MedSupport Intervention to Identify and Address Barriers to Pediatric Medication Adherence

PRIMARY OBJECTIVE:

1. To compare the mean change in 6-mercaptopurine chemotherapy adherence as assessed by the MEMS from baseline (T1) to 6 months (T2) between pediatric patients with ALL randomized to MedSupport intervention versus usual care

• To compare the mean change in 6MP chemotherapy adherence as assessed by the MEMS from baseline (T1) to 12 months (T3) between pediatric patients with ALL randomized to MedSupport intervention versus usual care

SECONDARY OBJECTIVES;

• To compare the mean change in 6MP chemotherapy adherence as assessed by the MEMS from baseline (T1) to 6 months (T2) within pediatric patients with ALL randomized to MedSupport intervention versus usual care
• To compare the mean change in 6MP chemotherapy adherence as assessed by the MEMS from baseline (T1) to 12 months (T3) within pediatric patients with ALL randomized to MedSupport intervention versus usual care

EXPLORATORY OBJECTIVES:

1. To compare the proportion of pediatric acute lymphoblastic leukemia (ALL) patients with 6-mercaptopurine chemotherapy adherence based on 6-MP metabolite analysis of peripheral blood biospecimens collected during the Consolidation II and Continuation phases of treatment in patients randomized to either MedSupport intervention or usual care. (PATIENT) II. To use statistical modeling to examine potential mechanisms/mediators (medication barriers verse [vs.] social support, medication beliefs) of intervention efficacy in patients randomized to either MedSupport intervention or usual care. (PATIENT) III. To use statistical modeling to explore potential moderators of intervention efficacy including child age, caregiver socioeconomic status, race, ethnicity, and household structure in patients randomized to either MedSupport intervention or usual care. (PATIENT) IV. To determine parent intervention uptake by examining engagement with the screening questionnaire among parents from the intervention arm as a percentage based upon the ratio of the number of screening questionnaires completed to the number of questionnaires the participant was eligible to complete. (CAREGIVER) V. To assess whether parents from the intervention arm engaged with the educational videos as a percentage based upon the ratio of the number of minutes of videos watched compared to the number of minutes of educational videos the participant was prompted to view. (CAREGIVER) VI. To examine the strategies that may hinder or support implementation within routine care by assessing how parents from the intervention arm rated the acceptability, appropriateness, and feasibility of the MedSupport intervention. (CAREGIVER) VII. To explore barriers and facilitators to adoption, feasibility, and sustainability of the MedSupport intervention by examining the responses of a sample of 20 parent participants from the intervention arm who participate in semi-structured qualitative interviews. (CAREGIVER) VIII. To determine healthcare provider uptake by examining documentation of 4 weeks of adherence/medication-related consultations from intervention arm patient's Electronic Health Record (EHR) following a medication barrier alert. (INSTITUTIONAL) IX. To examine strategies that may hinder or support implementation within routine care by assessing healthcare provider ratings of the acceptability, appropriateness, and feasibility of the MedSupport intervention. (INSTITUTIONAL) X. To explore barriers and facilitators to adoption, feasibility, implementation, organizational/contextual factors that support maintenance and cost of the MedSupport intervention by examining the responses of a sample of 20 healthcare providers who participated in semi-structured qualitative interviews. (INSTITUTIONAL)

OUTLINE: Participants are randomized to 1 of 2 groups.

GROUP A: Participants receive the MedSupport intervention consisting of three components: universal screening for adherence barriers, tailored virtual education enhancement, and communication of barriers to activate multidisciplinary healthcare teams for 12 months. Participants also use the MEMS device to track oral chemotherapy adherence at baseline and follow-up. Patients also undergo blood sample collection throughout the study.

GROUP B: Participants receive usual care consisting of medical consultations and supportive care for 12 months. Participants also use the MEMS device to track oral chemotherapy adherence at baseline and follow-up. Patients also undergo blood sample collection throughout the study.

After completion of study intervention, participants are followed up at 1 year and 2 years.