title: 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 non-compliant days was 16.6 (s.d. 15.6). Men were more likely than women to be non-compliant (P<0.05); as were participants with an elevated depression score (P<0.05). Stepwise regression models identified significant predictors of non-compliance: gender, depression, global distress and nausea and vomiting severity (P-values all <0.01). Further analysis revealed that the interaction of the psychological variables with gender was a more robust predictor of non-compliance (P<0.001). 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.
authors.affiliation: Department of Psychiatry and Behavioral Neurosciences, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL 60153, USA. pmumby@lumc.edu
authors.forename: P B
authors.initials: PB
authors.lastname: Mumby
authors.forename: C
authors.initials: C
authors.lastname: Hurley
authors.forename: M
authors.initials: M
authors.lastname: Samsi
authors.forename: S
authors.initials: S
authors.lastname: Thilges
authors.forename: M
authors.initials: M
authors.lastname: Parthasarathy
authors.forename: P J
authors.initials: PJ
authors.lastname: Stiff
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology / Q000628:therapy*; D010349:Patient Compliance; D012737:Sex Factors; D014182:Transplantation, Autologous; D016312:Treatment Refusal