REVIEW OF PATIENT’S UNDERSTANDING ON ORAL SACT (DFIT)

The patient is currently prescribed with:

Targeted Therapy
Drug Dose Frequency D F I T Remark
Alecitinib
Abemaciclib
Afatinib
Axitinib
Crizotinib
Dacomitinib
Enzalutamide
Erlotinib
Gefitinib
Ibrutinib
Imatinib
Lenvatinib
Lorlatinib
Nilotinib
Nintedanib
Olaparib
Osimertinib
Palbociclib
Pazopanib
Ribociclib
Ruxolitinib
Sorafenib
Sunitinib
Others [Including supportive therapy]

Scoring: Yes = 1; No = 0
Total DFIT Score (%)
Total DFIT Score (%)
Passing score : 100%
= (No. of ‘Yes’/No. of Question) X 100%
 REVIEW OF PATIENT’S UNDERSTANDING ON ORAL SACT (DFIT)

The patient is currently prescribed with:

Chemotherapy / Hormonal Therapy

Drug Dose Frequency D F I T Remark
Apalutamide
Abiraterone
acetate
Azathioprine
Bicalutamide
Capecitabine
Chlorambucil
Degarelix
Everolimus
Exemestane
Fulvestrant
Lanreotide
Lenalidomide
Tegafur + gimeracil
+ oteracil
Temozolamide
Trifluridine/Tipiracil
Vinorelbine
Others [Including supportive therapy]

Scoring: Yes = 1; No = 0
Total DFIT Score (%)
Total DFIT Score (%)
Passing score : 100%
= (No. of ‘Yes’/No. of Question) X 100%
 Simplified Morisky Medication Adherence Scale for oral SACT (S-MAS-SACT)

No Item Not at all Rarely Sometime Often Remark

(0 point) (1 point) (2 point) (3 point)
1 How often are you ever
forgotten to take your
medication as prescribed
2 How you ever unsure
about whether you have
taken your medication.
4 Have you ever felt that
the treatment regime
prescribed is too complex
for you to remember?
5 Have you ever faced
challenges in getting
medication ( Financial,
Geographical and etc)

No Item No Yes Remark

(0 point) (3 point)
6 Have you ever reduced or
stop medication intake
because felt better.
7 Have you ever reduced or
stop medication intake
because felt worse or fear
of side effects to body.
8 Have you reduced or stop
taking medication intake
due to uncertain about
doses of each medication
prescribed.
9 Have you reduced or
stopped taking
medication because felt it
was unnecessary/
insignificant.
10 Have you ever altered the
dose or frequency of your
medication without
 consulting your
healthcare provider
Risk Scoring System:
0-2 points: Low risk - Patient demonstrates good adherence behavior.
3-5 points: Moderate risk - Patient shows occasional adherence issues.
6-8 points: High risk - Patient struggles with adherence and requires intervention.
8 points and above: Very high risk - Patient's adherence issues are severe and need intervention and
urgent attention.

Risk calculations (Combining DFIT and S-MAS-SACT):

- Patient is expected to able to score 100% in the DFIT session, any deviation the risk score will
automatically added with 6 points.
- Otherwise, if patient able to score 100% in DFIT session, risk score is fully based on the calculated
score in S-MAS-SACT

Risk Categories :

Low Risk (0-2 points):

Follow-Up Recommendation via phone call :

Frequency: No further phone call is required for this category group of patient.

Rationale: Patients in the low-risk category demonstrate good adherence behavior.

Moderate Risk (3-5 points):

Follow-Up Recommendation via phone call :

Frequency: To call patient within the first three days from the date of initial face-to-face interview.
(TOTAL PHONE CALL : 1)

Rationale: Patients in the moderate-risk category show occasional adherence issues. More frequent
follow-ups are necessary to address challenges promptly, provide additional support, and assess the
impact of interventions.

High Risk (6-8 points):

Follow-Up Recommendation via phone call :

Frequency : To call patient within the first 3 working days from the date of initial face-to-face
interview and 3 working days before the end of oral SACT cycle. (TOTAL PHONE CALLS : 2)
Rationale: Patients in the high-risk category struggle with adherence and require intensive support.
Regular and frequent follow-ups is essential to closely monitor progress, adjust interventions as
needed, and ensure that the patient is receiving the necessary assistance.
Very High Risk (8 points and above):
Follow-Up Recommendation:

Frequency: To call patient within the first 3 working days from the date of initial face-to-face interview,
and at one random date (or date which prefer by patient to receive call) , as well as one call during 3
working days before the end of oral SACT cycle. (TOTAL PHONE CALLS : 3)

Rationale: Patients in the very high-risk category face severe adherence challenges and need more
intensive intervention.

RISK SCORE (DFIT + S-MAS-SACT)

Low Risk : Medium Risk: High Risk Very High Risk

F2F interview x 1 F2F interview x1 F2F interview x 1 F2F interview x 1

F/up phone call : Nil F/up phone call x 1 F/up phone call x 2 F/up phone call x 3
De- escalation:

For patient who initially was medium , high and very high risk, there is a possibility where patient risk
was improved during the second f/up or interview and hence de-escalation on phone call was
clinically practical.

For medium risk :

De-escalation to low risk during f/up : discharge from MTAP

High risk :
De-escalation to low risk during 1st phone call follow up : discharge from MTAP
De-escalation to medium risk during 1st phone call follow up : no further phone call is required, to
reassess patient during actual clinic TCA.
De-escalation to low risk during 2nd phone call/actual follow up : discharge from MTAP
De-escalation to medium risk during 2nd phone call : no further phone call is required, to reassess
patient during actual clinic TCA.

Very high risk:

De-escalation to low risk during 1st, 2nd or 3rd phone call/ actual follow up : discharge from MTAP
De-escalation to high risk during 1st phone call follow up : follow phone call f/up as high risk group
De-escalation to high risk during 2nd phone call follow up : follow phone call f/up as high risk group
De-escalation to high risk during 3rd phone call follow up : Strongly recommend clinician to re-enroll
patient into MTAP
De-escalation to medium risk during 1st phone call follow up : follow phone call f/up as medium risk
group [Another phone call f/up x 1]
De-escalation to medium risk during 2nd phone call follow up : follow phone call f/up as medium risk
group [Another phone call f/up x 1]
De-escalation to medium risk during 3rd phone call follow up : May suggest clinician to re-enroll
patient into MTAP, to discuss with clinician.

Escalation and no improvement.

For patients who initially were medium, high, and very high risk, there is a possibility where patient
risk score does not improve or worsen after respective phone calls f/up in each risk categories were
done. For such cases, pharmacists are required to discuss with treating clinician to re-enroll patient
into MTAP program again.

Any cases where risk score where worsen, pharmacist required to inform treating clinician and
number of phone call f/up required to perform are in respective to the number frequency mentioned
in each risk category. For eg: during initial F2F interview, patient is belongs to category of medium
risk, during first phone call f/up, it was noted that patient risk score were increased to high risk,
hence additional f/up phone call x 2 are required to perform.
References
1) Morisky Medication Adherence Scale. http://www.moriskyscale.com/.
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2015;15(2):121-9. PMID: . PMCID: . 10.1016/j.ijchp.2014.11.003
3) Moon SJ, Lee WY, Hwang JS, Hong YP, Morisky DE. Accuracy of a screening tool for medication
adherence: A systematic review and meta-analysis of the Morisky Medication Adherence Scale-8.
PLoS One. 2017;12(11):e0187139. PMID: . PMCID: . 10.1371/journal.pone.0187139
4) Hatah E, Rahim N, Makmor-Bakry M, et al.. Development and validation of Malaysia Medication
Adherence Assessment Tool (MyMAAT) for diabetic patients. PLoS One. 2020;15(11):e0241909.
PMID: . PMCID: . 10.1371/journal.pone.0241909
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Sep 30. PMID: 34604127; PMCID: PMC8483895.