Improving Compliance in Dialysis Patients: Does Anything Work?

Abstract

Noncompliance with prescribed therapy significantly impacts dialysis patient care and outcome. At least one-half of hemodialysis (HD) patients are likely to be noncompliant with some part of their treatment regimen, and one-third of peritoneal dialysis (PD) patients are believed to miss prescribed exchanges. Psychosocial issues, younger age, and smoking behavior have been linked with compliance problems in multiple studies. Few interventions have been rigorously tested, but patient education and/or individualized attention, supervision, encouragement, and support are widely advocated strategies to improve patient compliance. Areas in need of continued study include psychosocial determinants of compliance in PD as well as HD patients, compliance behavior patterns over time, and the parameters within which dialysis compliance can vary and still achieve specified treatment goals.

Determinants of Compliance Behaviours among Patients Undergoing Hemodialysis in Malaysia

“…Other studies have also reported that older age was associated with higher compliances to fluid restriction and medication prescription [24], [36]–[37]. Possible explanations are older patients may have more structured lifestyle that accommodates the demands of the treatment regimen while younger patients may perceive themselves as less vulnerable to negative health outcomes [38], confirming the existence of an “intentional noncompliance” [39]. The finding that younger patients were more likely to be non-compliant to treatment recommendation may lead to the future poorer quality of life and higher rates of mortality among these dialysis patients.…”

Psychosocial Influences on Suboptimal Adjuvant Breast Cancer Treatment Adherence Among African American Women: Implications for Education and Intervention

“…As with most chronic diseases, there is an inevitable tension between treatmentrelated constraints and side effects and the patient's desire to maintain a normal life (Kutner, 2001). In the context of breast cancer treatment, this balancing act often involves trading off toxicity concerns against survival and quality-of-life benefits (Chung & Carlson, 2003;Detmar, Muller, Schnornagel, Wever, & Aaronson, 2002).…”

“…Compliance literatures also offer a mixed picture, with knowledge-based interventions being intermittently successful; writers have noted that even when information is effectively communicated, knowledge may be variably important (Kutner, 2001;Wolcott, Maida, Diamond, & Nissenson, 1986), and it has been suggested that the consideration of other factors is needed (Wang et al, 2002).…”

Cognitive Behavioral Treatment to Improve Adherence to Hemodialysis Fluid Restrictions: A Case Report

“…It has been estimated that more than 50% of hemodialysis patients are nonadherent in some manner within a one-month time period [1] and upwards of 70% of patients fail to adequately restrict their fluid intake [2]. These rates are alarming, particularly with the consideration that even occasional episodes of serious noncompliance can have severe adverse effects.…”