As Severity Of Illness Increases, Compliance Decreases

07-23-2007 | Categories:

Clinical Info

Health Beliefs, Disease Severity, and Patient Adherence: A Meta-Analysis. DiMatteo, M Robin PhD; Haskard, Kelly B. MA; Williams, Summer L. MA. Medical Care. 45(6):521-528, June 2007.

The Study

The study is a meta-analysis of 116 articles published from 1948 to 2005 that dealt with “the relationship between patient adherence and patients’: (1) beliefs in disease threat; (2) rated health status (by physician, self, or parent); and (3) objective disease severity.”

Results & Conclusions Excerpted From The Abstract

Adherence is significantly positively correlated with patients’ beliefs in the severity of the disease to be prevented or treated (”disease threat”). Better patient adherence is associated with objectively poorer health only for patients experiencing disease conditions lower in seriousness (according to the Seriousness of Illness Rating Scale). Among conditions higher in seriousness, worse adherence is associated with objectively poorer health. Similar patterns exist when health status is rated by patients themselves, and by parents in pediatric samples.

Results suggest that the objective severity of patients’ disease conditions, and their awareness of this severity, can predict their adherence. Patients who are most severely ill with serious diseases may be at greatest risk for nonadherence to treatment. Findings can contribute to greater provider awareness of the potential for patient nonadherence, and to better targeting of health messages and treatment advice by providers.

The authors speculate that “patients may have doubts about the efficacy of their treatments, particularly if some have failed them, and their expectations for and interactions with their providers may be reduced in quality as they grow more severely ill. For patients in poor health with serious disease conditions, adherence may even seem futile, and patients may become depressed, pessimistic, socially withdrawn, and hopeless about surviving.”¹

Commentary

While the finding that patients with the most serious illnesses are least likely to adhere to treatment is counterintuitive to the common sense notion that those facing the greatest threat would be the group most likely to follow healthcare instructions, this result resonates with my clinical and personal experiences.

As DiMatteo and colleagues note, anxiety and depression associated withs severe disorders may play interfere with a patient’s ability to understand or execute a treatment plan or deplete a patient’s energy or motivation.

Also, however, more severe disorders may call for more rigorous, costly, and complex treatment regimens which could negatively affect compliance.

Regardless of the cause, however, this evidence that these individuals afflicted with the most serious illnesses are especially vulnerable to noncompliance should be a concern physicians automatically consider and monitor in the treatment of such patients.

Footnotes