Ensuring patient adherence when prescribing new medications or changing a therapeutic approach
can be difficult, particularly for patients with rheumatologic diseases and related inflammatory conditions.
Helping patients understand the value of newer, more effective medications is a common challenge, says Jayanth R. Doss, MD, MPH, a Duke rheumatologist who studies behavioral models and applies them to patient care. Doss notes that working to understand the individual's thought process and reasons for their current beliefs can often foster a more constructive conversation.
For example, rheumatologists may encounter patients who have read about a new medication or diet—typically an "all-natural" option—associated with inflammatory relief. In other cases, a patient may believe strongly in a product and express a desire to remain on that medication. And in some cases, patients feel more comfortable running changes by a naturopath or other alternative medicine provider.
"We often present data to appeal to patients' rationality," says Doss. In reality, though, it is more productive to frame suggested clinical changes in a way that aligns with the patient's belief systems and goals. Physicians can do this by studying the approaches derived from behavioral economics.
"Every clinician has seen the type of patient who makes a suboptimal decision for a reason that is logical to the individual, but clearly not the correct therapeutic choice," Doss says. He offers these suggestions for helping patients appreciate the importance of therapeutic change:
- Determine the patient's perspective about the medication or therapeutic change, which may be quite different from the clinician's. Once these different points of view are shared, discuss the differences to help bridge the gap.
- Discuss the patient's specific reasons for resisting a therapeutic change and encourage discussion and reconsideration. Behavioral studies show that humans dislike losing more than they like winning. This perspective may limit patients' willingness to change, Doss says, so he encourages physicians to listen closely to their patients' logic and gently encourage change.
- Demonstrate a supportive, not directive, role that is both compassionate and caring. This approach will help to build a relationship between the clinician and the patient and facilitate shared decision making.
"All of these steps help patients overcome their own reluctance," says Doss.