Solutions for Compliance After Stroke

Updated:May 15,2014

Much Information

1. Denial
It’s hard to deny that you’ve had a stroke, though survivors often try because it’s so hard to accept, much less embrace, the changes that stroke brings. Having had a stroke also puts you at higher risk of having another one. That should only be scary if you refuse to deal with your risk factors. The drugs and lifestyle modifications your doctors have given you are designed to do that. “In overcoming denial, scaring the patient almost never works,” says Dr. Jacobs. “People blow off those kinds of messages by concluding that the doctor doesn’t know what he’s talking about. “I train clinicians in our program to assess where someone is on the change continuum and try to move them from one stage to another when they come in. For instance, most people with diabetes don’t start making changes immediately, but they gradually start to take in the information and modify their behavior. “It may also be helpful to bring in the spouse or other family members to help patients change a longstanding habit.”

2. Stubborn refusal
Patients who aren’t cooperating with their medical team aren’t taking responsibility for their condition. Stroke is the dictionary definition of serious medical problem, and survivors are at higher risk, so you can’t afford not to take responsibility for your situation. If you can’t accept your doctors and therapists as allies, they will inevitably become your adversaries, and your health and recovery will
suffer. If you don’t trust what they are doing or you don’t understand the goals and schedule of your treatment, ask them to explain. If you don’t agree with the goals or treatment plan, find doctors with whom you can agree. Your chance for success improves when you understand and agree with your treatment plan. Studies have shown that patients who make written commitments to follow their treatment plans are more successful. Such a statement is solid evidence that you have accepted responsibility for your condition. “The relationship between a doctor and patient has tremendous impact on whether patients adhere to their treatment plan,” says Dr. Jacobs. “At a minimum, a patient must feel listened to and understood, those are prerequisites if he is to put any stock in what the doctor says. If the physician has his head buried in a chart, the patient is unlikely to feel heard. When the patient feels understood, the doctor is in a position to offer treatment advice. If the doctor comes in and gives directives and the patient hasn’t spoken, then probably nothing is going to happen. But if a physician says ‘here are four things that will make an impact,’ and the patient says ‘I can do two and three,’ then they will develop a plan that the patient is more likely to follow.” “Sometimes giving a person a simple choice allows them to feel some control in the situation,” says Dr. Bernardi. “Giving the choice between taking medication now or in 15 minutes. However, refusing to comply often has deeper roots, so asking the patient what is bothering them and then just listening can help.”     

3. Cognitive deficits
Cognitive deficits that undermine compliance are the most difficult to compensate for. Medication maps and simplified drug regimens are helpful. Family support is important, but professional caregiving services may be necessary in dealing with this barrier. “This can get complicated when a patient becomes belligerent,” says Dr. Bernardi. “There may not be a way around the behavior changes, and there will be a struggle. Caregivers must remain creative. For instance, they may mask the medication by putting it in food or drink. Sometimes these kinds of instructions are better accepted when they come from a nonfamily member.” Dr. Rybacki says, “There are pager-based systems that can give a patient a ‘beep’ with the name of the medicine and instructions for using it.”

4. Lack of knowledge
The Internet contains a staggering amount of health information, but just because it’s out there doesn’t mean it’s accurate. Always be concerned about the source of information, and never act on anything until you have discussed it with your physician. Not all Web sites are created equal. Timely information from reputable Web sites such as www.strokeassociation.org, www.fda.gov, www.diabetes.org and  www.nih.gov provide reliably gathered and objectively reviewed information. Getting in touch with national health organizations like the American Stroke Association for relevant publications is always a smart approach. “Understanding what you are facing is half the battle,” says Dr. Rybacki. “Never be afraid to ask your nurse, doctor or pharmacist questions. You actually make their jobs easier when you help yourself. All competent healthcare professionals welcome the chance to help you understand your health, diseases or conditions and medicines as they relate to their particular expertise — regardless of how  busy they may be.”

5. Life gets busy and other priorities arise
You can’t make something a habit until you’ve made it a priority, so make taking your medicine as important as brushing your teeth. Most people don’t wait until someone tells them their breath reeks before using a toothbrush. Don’t wait for your body to tell you that you need to take your medication. Making a written commitment can help. If yours is a complicated treatment plan, ask your doctor if it can be simplified. Use a weekly pill dispenser where a week’s worth of pills can be allotted. Keep it somewhere where you will be cued to take them, such as by the bathroom sink when you brush your teeth. Cue pill taking with some other activity, like eating. Dr. Rybacki had trouble remembering to take his blood pressure medicine, but after he asked his family to help him remember, he didn’t miss a day. Enlisting family support is often a successful strategy.

Doing what we’re told — everyone has a problem with that. It starts young, and judging by the noncompliance figures, it stays with us till we die. People resist following orders, so perhaps that is where the change needs to start. It’s a simple shift in attitude, from seeing a  person as an adversary to viewing them as a friend.

Read the beginning of this article, Why Not Comply I
Read the second part of this article, Why Not Comply II



This content was last reviewed on 04/30/2014.