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Even though strict adherence to a treatment plan is critically important for the health of chronically ill patients, noncompliance is often high. That may be due, in part, to attitudes those patients hold about people and about physician control, says Alan Christensen, UI associate professor of psychology.
Christensen and his colleagues, John Wiebe, also in the department of psychology, and Dr. William Lawton, UI associate professor of internal medicine, found that a high level of cynical hostility -- mistrust and suspicion that others don't have your best interest at heart, and the belief that physicians' actions or advice can't control future health, are associated with regimen noncompliance. These findings are published in the May/June issue of Psychosomatic Medicine.
Christensen says that it is difficult to adhere to medical regimens that demand a lifestyle or behavioral change. Patients with kidney failure, for example, need to follow a challenging medical regimen that includes medication, restrictions in the amount of fluid that can be consumed, and changes in the types and amount of foods that are eaten. Past research has shown that failure to follow these guidelines can result in serious complications, including death. Despite these dangers, between 30 and 50 percent of hemodialysis patients don't adhere to their doctor's advice.
"When you're asking someone to adopt a medical treatment, you're asking them to change their behavior. Even pill-taking constitutes a behavior change, and physicians tend to underestimate just how difficult it is for most people to modify long-standing patterns of behavior, even when their life depends upon it," Christensen says.
This study shows that a personality trait, such as cynical hostility, can affect the way people face behavioral changes imposed by a medical regimen. The researchers' findings provide physicians with a way to identify patients who may not follow their regimen.
Cynical hostility is one component of the "Type A" personality and is linked to the development of cardiovascular disease and death from heart attack. The personality trait is also associated with poor health habits such as smoking, excessive drinking and little exercise.
Christensen hypothesized that people with a high level of cynical hostility would be less likely to adhere to a medical regimen than people with less cynical hostility.
To test this hypothesis, the researchers measured regimen compliance, cynical hostility levels and degree of patient belief that his/her physician's advice or actions affect his/her health outcome in 48 patients undergoing hemodialysis at the UI renal dialysis centers in Davenport and Mount Pleasant. Fifty patients either did not consent to be studied, or could not be used.
The mean age of the participants was 56.2 years, and they had an average of 12.4 years of education.
The researchers found that suspicious mistrustful patients were more likely to ignore parts of their medical regimen than others, especially when they also believed that the physician had little control over their future health condition.
Though the scientists studied hemodialysis patients, Christensen believes that the findings apply to other types of patients.
"I think this information can be extrapolated to any population where the medical regimen requires patients to change their behavior -- which is almost any chronic illness," he says.
Christensen believes that the noncompliance he and his colleagues identified has a psychological basis, and that behavioral therapy can be used to change the patient's thinking about the regimen and improve a patient's ability to cope with treatment demands. The scientists are currently testing that hypothesis.
This study was funded by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases.
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