Predictors of non-compliance in autologous hematopoietic SCT patients undergoing out-patient transplants

Abstract

Non-compliance has received significant attention in medicine, yet few studies have examined its correlates in autologous hematopoietic SCT (AHSCT) patients. This study examined predictors of non-compliance in a sample of 151 AHSCT patients treated in an outpatient setting. Before AHSCT, participants completed a validated measure of mood and retrospective chart reviews were conducted to assess non-compliance during AHSCT, defined as refusal of oral hygiene, prescribed exercise programs, oral nutrition and/or prescribed medications. We found 121 patients (80%) were non-compliant with an aspect of the AHSCT regimen on 1 or more days; mean percentage of noncompliant days was 16.6 (s.d. 15.6). Men were more likely than women to be non-compliant (Po0.05); as were participants with an elevated depression score (Po0.05).Stepwise regression models identified significant predictors of non-compliance: gender, depression, global distress and nausea and vomiting severity (P-values all o0.01). Further analysis revealed that the interaction of the psychological variables with gender was a more robust predictor of noncompliance (Po0.001). For outpatient AHSCT, our findings suggest the need to broaden conceptualizations of risk factors for non-compliance and the importance of assessing patient barriers to compliance to ensure optimal treatment outcome.

Psychosocial risk predicts high readmission rates for hematopoietic cell transplant recipients

“…Non-compliance, driven by psychological issues, 43 limited financial resources, poor insight, or inadequate social support is often cited anecdotally as the root of these poor outcomes in transplant patients. This study lends limited support to this theory.…”

Risk factors for depression and fatigue among survivors of hematopoietic cell transplantation

“…Not only are depression and fatigue distressing to patients, they are also associated with adverse outcomes. Depression is associated with nonadherence to the post‐HCT regimen, increased hospital length of stay, and greater mortality . Suicidal ideation is 13 times more likely in HCT recipients with depression than recipients without depression .…”

Coping strategies modify risk of depression associated with hematopoietic cell transplant symptomatology

“…Depression is a cause for concern among HCT recipients due to its association with adverse health outcomes. For example, pre-transplant depression prospectively predicted slower white blood cell recovery in the first 3 weeks after transplant (McGregor et al, 2012), while post-transplant depression has been found to be associated with non-adherence to treatment (Mumby et al, 2011), increased hospital length of stay (Prieto et al, 2002), and greater mortality (Loberiza et al, 2002; Prieto et al, 2002). Moreover, HCT recipients with depression are 13 times more likely to report suicidal ideation as recipients without depression (Sun et al, 2013).…”