Reasons for Non Compliance in Medical Treatment - Research Paper Example

Noncompliance to Medical Treatment: The Case of Individuals with Multiple Sclerosis Introduction For some individuals a crystal-clear diagnosis is unburdening. For others, a definite diagnosis is overwhelming and generates either a detrimental reaction or pathological defiance such as non-compliance with medical treatment (Sullivan, Mikail, & Weinshenker 1997). Whatever the initial reaction, affirmation of the diagnosis conveys new difficulties. There is an extensive negative publicity about multiple sclerosis (MS); numerous patients as well as their families routinely take on a depressing course for the illness, with overall impairment taking place in short order (Sullivan et al. 1997). Normally, patient has several questions regarding their prognosis. A number of these are unanswerable with any assurance. Coping with a disabling and chronic disease is heightened by not having the knowledge of how it may develop. Phases of hopefulness come with the periods of reduction (Rosner & Ross 2008). It is essential that individuals responsible for the care of patients with multiple sclerosis are furnished with optimism and an encouraging explanation of the prospects of prognosis (Rosner & Ross 2008). Alexander Burnfield, a psychiatric specialist with multiple sclerosis, in his own description of the illness, has this to say (Sullivan et al. 1997: 249): In my experience, the vast majority of people with MS have wanted to know the nature of their disease as early as possible. They have been keen to discover all that they could about MS to enable them to make their own decisions about their future. Many have felt that they had a right to know about their own illness and to control their own treatment. Another psychiatric specialist with multiple sclerosis, Elizabeth Forsythe, stated that when informing the patient and the family about the illness: “Honesty is paramount but optimism comes a close second. Multiple sclerosis is not a death sentence; rather it is a diagnosis that needs some thought and considerable adaptation of life style” (Sullivan et al. 1997: 249). A diagnosis of multiple sclerosis creates several problems. Patients and their families should cope with a chronic, capably immobilising illness for which there is no treatment. Disease-modifying therapies (DMTs), which are presently available, are all capable of being injected (Polman 2006). Coupled with the necessity to take supplementary symptomatic treatments, compliance to MS treatments can be quite challenging. Given these difficulties, sustaining enthusiasm and treatment compliance in patients with MS is vital for most favourable health (Polman 2006). This paper centres on sustaining treatment compliance to patients with MS by evaluating explanations for decreases in enthusiasm and reviews suggestions to get the most out of treatment compliance. According to existing literature obstacles to sustaining treatment compliance in patients with MS comprise treatment exhaustion, complacency concerns, dealing with unpleasant incidents, believed lack of effectiveness, fear of injection or medication, and failing to remember the medication (Holland, Murray, & Reingold 2007). A sincere and truthful relationship between healthcare provider and patient is an integral component in sustaining enthusiasm and compliance in patients with MS. Furthermore, uninterrupted education and constant strengthening of the treatment value are important techniques in the sustenance of treatment compliance (Holland et al. 2007). Other techniques to encourage compliance involve management of treatment hopes and reduction of unfavourable incidents (Rosner & Ross 2008). Obstacles to Treatment Compliance Individuals with multiple sclerosis confront quite a few obstacles to compliance. Foremost among these are difficulties with unfavourable incidents, believed lack of effectiveness, and injecting or medicating (Polman 2006). Unfavourable incidents Unfavourable incidents are another primary basis for noncompliance to MS treatments, with investigations revealing that more or less 50% of patients withdraw from treatment for this reason (Stauffer 2006). The most prevalent unfavourable incidents, according to clinical trials, encouraging medical intervention such as need for supplementary medication, modification of prescribed amount, or discontinuation, include depression, increased liver enzymes, flu-like symptoms, and injection site effects (Stauffer 2006). An earlier hospital research on patients with MS treated for 8 years reported that the most prevalent unfavourable incidents resulting in discontinuation among therapy users were injection-site effects, exhaustion, depression, and flu-like symptoms (Kalb 2004). In clinical observations of glatiramer acetate, the most prevalent unfavourable incidents resulting in clinical intervention comprised depression, tachycardia, injection site effects, tremor, and vasodilation. Roughly 10% of glatiramer acetate users whine about a complete post-injection effect typified by dyspnea, flushing, and tachycardia (Satuffer 2006). Even though this has a tendency to weaken within minutes, it can be somewhat worrisome when first encountered and affect a patient’s eagerness to comply with therapy (Stauffer 2006). There have been various instances of lipoatrophy related to the injection of glatiramer acetate explained in quite a few pieces of empirical evidence. In an investigation by Edgar and associates, half of the sample population who were or had been using glatiramer acetate cultivated lipoatrophy and several patients discontinued treatment (Holland et al. 2007). Skin defects such as lipoatrophy was revealed as a prevalent reason for noncompliance. Growth of lipoatrophy is damaging, disabling, commonly a long-term effect, and is related to a major psychological effect (Holland et al. 2007). Hence, lipoatrophy may further encourage noncompliance. Believed Lack of Effectiveness There are patients who think that their therapy is not effective when present symptoms do not subside with regular inoculations or they encounter new symptoms. This believed lack of effectiveness can be the outcome of idealistic treatment hopes (Rosner & Ross 2008). MS therapies adjust the immune reaction but cannot alleviate MS; hence, patients may still experience deteriorations, development, and new brain lesions (Hohlfeld 1997). Dissimilar to some injectable medications such as insulin, which allows a patient to determine its efficacy by regularly monitoring levels of blood glucose, no consistent and explicit indicator has been found to measure whether a treatment is effective favourably for a patient with MS (Polman 2006). Investigations confirm that believed lack of effectiveness amounts to more or less 50% of noncompliance. Tremlett and associates revealed that lack of effectiveness was the most prevalent stated reason for disruptions of therapy longer than a month among patients using MS therapies (Poser 2003). Mohr and associates discovered that prior to the start of therapy, 57% of patients had idealistically positive hopes of the capability of treatment in lessening deteriorations and 34% had the same hopes about the capability of treatment in enhancing functional condition (Stauffer 2006). Difficulties with Injecting or Medicating One of the main obstacles to compliance among MS patients is that presently available treatments for deteriorating-abating MS necessitate parenteral supervision through infusion or self-injection (Poser 2003). Frequent responses when patients are instructed to self-inject include anxiety, avoidance, aversion, and autonomic responses. There are patients who evade self-injection by asking family members to perform the injection (Poser 2003). Relying on another individual to administer the injection can be an obstacle to compliance because it influences the self-reliance of the patient and enhances the possibility of neglected injections if the chosen family member is not around (Poser 2003). In an earlier research, of 12 patients who admitted missing more than one injection, only 2 administer self-injections. In the same research, only a small percentage of the sample population who withdrew from treatment at 6 months did so because they fear self-injection (Kalb 2004). Explanations for difficulties with injecting or medicating go beyond mere needle or drug anxiety. There are patients who think that injections or drugs are unsafe. In their minds, this is proven if they encounter an autonomic reaction, such as tremors and flushing, when administering an injection (Kalb 2004). Some patients foster erroneous ideas about injections or medications and believe that these treatments are an indication of illness trouble instead of a beneficial disease management (Polman 2006). Other possible obstacles to compliance become evident through conversations with patients. One of these obstacles is complacency or being unworried. In the initial phases, MS treatment is usually imposed when a patient is in decline, making it extra challenging for some patients to perform self-injection when they feel good (Polman 2006). Furthermore, patients who have been receiving treatment for a short time and have not encountered any deteriorations or symptoms of development may start to believe that they do not have to perform self-injection any more or perhaps not as frequently as prescribed (Rosner & Ross 2008). Treatment exhaustion can be a core problem among patients under long-term treatment. After quite a few years of performing self-injection, some patients become burned out of the procedure and the limitations MS treatment places on their life activities (Rosner & Ross 2008). Moreover, continuing MS therapy users may encounter deteriorations in their injection capabilities. In several instances, this is another kind of complacency, though in others it could be linked to understated functional or cognitive problems related to MS (Rosner & Ross 2008). Cognitive problems can hamper the memory of a patient, making it more probable that s/he will overlook the injection or encounter problems performing the task. Setbacks with fine motor capacities may hamper some patients’ capability of adjusting their medication or perform injections (Hohlfeld 1997). Exhaustion and depression can also impinge on a patient’s skill or eagerness to perform self-injection (Poser 2003). In other instances, support conditions or family situations could modify in such a way that patients with MS may no longer have someone else to administer treatment (Holland et al. 2007). Similarly essential, financial conditions or medical coverage of patients may adjust such that s/he can no longer pay for treatment (Sullivan et al. 1997). Determinants of Compliance Disability, expectation, self-efficacy, and self-confidence have been revealed as determinants of compliance (Holland et al. 2007). In line with this, Fraser and associates carried out an assessment of compliance determinants in patients using glatiramer acetate and discovered observed healthcare provider assistance and support, expectation, and self-efficacy to be important determinants (Polman 2006). In an independent assessment of patients with self-revealed progressive types of MS, spousal support, self-efficacy, and observed healthcare provider assistance and support were discovered to be important determinants of compliance to glatiramer treatment (Polman 2006). In an interview of veterans with chronic MS who were using an MS treatment for an average of 3 years, observed advantages of compliance separately determined treatment compliance over a 6-month follow-up phase (Stauffer 2006). Interviews with patients indicate that a key motivator for compliance is the fear of encountering deteriorations and future impairment. Other stimulators include the need to avoid troubling or burdening members of the family, witnessing progress on magnetic resonance images, encouraging other patients with MS, seeing the outcomes of not complying with medical prescription in relatives with other illnesses, indulging oneself after inoculations, and gaining control of MS treatment (Stauffer 2006). Meanwhile, the relationship between the patient and healthcare provider is usually multifaceted, and an unhealthy relationship can intensify treatment noncompliance (Hohlfeld 1997). For MS patients, it is vital to sustain a sincere and trusting relationship between patient and healthcare provider (Hohlfeld 1997). Both of them should know what each anticipates of the other, to build a healthy relationship. Due to the fact that it is known that early identification of MA is critical for opportune instigation of MS therapy, healthcare providers find themselves in need of talking about MS as a potential diagnosis earlier in the symptomatic procedure than previously (Poser 2003). The manner healthcare providers explain the diagnosis and treatment alternatives and their eagerness to pay attention to patients can determine the eventual therapeutic relationship. Sincerity and honest in the initial phases strengthens the relationship and determines the foundation for trust and confidence (Poser 2003). How patients encounter indications is personal and individualised. Views of symptom acuteness can differ noticeably from patient to patient. These variations in views can result in communication collapse (Sullivan et al. 1997). Sympathy for and understanding of patient’s anxieties, hopes, and health perceptions are important. Patients have to feel that their caregivers understand the difficulties that an MS diagnosis gives: feelings of vulnerability, adjusted family and work responsibilities, and the problem related to complying with injectable treatments (Rosner & Ross 2008). Fraser and associates discovered that observed healthcare providers assistance and support is an essential determinant of compliance. In 2007, an assembly of MS Representatives held a convention. At this particular convention, patients revealed inconsistency in the degree of healthcare provider support (Rosner & Ross 2008). For instance, some healthcare providers entrust the decision as to which MS therapy to start up to the patient. Even though most patients want to get involved in the decision-making process, they do not automatically wish to be the one and only decision-maker. In contrast, a number of patients revealed that their health care providers make decisions about their treatment without explaining available alternatives (Rosner & Ross 2008). These patients have knowledge of the medications and want to participate in the decision-making process and contribute as an associate in the treatment scheme (Rosner & Ross 2008). The MS Representatives felt that data/information to assist patients in making an enlightened decision is absent and that patients would be better capable of participating in the decision-making process with enhanced educational tools (Rosner & Ross 2008). The MS Representatives also revealed that several physicians pay no heed to the complaints of patients of unfavourable incidents, proposing that eventually patients will foster tolerance to these difficulties (Rosner & Ross 2008). In contrast, many physicians know that unfavourable incidents create tremendous challenges for treatment compliance and initiate steps to lessen the threat of unfavourable incidents and advise patients on means to avoid or get through them (Holland et al. 2007). A healthy relationship between healthcare provider and patient needs mutual trust, openness, and honesty. Such a relationship enables patients to gain most favourably from the physician’s skill and knowledge and the physician will be more apt to respond properly and correctly to the needs and expectations of the patients. Sustaining Treatment Compliance Various techniques are available to assist patients in surmounting obstacles related to complying with MS treatment (Kalb 2004). Instruction about injection strategies and about what patient can realistically hope from treatment, and from multiple sclerosis itself, is a major technique to effectively sustaining treatment compliance and should be a continuous process. Moreover, the importance of the treatment and the value of compliance have to be strengthened continually (Kalb 2004). Indications of noncompliance include overlooked appointments, overlooked refills, and dishonesty on the patient’s part. Patients should be consulted about their means of coping with their therapy in a direct, specific, and non-aggressive way (Polman 2006). Asking if a patient is administering their MS medication is not enough; instead, patients should be asked certain questions such as “Have you missed any of your injection schedules last month?” If patients show problems with compliance, physicians should make every attempt to collaborate with the patient to establish an appropriate and satisfactory solution (Polman 2006). In several instances, the solution may entail asking for assistance from members of the family and/or other loved ones. In other instances, reminder mechanisms, such as medication alarms or notes may be essential, specifically for patients experiencing cognitive deficits. In any case, a number of steps should be taken into account when identifying the most favourable means to sustain treatment compliance for a patient: determine practical expectations, deal with injection or medication fear, and cope with and lessen unfavourable incidents (Polman 2006). Establishing an uncomplicated starting point to encourage compliance is informing patients about the importance of treatment, while determining sensible expectations (Holland et al. 2007). Appropriately supporting patients prior to the therapy can prevent difficulties with compliance. For instance, patients should be educated that even though available means lessen the occurrence of deteriorations by roughly 50%, therapy also lessens the incidence and acuteness of deterioration (Holland et al. 2007). Even though MS treatments do not remedy MS, through reduction of deterioration and interruption in development, they can assist patients in sustaining vitality and quality of life (Poser 2003). Furthermore, patients who are in remission should be aware that even though they may not be encountering declines or symptoms of progression, the illness may be at work at a subclinical point and hence, continuation of treatment is indispensable to assist in lessening the burden of disease (Holland et al. 2007). Patients experiencing difficulties with the notion of self-injecting may require rigorous therapy to encourage compliance. Only when they are well educated, most patients will realise that the procedure is easier than they thought and will have hardly any difficulties with compliance (Hohlfeld 1997). For those who encounter difficulties, the first measure is to dispel their anxieties about the safety of injections. This can be achieved by informing them about appropriate medication planning and injection strategy (Hohlfeld 1997). For instance, some patients may be anxious that the syringe’s air bubble will bring about an air embolism, or that the inoculation itself will harm bones or muscle. The presence of air bubbles can assist in making inoculations less painful due to the fact that the air purifies the needle prior to removal, placing less medication to aggravate the tissue (Stauffer 2006). Clarifying this and stressing that these problems are highly improbable, especially if the injection is carried out hygienically and with the appropriate procedure, can assist in dealing with these anxieties (Stauffer 2006). Other means to lessen injection fear include decreasing unfavourable incidents, relaxation strategies, and cognitive reframing (Kalb 2004). Cognitive reframing implies changing one’s frame of thinking to make them more precise and functional. For instance, MS patients are persuaded to perceive injections as a means of sustaining future health instead of an additional burden of their illness (Kalb 2004). Autonomic reactions related to injection fear can be mitigated through relaxation procedures such as breathing skills and deep muscle relation to avoid autonomic disorders such as hyperventilation (Kalb 2004). Meanwhile, as is apparent from the above discussion, unfavourable incidents can be a key obstacle to compliance. Most unfavourable incidents related to MS treatments can be effectively handled with suitable injection procedures and adjustments in lifestyle (Polman 2006). Flu-like indications are related with the administration of IFN beta; these commonly happen within 2-6 hours of injection and mitigated within 24 hours. MS patients should become aware that their prescription is not inflicting them the flu; (Polman 2006) instead they may encounter indications identical to a flu-like disease; educating patients of particular symptoms instead of applying the term ‘flu-like indications’ could assist in lessening anxieties in some patients (Polman 2006). Methods that assist in alleviating these symptoms involve steady titration of the recommended means from a low preliminary dose, and gradually increasing to the full dose. Related administration of non-steroidal anti-inflammatory drugs will assist in alleviating sore and fever linked to flu-like indications (Holland et al. 2007). Non-pharmacologic methods involve evening injections, which enables patients with MS to sleep through the flu-like indications, or administering injections on days when the indications will be least troublesome (Holland et al. 2007). Conclusion While the capably disabling impacts of multiple sclerosis cannot be overlooked, healthcare providers can be integral in developing and improving treatment compliance and work abilities of patients with this illness. Individuals with MS, on average, are informed, have previous work history, and most individuals have manageable diseases. Healthcare providers have to be aware of the direction and practical restrictions of MS on an individual level. Treatment compliance can be enhanced if appropriate assessment procedures, alternative forms of medication, and support and assistive mechanisms are employed. Furthermore, the healthcare provider should keep his/her mind on hindrances to treatment compliance. All of these issues should be dealt with for adequate treatment planning for individuals with MS. References Hohlfeld, R. (1997) Multiple Sclerosis: Clinical Challenges and Controversies, London: Informa Healthcare. Holland, N.J., Murray, T.J., & Reingold, S.C. (2007) Multiple Sclerosis: A Guide for the Newly Diagnosed, New York: Demos Health. Kalb, R. C. (2004) Multiple Sclerosis: The Questions You Have-- The Answers You Need, New York: Demos Medical Publishing. Polman, C. H. (2006) Multiple Sclerosis: The Guide to Treatment and Management, New York: Demos Medical Publishing . Poser, C. M. (2003) An Illustrated Pocketbook of Multiple Sclerosis, Boca Raton, FL: Parthenon. Rosner, L. & Ross, S. (2008) Multiple Sclerosis: New Hope and Practical Advice for People with MS and their Families, New York: Fireside. Stauffer, M. (2006) Understanding Multiple Sclerosis, Jackson, MS: University Press of Mississippi. Sullivan, M.J., Mikail, S., & Weinshenker, B. (1997) Coping with a Diagnosis of Multiple Sclerosis, Canadian Journal of Behavioural Science , 249+. Read More