Psychological Barriers to Adherence

Patients may have many reasons for not adhering to their medication regimen, including unwanted side effects, unmanageable cost, simple forgetfulness and a host of psychological issues, such as anger, denial, apathy and depression. But not discussing those reasons can be problematic.

Patients want to please their providers, so at times, instead of telling the truth, they tell us what they think we want to hear,” says Carolyn Blasdel, a board certified family nurse practitioner with the Knight Cancer Institute in Portland, Ore. “I’ve had patients who just don’t want to deal with it or have a fear of criticism or of making the provider angry. And many are just in denial.”

The consequences of hiding nonadherence from one’s care team can be serious, adds Ann Partridge, an associate professor of medicine at Harvard Medical School in Boston. If patients don’t discuss adherence issues, they may not get the benefits of the therapy, which can be significant. “Medications are lifesaving,” Partridge says. “Nonadherence has been associated with increased illness, increased hospitalization and increased costs.”

The solution? Patients mustn’t be afraid to talk openly with their care team about any issues they may have with their oral medications. Most oncologists want only to help and will not judge their patients, Partridge says.

On the clinical side, it is important that providers match education to the patient’s style of learning. For many, a brochure or informational website is sufficient, but some people may have trouble with reading or comprehension and try to hide that fact. “If I suspect that’s the case, I usually discuss things verbally and ask them to repeat what I have told them,” Blasdel says. “It also helps if a family member is there to take notes.”