Solid Organ Transplantation: Are there Predictors for Posttransplant Noncompliance? A Literature Overview

Bunzel, Brigitta; Laederach‐Hofmann, Kurt

doi:10.1097/00007890-200009150-00001

Cited by 225 publications

(158 citation statements)

References 25 publications

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“…The resulting distress, no matter how 'normal', can have a considerably negative impact. Distress was found to be the strongest predictor both for medical and appointment noncompliance in renal transplant patients 8 and a high level anxiety was reported to be the most important predictor of noncompliance in the first year after heart transplantation. 8 Patients with high distress may find it difficult to assimilate information, engage in adaptive problem solving, and remember medical regimens.…”

Section: Patient-related Factorsmentioning

confidence: 94%

“…Distress was found to be the strongest predictor both for medical and appointment noncompliance in renal transplant patients 8 and a high level anxiety was reported to be the most important predictor of noncompliance in the first year after heart transplantation. 8 Patients with high distress may find it difficult to assimilate information, engage in adaptive problem solving, and remember medical regimens. Not unlike treating nausea, a 'normal' adverse effect of chemotherapy, distress should be directly treated, even though it is an expected consequence of the SCT experience.…”

Section: Patient-related Factorsmentioning

confidence: 94%

“…Elderly patients and those under 20 appear to be at risk. 8 Low socioeconomic status may be a barrier 6 if a patient does not have resources for transportation to clinic appointments, or to cover medication costs. Absence of social and family support can be a significant contributor to noncompliance [16][17][18]22 and may explain why the presence of a caregiver was a prognostic indicator of survival following allogeneic SCT.…”

Section: Patient-related Factorsmentioning

confidence: 99%

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Mismanaging the gift of life: noncompliance in the context of adult stem cell transplantation

Bishop

Rodrigue

Wingard

2002

Bone Marrow Transplant

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Summary:In this paper, we address the issue of noncompliance with medical regimens in adult stem cell transplant patients. We review the definition, prevalence, and consequences of noncompliance and address whether or not we should alter our medical decision-making with regard to stem cell transplantation based on patient noncompliance. We discuss how the health care team should handle noncompliance issues and propose clinical guidelines for stem cell transplant programs to consider regarding evaluation and management of medical compliance. Bone Marrow Transplantation (2002) 29, 875-880. DOI: 10.1038/sj/bmt/1703523 Keywords: compliance; adult; stem cell transplantation; medical decision-making; clinical guidelinesThe ultimate success of a medical therapy is dependent upon patients' ability and willingness to engage in and maintain certain health behaviors. Noncompliance with medical regimens can result in increased morbidity, mortality, unnecessary healthcare costs, and ultimately, loss of life. Given the advances of stem cell transplantation (SCT), now used successfully to treat a variety of once fatal diseases, very little attention has focused on factors that may maintain or maximize the life that is prolonged by this procedure. We are aware of no published studies that describe the compliance behaviors of adult SCT recipients. In this paper we review the definition, prevalence, and consequences of noncompliance and extrapolate from the general medical and solid organ transplantation (SOT) literatures, how these data could relate to post-SCT outcomes. We then pose two key questions. First, should we alter our medical decision-making based on patient noncompliance? Second, how should the health care team handle noncompliance issues? In conclusion, we propose clinical guidelines for SCT programs to consider regarding evaluation and management of medical compliance. Overview of noncompliance DefinitionThe most quoted definition of compliance is probably that of Haynes et al: 1 'the extent to which a person's behavior (in terms of medication, following diets, or executing lifestyle changes) coincides with medical or health advice'. This useful definition encompasses both the range of possible patient behaviors, as well as the degree to which a patient is compliant. Medical regimens include a variety of behaviors, such as taking medication, attending clinical appointments, following exercise and diet plans, abstaining from or limiting substance use, and engaging in preventive health behaviors. Thus, 'noncompliance is the degree to which behavior fails to coincide with medical recommendations in each of these areas'. 2 Compliance can be complete or partial, erratic or patterned. 3 Noncompliance is usually inadvertent, but can be intentional. Because of the range and number of health behaviors asked of patients, in most cases a patient cannot be described globally as noncompliant. Thus, health professionals should distinguish between compliers, partial compliers, and noncompliers, and not assume that patients who a...

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Section: Patient-related Factorsmentioning

confidence: 94%

Section: Patient-related Factorsmentioning

confidence: 94%

Section: Patient-related Factorsmentioning

confidence: 99%

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Mismanaging the gift of life: noncompliance in the context of adult stem cell transplantation

Bishop

Rodrigue

Wingard

2002

Bone Marrow Transplant

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“…In disentangling the effects of race, parental education and compliance on nephrologists' recommendations for transplantation in hypothetical, clinically 'appropriate' transplant candidates, our study points to further research in the direction of targeted interventions to erase differential access to transplantation. These interventions may include efforts to eradicate education biases, and the development of standardized, objective measures of compliance with care as part of the transplant evaluation (26).…”

Section: Compliancementioning

confidence: 99%

Effects of Patient Compliance, Parental Education and Race on Nephrologists' Recommendations for Kidney

Furth

Hwang²,

Neu

et al. 2003

American Journal of Transplantation

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Transplantation is the treatment goal for youth with kidney failure. To assess the effects of compliance, parental education and race on nephrologists' recommendations for transplantation in children, we surveyed a national random sample of adult and pediatric nephrologists. We elicited transplant recommendations for case vignettes created from random combinations of patient age, gender, race, cause of renal failure, family structure, parental education and compliance. Of 519 eligible physicians, 316 (61%) responded. Nephrologists were more likely to recommend transplantation for children of college-educated parents than children of parents who did not finish high school, despite identical clinical and demographic characteristics (adjusted OR 1.48, 95% CI 1.18, 1.86). Patient noncompliance negatively influenced transplant recommendations (adjusted OR 0.1, 95% CI 0.08, 0.13). Additionally, compliance had a different effect on transplant recommendations for white compared with black patients. The adjusted OR of a white, compliant patient being referred for transplantation were twice that of a black compliant patient (OR 2.06, 95% CI 1.17, 3.6). Education and compliance with therapy independently influence nephrologists' recommendations for transplantation in youth with kidney failure. Among the most compliant candidates, referral for transplantation may vary with patient race.

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“…Questions remain as to whether race, gender, marital status and occupation play a role in medication nonadherence. 1,9,13 Interventions aimed at improving medication adherence after transplantation have been proposed and evaluated. 14 In the US, the Centers of Medicare and Medicaid Services have stated that transplant teams must include an individual with qualifications, training, and experience in transplant pharmacology.…”

mentioning

confidence: 99%

Medication Adherence in Solid Organ Transplant Recipients and the Impact of Clinical Pharmacy Services

Martin

Gabardi

2009

Pharmacy Practice and Res

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Solid Organ Transplantation: Are there Predictors for Posttransplant Noncompliance? A Literature Overview

Abstract: The literature overview shows the necessity of preoperative psychosocial screening regarding predictors for posttransplant noncompliance.

Cited by 225 publications

References 25 publications

Mismanaging the gift of life: noncompliance in the context of adult stem cell transplantation

Mismanaging the gift of life: noncompliance in the context of adult stem cell transplantation

Effects of Patient Compliance, Parental Education and Race on Nephrologists' Recommendations for Kidney

Medication Adherence in Solid Organ Transplant Recipients and the Impact of Clinical Pharmacy Services

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