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Release: Oct. 18, 1999

UI psychology research to aid doctors in choosing treatment to suit individuals

IOWA CITY, Iowa -- A team of University of Iowa researchers has won a nearly $650,000 four-year grant from the National Institutes of Health to study the psychological factors that affect patients’ compliance with prescribed medical treatments.

Alan Christensen, a UI associate professor of psychology and the primary investigator for this study, along with Dr. William Lawton and Dr. Andrew Bertolatus, both associate professors of internal medicine, will study patients with kidney disease to find out which of several treatment options works best for individual personality types.

Patients experiencing chronic renal failure must undergo either a form of life-long kidney dialysis or receive a kidney transplant. Dialysis can be administered in a clinic by a nurse or technician or can be self-administered at home. Christensen said the various treatment options can all be quite effective as long as the patient adheres strictly to the treatment plan.

But how can doctors know whether their patients will follow one treatment plan better than the other? Right now, there is little psychological data to help doctors determine whether their patients’ personalities are better suited to the active role of administering their own dialysis, receiving a renal transplant, or to the passive role of allowing a clinician to run the dialysis.

"In health care we’ve often made the assumption that more control is better for all patients, but this is not always the case," Christensen said. "Some people prefer to remain passive and allow healthcare providers to direct and manage the treatment."

Earlier research has shown that the majority of people don’t comply with prescribed medical treatments, Christensen said. While in some cases this failure is as simple as not completing a course of antibiotics, other cases, such as skipping a kidney dialysis session, can have serious consequences.

"We need to understand what factors influence whether or not patients follow a medical regimen," he said. "This will lead us to finding ways to increase compliance."

Toward this end, Christensen and his colleagues will interview patients in the early stages of renal disease to assess their potential suitability to various treatment plans. The team will interview patients, asking a series of questions to assess each patient’s usual methods of coping with or responding to health-related stress and experiences.

The team will then follow these patients through their treatment to see how they respond to the regimen they and their doctors have chosen. By comparing personality types with responses to specific treatments, Christensen and his team will be able to point to characteristics that make a person suitable for one type of treatment over another.

The team will also study patients who are preparing for kidney transplants in order to gather hard evidence about the types of people who are most likely to comply with lifelong post-transplant treatment plans. Currently, Christensen said, patients are psychologically evaluated before transplants, but these assessments are not based on any hard data that can predict the type of person who will adapt well to the life-changing procedure.

"By the end of this four-year project, we hope to produce solid research findings that specifically point to psychological and social factors that reliably predict which patients respond most favorably to particular treatments," Christensen said.