Table 5.
Summary of Findings and Certainty of Evidence Using GRADE Confidence in the Evidence from Reviews of Qualitative Research Assessment
| Summary of Review Finding | Contributing Studies | Confidence in the Evidence | Explanation of Confidence in the Evidence from Reviews of Qualitative Research Assessment |
|---|---|---|---|
| High rates of nonadherence and nonpersistence to anti-VEGF treatment is observed, with the onset highest in the first 12 mos. | Lad 2014, Curtis 2012, Droege 2013, Westborg 2018, Subhi 2017, Boulanger-Scemama 2015, Rasmussen 2013, Heimes 2016, Kruger-Falk 2013 | Moderate | Moderate limitations based on variability in methodology, in particular with regard to selection and definition of outcomes; minor concerns regarding coherence across studies |
| Condition-related factors such as worse baseline visual acuity and poor response to treatment are associated with increased risk of both nonadherence and nonpersistence. | Oishi 2011, Polat 2017, Bobykin 2014, Boulanger-Scemama 2015, Ehlken 2018, Droege 2013, Obeid 2018, Vaze 2014, Nunes 2010 | Moderate | Moderate concerns regarding methodological limitations, in particular with regard to assessment of response to treatment; minor concerns with coherence |
| Injection regimens that individualize treatment reduce patient burden and improve adherence and persistence. | Droege 2013, Hanemoto 2017 | Low | Serious concerns regarding data adequacy and relevance to current practice |
| The most significant patient-related factor affecting treatment nonadherence or nonpersistence is significant systemic comorbidities and patient perception of treatment as not helpful or not needed. | Obeid 2018, Ehlken 2018, Rasmussen 2018, Bobykin 2014, Wintergerst 2018, Husler 2013, Droege 2013, Kruger-Falk 2013, Vaze 2014, Nunes 2010, Heimes 2016, Husler 2013 | Low | Serious concerns regarding methodological limitations, in particular with regard to assessment of patient perception of response to treatment; minor concerns regarding coherence across studies |
| Social isolation and lack of carer or transport were prominent factors for treatment nonadherence or nonpersistence. Indirect costs rather than direct costs of treatment were also barriers. | Oishi 2011, Droege 2013, Wintergerst 2018, Husler 2013, Heimes 2016, Polat 2017, McGrath 2015, Vaze 2014, Spooner 2018, Obeid 2018 | Low | Serious concerns regarding methodological limitations and adequacy of data, in particular with regard to the financial burden to patients across different health systems and settings |
| Health systems that allow for reduced visits (1-stop service) or for monitoring in a local center improved treatment adherence. | Heimes 2016, Krivosic 2017 | Low | Serious concerns regarding methodological limitations and adequacy of data given only 2 studies examined strategies to improve adherence |
VEGF = vascular endothelial growth factor.