A child and parent illustrating non-compliance with treatment: understanding non-compliance with treatment.
BACKGROUND
In children and adolescents non-compliance with treatment is a major concern. To shed light on its mechanisms, we present a family demonstrating non-compliance.


METHODS
B, a 10 year-old boy, treated for medulloblastoma, refused high-dose chemotherapy and Autologous Bone Marrow Transplantation. Six psychotherapeutic interviews with B, his parents and staff resolved the causative issues.


RESULTS
B's behavior expressed his parents' ambivalence, despite their informed consent. Their reasons were conscious and unconscious, rational and irrational, linked to both the past and present experiences. The mother was convinced that he would die. The discussions helped both parents to assume their parental role, B perceived their ability to truly accept the treatment and support him.


CONCLUSIONS
Non-compliance should not be viewed as a child's or parents' intrapsychic problem, but as the result of multi-determined interaction between the child, the parents, the staff interacting with present and past events. When the child's death is a possibility, the parents' ambivalence confuses their understanding and acception of the therapy. The development of confidence between the staff, the child and parents and clear agreement about the goals of therapy is necessary to avoid the occurrence of and escalation of non-compliance, which raises difficult clinical, legal and ethical questions.
Dept. of Pediatrics, and Unit of Psycho-Oncology, Institut Gustave-Roussy, 94805 Villejuif, France.
Daniel
D
Oppenheim
Olivier
O
Hartmann
Arthur
A
Ablin
Barbara
B
Sourkes
D000970:Antineoplastic Agents / Q000627:therapeutic use; D001294:Attitude to Health; D016026:Bone Marrow Transplantation / Q000523:psychology; D002528:Cerebellar Neoplasms / Q000523:psychology* / Q000628:therapy; D002648:Child; D006801:Humans; D008297:Male; D008527:Medulloblastoma / Q000523:psychology* / Q000628:therapy; D010290:Parents / Q000523:psychology*; D011368:Professional-Family Relations; D016312:Treatment Refusal / Q000523:psychology*
D000970:Antineoplastic Agents