For patients, adherence decision-making is based on a mix of emotion and logic. Understanding where an individual patient’s balance point lies and responding appropriately could be a major key to better adherence.
Roles of Emotion and Logic in Decision-Making
If asked whether your decision-making processes leaned more on logic or emotion; what would you say? I’d guess most of us believe our decisions emerge from a rational and logical consideration of the options. You may be surprised to learn this does not appear to be the case.
There’s a growing body of opinion that decisions are emotional, not logical. A champion of this view is the USC neuroscientist, Antonio Damasio. He argues that emotion and feelings are not in opposition to reason. Instead, he proposes they provide essential support for the reasoning process (see here).
Damasio supports this view with the following observations (see here):
- Patients with damage to the brain’s emotional center cannot make even simple decisions
- Pure thought, free from emotion, is less useful than generally assumed
- Personally beneficial decision-making needs emotion as well as reason
- The brain ‘decides’ among choices by ‘marking’ one option as more emotionally important
So how does all this effect adherence decision-making?
The rest of this post examines this question from the patients’ perspective. While a future post will consider the other side of the coin; focusing on HCPs’ balance of logic and emotion when seeking to improve adherence decision-making.
With respect to adherence decision-making, my starting assumption is it that patients act just like people. So – like all of us – they need to combine emotion with logic to make ‘good’ decisions.
However, patients treated for chronic illnesses often deal with exaggerated emotions, beyond the ‘normal’. For example, such a patient may:
- Have an impaired self-image (eg, stigma of illness, restricted lifestyle)
- Present irrational biases (eg, emphasize present treatment discomforts over future health benefits) – see here for more on biases
- Feel a lack of motivation (eg, low feelings of treatment necessity, high perceptions of treatment concerns)
The emotions triggered by these factors may in part explain why levels of intentional non-adherence are so high. For instance, intentional non-adherence rates of 40%-80% have been reported (see here and here).
Patients treated for chronic illnesses are where non-adherence rates are the highest. And for these patients, it’s likely that emotion reasoning plays a greater role in adherence decision-making.
Implications for Improving Adherence Decision-Making
How does all this impact the way HCPs go about approaching the task of improving patient adherence? As chronically ill patients have more emotional reasoning behind their non-adherence, shouldn’t HCPs response in kind?
If emotions drive non-adherence, then logical arguments to improve adherence are unlikely to gain traction. Patients won’t make the ‘right’ decision because it is logical. They’ll make the decision to adhere because they feel it’s to their advantage to do so. The HCP’s role is to help them feel this way.
As an example, the aim of Motivational Interviewing (see here) is to help a patient discover their own internal motivation to adhere. Maybe that’s one route to consider?
How else might HCPs address emotional reasons for non-adherence?