Adherence to Pediatric Medical Regimens

1. It is incumbent on medical providers that they are asking patients to - here to regimens with demonstrated eficacy, Providers need to remind themselves of the Hippocratic oath: "I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit ofmy patients, and abstain from whatever is deleterious and mischievous" (as cited in Cassell, 199 1, p. 145). 2. Providers need to abandon the "blame and shame" approach to dealing with medical adherence problems. It is tempting to blame patients for adherence failures and shame them into changing their behavior. Providers need to share the blame (or better yet omit blame) and look at their own attitudes and behaviors that impact adherence. For example, failing to simplify regimens or minimize negative side effects can adversely impact patient adherence. 3. Patients and their families are no longer (or maybe were never) satisfied with apassive role in their health care. In fact, the tern compliance lost favor in the literature because it implied for some an authoritarian approach to health care that required unquestioned obedience by patients to provider recommendations (DiMatteo & DiNicola, 1982). Comprehensive and effective health care requires a cooperative relationship between providers and patients and their families. It also acknowledges the following realities, particularly for treating persons with chronic illness: "Doctors do not treat chronic illnesses. The chronically ill treat themselves with the help of their physicians; the physician is part of the treatment.

About the Author

Christina Duncan, Ph.D., is a Professor in the Department of Psychology and an Adjunct Clinical Professor in the Department of Pediatrics at West Virginia University. For more than 20 years, she has had a consistent record of publishing and garnering extramural funding to support her program of research on adherence in pulmonary disorders. Dr. Duncan is active in the Cystic Fibrosis Foundation, having been appointed to the Clinical Research Committee (grant review panel), Data Safety and Monitoring Board, and conference program planning committee. She served two consecutive terms as secretary for the Society of Pediatric Psychology. Dr. Duncan has received awards for her scholarly productivity as well as her clinical and professional service.

Cynthia Karlson, Ph.D., is an Associate Professor of Pediatric Hematology/Oncology and Psychiatry and Human Behavior at the University of Mississippi Medical Center. Dr. Karlson’s clinical interests focus on psychosocial adjustment to pediatric chronic medical conditions. Her research program focuses on chronic pain and sleep disturbance in children with cancer and sickle cell disease. She has published on developmental and biopsychosocial models of pediatric chronic pain and long-term pain in survivors of childhood cancer. Dr. Karlson is active as a Behavioral Science Member on Children’s Oncology Group clinical trial prools as well as in local and national clinical trials in pediatric sickle cell disease.