Following advice ... or being non-compliant

Why don’t I always comply? What is compliance, anyway?  Wikipedia says that, “In medicine, compliance (also adherence) describes the degree to which a patient correctly follows medical advice.”

Compliance usually means sticking to your medications but it can mean the use of medical devices, exercises, self-care or therapy. 

In my case I haven’t been totally compliant in my trismus exercises, my teeth cleaning or in making sure I compensate for limited food options by eating a range of the foods I know I need.

I HAVE been compliant when it come to head and neck exercises and fitness exercise in general. I’m compliant with my medications.

According to Wikipedia again, “non-compliance is a major obstacle to the effective delivery of health care. Estimates from the World Health Organization (2003) indicate that only about 50% of patients with chronic diseases living in developed countries follow treatment recommendations.In particular, low rates of adherence to therapies for asthma, diabetes, and hypertension are thought to contribute substantially to the human and economic burden of those conditions.

Major barriers to compliance are thought to include the complexity of modern medication regimens, poor "health literacy" and lack of comprehension of treatment benefits, the occurrence of undiscussed side effects, the cost of prescription medicine, and poor communication or lack of trust between the patient and his or her health-care provider.”

If I look at my case as an example, I think I comply when there is a clear benefit. After my first big HNC surgery I couldn’t lift my left arm up above my shoulder but a few weeks of the prescribed exercise of walking my arm up the wall brought movement back to normal. This was a case of an easy exercise which showed quick improvement. I keep myself fit because I enjoy walking and hard physical work. The medications I take are a no-brainer because they give me clear benefits and I have no qualms about taking drugs, unlike some people who, probably rightly, want to keep medications to a minimum.

As for the trismus exercises, there were a couple of things going on there: my trismus didn’t worry me except then I was at the dentist’s. It seemed to be the least of my worries. And two, there seemed no benefit that I could perceive from doing them (they weren’t working) and thirdly I couldn't carry out the preferred exercise which involved pushing an increasing number popsicle sticks in the mouth, an unpleasant activity which led to a broken tooth!

Teeth! I try but not hard enough!

The following extract from Medscape looks at why people might not comply in terms of their medications.

To thicken the plot, a patient's unique cluster of reasons for not complying at any given time isn't stable. With the loss of a job, for example, medications may become unaffordable, so the patient stops taking them, or cuts the pills in half to make them last longer, or skips some doses.

After a divorce, job loss, or any traumatic event, depression may set in; taking medication as directed may then be the last thing on the patient's mind.

Or a compliant patient may suffer a medication-related adverse event. As a result, she may stop taking her pills, as up to 20% of patients do because of perceived side effects.

Does the patient tell the doctor? Probably not. Why? The doctor is so busy; she doesn't want to be a bother. Or she doesn't like the doctor, so this is how she retaliates. Or she decides that her ill effects are a sign that she's taking too many drugs, so she goes off-regimen. Or she consults with a friend on a social networking Website for patients with similar chronic conditions, and the friend advises her to try alternative medicine instead.

"Is it widely known that adherence is a cluster of behaviors and not a single construct?" asks internist John F. Steiner, MD, MPH, Research Director at Kaiser Permanente's Institute for Health Research in Denver, and a thought leader on medication compliance issues. "No, that's actually a radical claim."

Here is a chart showing ways in which compliance can be improved, through more support. Maybe effort needs to be expended on both sides!


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Diana Ayling

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  • Ooh this is good. I can see from the graph that support makes a huge difference. Another reason to have specialised cancer care support. How could we bring that to life in reality and virtually?

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