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Sickest Patients Less Likely to Follow Orders

Sickest Patients Less Likely to Follow Doctors' Orders, UCR Study Finds

Anxiety and depression may contribute to difficulty adhering to prescribed treatment, says research team led by psychology professor Robin DiMatteo.

(June 7, 2007)

RIVERSIDE, Calif. ( — Are more seriously ill patients more likely to follow their treatment recommendations than patients whose health is not as seriously threatened?

Despite its importance to practicing physicians, this question has not been answered conclusively until now. UC Riverside researchers have found that patients who are most severely ill with a serious disease are less likely to follow a physician’s recommendations for treatment.

In a study published in the June issue of the journal Medical Care, the UCR researchers also found that patients in the worst health with less serious diseases are more likely to adhere to treatment.

Those findings have significant implications for health-care professionals, said Robin DiMatteo, UCR distinguished professor of psychology and lead researcher and author of the journal article, “Health Beliefs, Disease Severity, and Patient Adherence, A Meta-Analysis.” Medical Care is the official journal of the Medical Care Section of the American Public Health Association.

The research is funded by a two-year, $267,501 grant from the Robert Wood Johnson Foundation. The study is the work of the authors and does not imply endorsement by the foundation.

DiMatteo and graduate students Kelly Haskard and Summer Williams analyzed 60 years of research on patient adherence. They found that when patients are severely ill with serious diseases like cancer heart disease and HIV, there are many physical, psychological and practical reasons why it may be difficult to follow prescribed treatment regimens.

“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,” DiMatteo and colleagues wrote. “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serious disease conditions, adherence may even seem futile, and patients may become depressed, pessimistic, socially withdrawn, and hopeless about surviving.”

DiMatteo's work finds that when patients struggle with serious conditions, distressed states such as anxiety and depression may contribute to difficulty in processing and acting upon clinical directives.

“When patients have very serious illnesses, those who are in the poorest health should be recognized as having the greatest risk for nonadherence to treatment,” the researchers wrote.



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