The Role of Beliefs in Decisions about Medication

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The Role of Beliefs in Decisions about Medication

• Kathleen Mazor, EdD
• HMORN CERT
• Meyers Primary Care Institute,
• University of Massachusetts Medical School,
• Fallon Community Health Plan and Fallon Clinic

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Background

• For therapy to occur, the patient must accept
  the recommendation to initiate medication.
• This step is often overlooked.
• This session will focus on the role that beliefs
  play in patients decisions to accept medication.

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Three Relevant Studies

• The role of beliefs, communication and trust in a
  hypothetical decision
• The role of knowledge, beliefs, communication and
  trust in initiating OP medications
• Questionnaire study
• Interview study

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Accepting HTN medication in a hypothetical
situation

• 210 lay people recruited from the community
• Questionnaire
• Imagine yourself just diagnosed with HTN, you
  have this conversation with your doctor
• Questions would you accept medication, trust,
  doctors communication, beliefs about medication
  and HTN.

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Analysis

• Bivariate correlations
• Multivariate models predicting acceptance

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Results Best predictors of initiation

• Trust in the physician.
• Perception that the physician has communicated
  well.
• Belief that medication is effective in treating
  HTN.
• Belief that doctors do not prescribe unsafe
  medications.

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Initiation of Prescription Medication for
Osteoporosis

• Women with recent bone density study meeting WHO
  criteria for OP, not treated in prior 6 months
• Mailed questionnaire
• knowledge, beliefs, experiences
• Electronic medical record review and pharmacy
  records

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Results

• 465 women invited to participate
• 271 returned survey (58)
• 57 started prescription OP treatment within 3
  months of testing

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Women who do not start are more likely to agree

• I can take care of my OP without medications (26
  vs 5)
• There are better ways for me to treat my OP
  besides medications (45 vs 24)
• I worry about the side effects of taking OP
  medication. (77 vs 57)

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Women who do not start are more likely to agree

• Medications often cause more problems than they
  solve. (50 vs 31)
• I prefer not to take medications. (61 vs 43)
• Doctors are too quick to prescribe medications
  (46 vs 30)
• Doctors often give medication when advice would
  be better. (40 vs 24)

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Women who do start are more likely to agree

• Taking OP medication is good for me. (62 vs 37)
• Medication can effectively treat my osteoporosis.
  (72 vs 49)
• I worry about having OP. (72 vs 51)

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Women who do start are more likely to agree

• Taking OP medication can help my bones become
  stronger. (77 vs 58)
• Taking OP medication can help me stay
  independent. (66 vs 47)
• Taking OP medication can help me stay active. (66
  vs 48)

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No difference or very small difference

• My prescriptions sometimes cost more than I can
  afford.
• I think OP is a very serious disease.
• I sometimes forget to take my medications on
  time.
• I worry about interactions between my
  medications.

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Summary

• More likely to accept med if
• Believe OP will be effective and beneficial
• More likely to decline if..
• Believe can prevent OP otherwise
• Distrust medication, concerned about side effects
  and problems

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Further exploration of acceptance of OP meds

• 35 in-depth qualitative interviews
• Women age 65 and older
• Have had BMD testing
• meet WHO criteria for OP
• Focus on 3 decisions accept, decline,
  discontinue

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Preliminary Findings

• Analysis is currently underway

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Why women accept treatment

• Believe medication will be helpful
• I should take something because I want to keep my
  bones as strong as possible
• I was glad to take it if it was going to help.
• I dont like taking prescription drugs, but
  obviously since my exercise and diet was not
  working, I had to do it ...

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Why women accept treatment

• Trust in their physician
• if your doctor tells you that you have to, you
  more than likely listen
• I took his word that this was what I should
  doI do trust him. I feel comfortable and I dont
  think that he would lead me in the wrong
  direction.

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Why women accept treatment

• Awareness of the debilitating consequences
• I see people that do have it and the way theyre
  bent way over due to the back problem and theyre
  in a lot of pain and its kind of scary. I
  visualize myself in five years, is that going to
  be me?

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Why women decline treatment

• See medication as unnecessary
• Like I said, I dance, I jump, I fall down, I get
  up, I plant, I dig, I plant, I do everything I
  want. Dont have a problem.
• my bones seem to be pretty good. Ive fallen a
  few times and Ive never broken a bone. Ive
  never broken anything.

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Why women decline treatment

• Concerns about side effects
• Id rather risk a fall, which could happen
  tomorrow or it could happen when Im 80, rather
  than take something daily that has high risks of
  side effects.
• Theres all kinds of things that happen when you
  take this prescription medicine

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Why women decline treatment

• Concerns about medication precautions
• But if they say, You have to stand up, or you
  cant lay down when you take these pills, and Im
  going, What is going on here? Just how much does
  this involve? I dont like that...And what is
  this stuff anyway? Is it like plutonium? What is
  it? Am I going to blow up if I lay down?
• youre ingesting something that sounds pretty
  powerful to me I have no problem standing,
  sitting, but I just even think that precaution
  makes me leery.

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Why women discontinue treatment

• Experience with side effects
• I was sick. I went down in my bed. I was
  vomiting, and I dont vomit.
• I had side effects from this medicationthere was
  something in there that didnt agree with me.
• I started getting clicking of the jaw. Sort of
  like a lockjaw type of thing. after a month or
  two, I stopped taking it because of that and it
  went away.

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Why women discontinue treatment

• Fear of side effects
• ..I read an article about fosamax, something
  about the jaw, it could cause a big problem
  there...when I read that, I said, Thats it, I
  will never take them again.
• I had heard of a friend of mine who had been
  taking fosamax for like ten years, she started
  losing her teeth. So I got kind of worried about
  that because thats one thing I dont want to do
  is lose my teeth.

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Why women discontinue treatment

• Lack of reaction from prescriber
• But I got sick on it. So then he said, Well never
  mind, just dont take anything. So that was that.
• Theyre overloaded and I guess with me saying I
  wasnt going to take it anymore he just said,
  Well thats your decision, abruptly, and that was
  that.
• in November when I went and I told her I wasnt
  taking it, she didnt push me or say anything.
  She just wrote it on my chart.

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Conclusions

• Beliefs are important influences on decisions
  about medications
• Belief in the need for the medication
• Belief that the medication will help
• Belief that the medication is safe side effects
  unlikely or minimal

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Conclusions

• Dont yet fully understand how beliefs function
  impact is probably not constant across people,
  conditions, medications.
• Dont yet know how to change beliefs.

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Next steps

• Better understanding of mental models
• What affects perceptions of need?
• What affects perceptions of safety?
• What affects perceptions of benefit?
• Strategies for changing beliefs
• For physicians
• Print/media/web materials

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References

• Mazor KM, Fischer MA and Billings-Gagliard S.
  Initial Acceptance of Treatment with
  Antihypertensive Medication The Importance of
  Communication, Trust and Beliefs. Journal of
  Communication in Healthcare. 2008. 1(3).
  311-323.
• Yood RA, Mazor KM, Andrade SE, Emani S, Chan W,
  Kahler KH. Patients Decisions to Initiate
  Therapy for Osteoporosis The Influence of
  Knowledge and Beliefs. In press. Journal of
  General Internal Medicine. (expected out online
  next week)
• Interview manuscript is in process

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Contact information

• Kathleen.mazor_at_umassmed.edu