Goode, M., Harrod, M. E., Wales, S., & Crisp, J. (2004). The role of specialist nurses in improving treatment adherence in children with a chronic illness. <i>Australian Journal of Advanced Nursing, 21</i>(4), 41-45.

Green, A., & Ray, T. (2006). Attention to child development: A key piece of family-centered care for cardiac transplant recipients. <i>Journal for Specialists in Pediatric Nursing, 11</i>, 143-148. http://dx.doi.org/10.1111/j.1744-6155.2006.00057.x

Hale, J. P., & Lilleyman, J. S. (1991). Importance of 6-mercaptopurine dose in lymphoblastic leukaemia. <i>Archives of Disease in Childhood, 66</i>, 462-466. http://dx.doi.org/10.1136/adc.66.4.462

Hauser, S. T., Jacobson, A. M., Lavori, P., Wolfsdorf, J. I., Herskowitz, R. D., Milley, J. E., … Stein, J. (1990). Adherence among children and adolescents with insulin-dependent diabetes mellitus over a four-year longitudinal follow-up: II. Immediate and long-term linkages with the family milieu. <i>Journal of Pediatric Psychology, 15</i>, 527-542. http://dx.doi.org/10.1093/jpepsy/15.4.527

Haynes, R. B., Taylor, D. W., & Sackett, D. L. (1979). <i>Compliance in health care.</i> Baltimore, MD: Johns Hopkins University Press.

Horner, M. J., Ries, L. A. G., Krapcho, M., Neyman, N., Aminou, R., Howlader, N., … Edwards, B. K. (Eds.). (2009). <i>SEER cancer statistics review, 1976-2006, based on November 2008 SEER data submission.</i> Bethesda, MD: National Cancer Institute.

Hovell, M., Blumberg, E., Gil-Trejo, L., Vera, A., Kelley, N., Sipan, C., … Moser, K. (2003). Predictors of adherence to treatment for latent tuberculosis infection in high-risk Latino adolescents: A behavioral epidemiological analysis. <i>Social Science and Medicine, 56</i>, 1789-1796.

Hovell, M., Sipan, C. L., Blumberg, E. J., Hofstetter, C. R., Slymen, D., Friedman, L., … Vera, A. Y. (2003). Increasing Latino adolescents' adherence to treatment for latent tuberculosis infection: A controlled trial. <i>American Journal of Public Health, 93</i>, 1871-1877. http://dx.doi.org/10.2105/AJPH.93.11.1871

Jemal, A., Siegel, R., Xu, J., & Ward, E. (2010). Cancer statistics 2010. <i>CA: A Cancer Journal for Clinicians, 60</i>, 277-300. http://dx.doi.org/10.3322/caac.20073

Kim, M. J., & Moritz, D. A. (Eds.). (1982). <i>Classification of nursing diagnoses: Proceedings of the third and fourth national conferences.</i> New York, NY: McGraw-Hill.

Klopovich, P. M. (1983). Research on problems of chronicity in childhood cancer. <i>Oncology Nursing Forum, 10</i>(3), 72-75.

Knight, D. (2005). Beliefs and self-care practices of adolescents with asthma. <i>Issues in Comprehensive Pediatric Nursing, 28</i>(2), 71-81.

Koren, G., Ferrazini, G., Sulh, H., Langevin, A. M., Kapelushnik, J., Klein, J., … Greenberg, M. (1990). Systemic exposure to mercaptopurine as a prognostic factor in acute lymphocytic leukemia in children. <i>New England Journal of Medicine, 323</i>, 17-21. http://dx.doi.org/10.1056/NEJM199007053230104

Kyngäs, H. (1999). A theoretical model of compliance in young diabetics. <i>Journal of Clinical Nursing, 8</i>, 73-80. http://dx.doi.org/10.1046/j.1365-2702.1999.00213.x

Kyngäs, H. (2000a). Compliance of adolescents with chronic disease. <i>Journal of Clinical Nursing, 9</i>, 549-556. http://dx.doi.org/10.1046/j.1365-2702.2000.00368.x

Kyngäs, H. (2000b). Compliance of adolescents with diabetes. <i>Journal of Pediatric Nursing, 15</i>, 260-267. http://dx.doi.org/10.1053/jpdn.2000.6169

Kyngäs, H. (2007). Predictors of good adherence of adolescents with diabetes (insulin-dependent diabetes mellitus). <i>Chronic Illness, 3</i>(1), 20-28.

Kyngäs, H., Duffy, M. E., & Kroll, T. (2000). Conceptual analysis of compliance. <i>Journal of Clinical Nursing, 9</i>, 5-12. http://dx.doi.org/10.1046/j.1365-2702.2000.00309.x

Kyngäs, H., Kroll, T., & Duffy, M. E. (2000). Compliance in adolescents with chronic diseases: A review. <i>Journal of Adolescent Health, 26</i>, 379-388. http://dx.doi.org/10.1016/S1054-139X(99)00042-7

Kyngäs, H., & Rissanen, M. (2001). Support as a crucial predictor of good compliance of adolescents with a chronic disease. <i>Journal of Clinical Nursing, 10</i>, 767-774. http://dx.doi.org/10.1046/j.1365-2702.2001.00538.x

Kyngäs, H. A., Skaar-Chandler, C. A., & Duffy, M. E. (2000). The development of an instrument to measure the compliance of adolescents with a chronic disease. <i>Journal of Advanced Nursing, 32</i>, 1499-1506. http://dx.doi.org/10.1046/j.1365-2648.2000.01611.x

La Greca, A. M. (1990). Issues in adherence with pediatric regimens. <i>Journal of Pediatric Psychology, 15</i>, 423-436. http://dx.doi.org/10.1093/jpepsy/15.4.423

Landier, W. (2001). Childhood acute lymphoblastic leukemia: Current perspectives. <i>Oncology Nursing Forum, 28</i>, 823-833.

Lansky, S. B., Smith, S. D., Cairns, N. U., & Cairns, G. F., Jr. (1983). Psychological correlates of compliance. <i>American Journal of Pediatric Hematology/Oncology, 5</i>, 87-92.

Lask, B. (2003). Motivating children and adolescents to improve adherence. <i>Journal of Pediatrics, 143</i>, 430-433. http://dx.doi.org/10.1067/S0022-3476(03)00447-5

Last, B. F., & Grootenhuis, M. A. (2007). The enhancement of coping skills and compliance to treatment in adolescents with a chronic serious disease. <i>Clinical Therapeutics, 29</i>(Suppl. C), S107-S108.

Lau, R. C., Matsui, D., Greenberg, M., & Koren, G. (1998). Electronic measurement of compliance with mercaptopurine in pediatric patients with acute lymphoblastic leukemia. <i>Medical and Pediatric Oncology, 30</i>(2), 85-90. http://dx.doi.org/10.1002/(SICI)1096-911X(19980230:2<85AID-MPO3>3.0.CO;2-W

Lemanek, K. (1990). Adherence issues in the medical management of asthma. <i>Journal of Pediatric Psychology, 15</i>, 437-458. http://dx.doi.org/10.1093/jpepsy/15.4.437

Lennard, L., Lilleyman, J. S., Van Loon, J., & Weinshilboum, R. M. (1990). Genetic variation in response to 6-mercaptopurine for childhood acute lymphoblastic leukaemia. <i>Lancet, 336</i>, 225-229. http://dx.doi.org/10.1016/0140-6736(90)91745-V

Lennard, L., & Singleton, H. J. (1992). High-performance liquid chromatographic assay of the methyl and nucleotide metabolites of 6-mercaptopurine: Quantitation of red blood cell 6-thioguanine nucleotide, 6-thioinosinic acid and 6-methylmercaptopurine metabolites in a single sample. <i>Journal of Chromatography, 583</i>, 83-90.

Lennard, L., Welch, J., & Lilleyman, J. S. (1995). Intracellular metabolites of mercaptopurine in children with lymphoblastic leukaemia: A possible indicator of non-compliance? <i>British Journal of Cancer, 72</i>, 1004-1006. http://dx.doi.org/10.1038/bjc.1995.450

Lilleyman, J. S., & Lennard, L. (1996). Non-compliance with oral chemotherapy in childhood leukaemia. <i>BMJ, 313</i>, 1219-1220.

Logan, D., Zelikovsky, N., Labay, L., & Spergel, J. (2003). The Illness Management Survey: Identifying adolescents' perceptions of barriers to adherence. <i>Journal of Pediatric Psychology, 28</i>, 383-392.

Magyary, D., & Brandt, P. (1996). A school-based self-management program for youth with chronic health conditions and their parents. <i>Canadian Journal of Nursing Research, 28</i>(4), 57-77.

Maikranz, J. M., Steele, R. G., Dreyer, M. L., Stratman, A. C., & Bovaird, J. A. (2007). The relationship of hope and illness-related uncertainty to emotional adjustment and adherence among pediatric renal and liver transplant recipients. <i>Journal of Pediatric Psychology, 32</i>, 571-581. http://dx.doi.org/10.1093/jpepsy/jsl046

Malbasa, T., Kodish, E., & Santacroce, S. J. (2007). Adolescent adherence to oral therapy for leukemia: A focus group study. <i>Journal of Pediatric Oncology Nursing, 24</i>, 139-151. http://dx.doi.org/10.1177/1043454206298695

Manne, S. L., Jacobsen, P. B., Gorfinkle, K., Gerstein, F., & Redd, W. H. (1993). Treatment adherence difficulties among children with cancer: The role of parenting style. <i>Journal of Pediatric Psychology, 18</i>, 47-62. http://dx.doi.org/10.1093/jpepsy/18.1.47

Marhefka, S. L., Tepper, V. J., Brown, J. L., & Farley, J. J. (2006). Caregiver psychosocial characteristics and children's adherence to antiretroviral therapy. <i>AIDS Patient Care and STDS, 20</i>, 429-437.

Martin, S., Elliott-DeSorbo, D. K., Wolters, P. L., Toledo-Tamula, M. A., Roby, G., Zeichner, S., & Woods, L. V. (2007). Patient, caregiver and regimen characteristics associated with adherence to highly active antiretroviral therapy among HIV-infected children and adolescents. <i>Pediatric Infectious Disease Journal, 26</i>(1), 61-67.

McQuaid, E. L., Kopel, S. J., Klein, R. B., & Fritz, G. K. (2003). Medication adherence in pediatric asthma: Reasoning, responsibility, and behavior. <i>Journal of Pediatric Psychology, 28</i>, 323-333. http://dx.doi.org/10.1093/jpepsy/jsg022

Mears, C. J., Charlebois, N. M., & Holl, J. L. (2006). Medication adherence among adolescents in a school-based health center. <i>Journal of School Health, 76</i>(2), 52-56. http://dx.doi.org/10.1111/j.1746-1561.2006.00068.x

Nicholson, O., Mellins, C., Dolezal, C., Brackis-Cott, E., & Abrams, E. J. (2006). HIV treatment-related knowledge and self-efficacy among caregivers of HIV-infected children. <i>Patient Education and Counseling, 61</i>, 405-410. http://dx.doi.org/10.1016/j.pec.2005.05.006

O'Hanrahan, M., & O'Malley, K. (1981). Compliance with drug treatment. <i>BMJ, 283</i>, 298-300. http://dx.doi.org/10.1136/bmj.283.6286.298

Osterberg, L., & Blaschke, T. (2005). Adherence to medication. <i>New England Journal of Medicine, 353</i>, 487-497. http://dx.doi.org/10.1056/NEJMra050100

Palardy, N., Greening, L., Ott, J., Holderby, A., & Atchison, J. (1998). Adolescents' health attitudes and adherence to treatment for insulin-dependent diabetes mellitus. <i>Journal of Developmental and Behavioral Pediatrics, 19</i>, 31-37.

Pritchard, M. T., Butow, P. N., Stevens, M. M., & Duley, J. A. (2006). Understanding medication adherence in pediatric acute lymphoblastic leukemia: A review. <i>Journal of Pediatric Hematology/Oncology, 28</i>, 816-823. http://dx.doi.org/10.1097/00004703-199802000-00005

Puccio, J. A., Belzer, M., Olson, J., Martinez, M., Salata, C., Tucker, D., … Tanaka, D. (2006). The use of cell phone reminder calls for assisting HIV-infected adolescents and young adults to adhere to highly active antiretroviral therapy: A pilot study. <i>AIDS Patient Care and STDS, 20</i>, 438-444. http://dx.doi.org/10.1089/apc.2006.20.438

Pui, C. H., & Evans, W. E. (1998). Acute lymphoblastic leukemia. <i>New England Journal of Medicine, 339</i>, 605-615. http://dx.doi.org/10.1056/NEJM199808273390907

Putnam, D. E., Finney, J. W., Barkley, P. L., & Bonner, M. J. (1994). Enhancing commitment improves adherence to a medical regimen. <i>Journal of Consulting and Clinical Psychology, 62</i>, 191-194.

Rapoff, M. A. (2006). Management of adherence and chronic rheumatic disease in children and adolescents. <i>Best Practice and Research: Clinical Rheumatology, 20</i>, 301-314. http://dx.doi.org/10.1016/j.berh.2005.11.002

Relling, M. V., Hancock, M. L., Boyett, J. M., Pui, C. H., & Evans, W. E. (1999). Prognostic importance of 6-mercaptopurine dose intensity in acute lymphoblastic leukemia. <i>Blood, 93</i>, 2817-2823.

Rianthavorn, P., & Ettenger, R. B. (2005). Medication non-adherence in the adolescent renal transplant recipient: A clinician's viewpoint. <i>Pediatric Transplantation, 9</i>, 398-407.

Rich, M., Lamola, S., Gordon, J., & Chalfen, R. (2000). Video intervention/prevention assessment: A patient-centered methodology for understanding the adolescent illness experience. <i>Journal of Adolescent Health, 27</i>, 155-165. http://dx.doi.org/10.1016/S1054-139X(00)00114-2

Rivard, G. E., Lin, K. T., Leclerc, J. M., & David, M. (1989). Milk could decrease the bioavailability of 6-mercaptopurine. <i>American Journal of Pediatric Hematology/Oncology, 11</i>, 402-406.

Roberts, K. J. (2005). Barriers to antiretroviral medication adherence in young HIV-infected children. <i>Youth and Society, 37</i>, 230-245.

Rodgers, B. L. (2000). Concept analysis: An evolutionary view. In B. L. Rodgers & K. A. Knafl (Eds.), <i>Concept development in nursing: Foundations, techniques, and applications</i> (2nd ed., pp. 77-102). Philadelphia, PA: W. B. Saunders.

Rogers, A. S., Miller, S., Murphy, D. A., Tanney, M., & Fortune, T. (2001). The TREAT (Therapeutic Regimens Enhancing Adherence in Teens) Program: Theory and preliminary results. <i>Journal of Adolescent Health, 29</i>(3, Suppl.), 30-38. http://dx.doi.org/10.1016/S1054-139X(01)00289-0

Rosina, R., Crisp, J., & Steinbeck, K. (2003). Treatment adherence of youth and young adults with and without a chronic illness. <i>Nursing and Health Sciences, 5</i>, 139-147. http://dx.doi.org/10.1046/j.1442-2018.2003.00149.x

Salabarría-Peña, Y., Trout, P. T., Gill, J. K., Morisky, D. E., Muralles, A. A., & Ebin, V. J. (2001). Effects of acculturation and psychosocial factors in Latino adolescents' TB-related behaviors. <i>Ethnicity and Disease, 11</i>, 661-675.

Sawyer, S. M., & Aroni, R. A. (2003). Sticky issue of adherence. <i>Journal of Paediatrics and Child Health, 39</i>, 2-5.

Schäfer-Keller, P., Lyon, S., Van-Gelder, F., & De Geest, S. (2006). A practical approach to promoting adherence to immunosuppressive medication after renal transplantation. <i>Current Opinion in Nephrology and Hypertension, 15</i>(Clinical Update 2), S1-S6.

Schmidt, L. E., & Dalhoff, K. (2002). Food-drug interactions. <i>Drugs, 62</i>, 1481-1502. http://dx.doi.org/10.2165/00003495-200262100-00005

Shay, L. E. (2008). A concept analysis: Adherence and weight loss. <i>Nursing Forum, 43</i>, 42-52. http://dx.doi.org/10.1111/j.1744-6198.2008.00095.x

Shemesh, E., Annunziato, R. A., Yehuda, R., Shneider, B. L., Newcorn, J. H., Hutson, C., … Emre, S. (2007). Childhood abuse, nonadherence, and medical outcome in pediatric liver transplant recipients. <i>Journal of the American Academy of Child and Adolescent Psychiatry, 46</i>, 1280-1289.

Singh, N., Berman, S. M., Swindells, S., Justis, J. C., Mohr, J. A., Squier, C., & Wagener, M. M. (1999). Adherence of human immunodeficiency virus-infected patients to antiretroviral therapy. <i>Clinical Infectious Diseases, 29</i>, 824-830. http://dx.doi.org/10.1086/520443

Smith, B. A., & Shuchman, M. (2005). Problem of nonadherence in chronically ill adolescents: Strategies for assessment and intervention. <i>Current Opinion in Pediatrics, 17</i>, 613-618.

Smith, S. D., Rosen, D., Trueworthy, R. C., & Lowman, J. T. (1979). A reliable method for evaluating drug compliance in children with cancer. <i>Cancer, 43</i>, 169-173.

Sofianou-Katsoulis, A., Khakoo, G., & Kaczmarski, R. (2006). Reduction in bioavailability of 6-mercaptopurine on simultaneous administration with cow's milk. <i>Pediatric Hematology and Oncology, 23</i>, 485-487.

Stanulla, M., & Schrappe, M. (2009). Treatment of childhood acute lymphoblastic leukemia. <i>Seminars in Hematology, 46</i>(1), 52-63.

Stewart, K. S., & Dearmun, A. K. (2001). Adherence to health advice amongst young people with chronic illness. <i>Journal of Child Health Care, 5</i>(4), 155-162.

Sveum, R. J. (2005). Childhood asthma. Balancing efficacy and adherence for optimum management. <i>Postgraduate Medicine, 118</i>(3), 43-50.

Tamaroff, M. H., Festa, R. S., Adesman, A. R., & Walco, G. A. (1992). Therapeutic adherence to oral medication regimens by adolescents with cancer. II. Clinical and psychologic correlates. <i>Journal of Pediatrics, 120</i>, 812-817. http://dx.doi.org/10.1016/S0022-3476(05)80257-4

Tebbi, C. K. (1993). Treatment compliance in childhood and adolescence. <i>Cancer, 71</i>(Suppl.), 3441-3449.

Tebbi, C. K., Cummings, K. M., Zevon, M. A., Smith, L., Richards, M., & Mallon, J. (1986). Compliance of pediatric and adolescent cancer patients. <i>Cancer, 58</i>, 1179-1184.

Tebbi, C. K., Richards, M. E., Cummings, K. M., Zevon, M. A., & Mallon, J. C. (1988). The role of parent-adolescent concordance in compliance with cancer chemotherapy. <i>Adolescence, 23</i>, 599-611.

Tebbi, C. K., Zevon, M. A., Richards, M. E., & Cummings, K. M. (1989). Attributions of responsibility in adolescent cancer patients and their parents. <i>Journal of Cancer Education, 4</i>, 135-142.

Traore, F., O'Riordan, M. A., Myers, C., Groth, K., Hoff, A., Angiolillo, A., … Kodish, E. (2006). How low is too low? Use of cluster analysis to define low levels of mercaptopurine metabolites. <i>Pediatric Blood and Cancer, 46</i>, 187-192. http://dx.doi.org/10.1002/pbc.20518

Van Sciver, M. M., D'Angelo, E. J., Rappaport, L., & Woolf, A. D. (1995). Pediatric compliance and the roles of distinct treatment characteristics, treatment attitudes, and family stress: a preliminary report. <i>Journal of Developmental and Behavioral Pediatrics, 16</i>, 350-358.

Wichowski, H. C., & Kubsch, S. M. (1997). The relationship of self-perception of illness and compliance with health care regimens. <i>Journal of Advanced Nursing, 25</i>, 548-553.

Wysocki, T., & Gavin, L. (2006). Paternal involvement in the management of pediatric chronic diseases: Associations with adherence, quality of life, and health status. <i>Journal of Pediatric Psychology, 31</i>, 501-511. http://dx.doi.org/10.1093/jpepsy/jsj042

Zindani, G. N., Streetman, D. D., Streetman, D. S., & Nasr, S. Z. (2006). Adherence to treatment in children and adolescent patients with cystic fibrosis. <i>Journal of Adolescent Health, 38</i>, 13-17.