“Patients’ trust in their physicians is essential to their emotional disclosure and is therefore a crucial component of the patient–physician relationship. Patients must believe that their physician is someone who can understand their unique experience of being a patient, and someone who can provide them with reliable and honest advice”
Branch WT., Jr The ethics of caring and medical education. Acad Med.2000;75:127–32

Adherence and Emotions


In a review of about 40 to 50 scientific, peer-reviewed articles involving adherence to long term therapy, we have found that adherence research and programs may be missing the point: emotions are rarely taken into account. 

Adherence is one of the key issues facing the industry. Hundreds, if not thousands of studies have been conducted to assess adherence issues, but the problem persists. The total annual cost of non-adherence in the United States is estimated at $300 billion. This is largely related to the cost of hospitalization and medical procedures for people suffering from cardiovascular disease and diabetes. The cost to the pharmaceutical industry is staggering given that average adherence on medications for chronic diseases is only around six months.

While the research is interesting, one thing seems to be missing: none of it focuses much attention on the underlying emotional factors that impact patient willingness or ability to adhere to a therapeutic regimen over the long term.

In the word cloud above, built by aggregating the text of 30 articles on compliance and adherence, the size of the words indicates their relative frequency. Two elements are noticeable: the size of the words “patient” or “patients” compared to “physician”. And the absence of the word “emotion”. The burden of adherence is placed on patients and yet nothing is done to truly understand their perspective.

According to many research studies, typical patient adherence programs have little success, especially for chronic disease. Most efforts are behavioral, working on ways to increase the physical actions of adherence (i.e., making sure the patient takes a pill). Few efforts focus on the fundamental issue of trust between patient and physician. How do you get the patient to believe that the physician’s treatment decisions are valid and the best for the patient’s health? How do you get the patient to overcome the anxiety and fear when facing a disease state?

New models are emerging to address adherence and improve outcomes. Accountable Care Organizations, Care Alliances, Integrated Systems, Nurse Navigators and others all try to improve practitioner/patient relationships by focusing on treating patients comprehensively. This includes, for some of these organizations, obtaining an understanding of the patient’s emotional state.

There is, on the other hand, a decent body of research assessing communication between physicians and patients. The findings are quite conclusive: physicians have difficulty communicating effectively with patients and this has a strong negative impact on adherence. Patients forget most information about disease and treatment that physicians communicate to them, and this happens almost before they leave the doctor’s office.

At Stone Arabia Consulting we are experienced in conducting research into emotional drivers of choice. We’ve worked with leading pharmaceutical companies as well as smaller firms, even one-person startups, to help determine strategies for improving patient or physician emotional engagement to therapy over time. This research can take the form of a fully comprehensive program of exploratory research on patient journey and flow, or it can work in a smaller online survey. We rely heavily, though not solely, on visual stimuli, often shared across patient and physician targets, to assess unconscious emotional factors determining treatment choice by doctors and patient response to those choices. We are available to answer all questions.