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Suspicion may prevent patients from following their treatment plan
IOWA CITY, Iowa -- A certain amount of suspicion is a good thing but
too much can be unhealthy. University of Iowa researchers have shown that
personality traits and attitudes can affect how well patients follow their
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
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
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
This study was funded by a grant from the National Institute of Diabetes
and Digestive and Kidney Diseases.