How Video Reflexive Ethnography Can Improve Oral Anti-cancer Agent Patient Education


More than half of the patients prescribed oral anticancer agents report persistent moderate-to-severe symptoms, despite receiving counseling on adverse effect management.

Among 1.8 million patients who are newly diagnosed with cancer each year, many are prescribed oral anticancer agents (OAAs). Although OAAs offer the convenience of home treatment, these medications can cause uncomfortable symptoms leading to medication nonadherence. In fact, more than half of the patients prescribed OAAs report persistent moderate-to-severe symptoms, despite receiving counseling on adverse effect (AE) management.

Image credit: Nathan Devery com -

Image credit: Nathan Devery com -

A new publication in PEC Innovation reviews a pilot study in which researchers applied video reflexive ethnography (VRE) as an intervention to improve OAA patient education and reduce nonadherence. VRE is a tool that captures in situ video footage of care practices that participants can later review.

In the study, researchers filmed patient counseling sessions between pharmacists and patients receiving an OAA. Later, both the participating pharmacist and patient collaboratively engaged in “reflexivity,” which refers to a collective process in which group members evaluate what happened and identify areas for further improvement.

Researchers intended VRE to help pharmacists identify their shortcomings in OAA patient education. Patients also contributed their feedback during data collection. As a whole, this process enabled pharmacists to understand how to deliver patient education more effectively.

Researchers found that patients often struggled to understand and recall instructions from the counseling sessions due to information overload. Counseling clinicians may overcome this barrier if they use multi-modal strategies and teach-back techniques. Clinicians may also enhance patients’ educational experiences by reiterating main teaching points and scheduling follow-up appointments to monitor AEs.

Participating pharmacists also suggested adding computer monitors in the counseling room to possibly aid in the delivery of counseling points. Compared to the traditional verbal approach, visual aids displayed on monitors can provide a focal point for patients. Incorporating visual diagrams or images can also help patients who are hearing the information for the first time.

Overall, this study showed the potential pharmacist have to:

  1. Close the knowledge gap in their understanding of the best education methods to engage patients and caregivers.
  2. Explore factors that interfere with patients’ and caregivers’ ability to internalize education information to be applied at home properly.

In this small study of 4 participants, the 2 pharmacists identified several areas of practice improvement, which may not have occurred otherwise. The patients also appreciated the opportunity to provide feedback on their OAA counseling experience. Although clinicians have already applied VRE to improve practice ICU rounds, end-of-life safety, and transitions of care processes, pharmacists can continue to use VRE to improve all types of care processes at any site.

About the Author

Kimberly Ma is a 2024 PharmD candidate at the University of Connecticut.


Manojlovich M, Rizvi-Toner A, DasGupta R, et al. Video reflexive ethnography as an intervention to improve oral anti-cancer agent patient education: A pilot study. PEC Innov. 2023;2:100148. Published 2023 Mar 21. doi:10.1016/j.pecinn.2023.100148

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