Abstract
The purpose of the study was to examine treatment compliance in hemodialysis patients and to determine which personality or psychosocial factors might be predictive of compliance. A total of fiteen patients entered the study and were given the Millon Behavioral Health Inventory, Moos Family Environment Scale, and the Beck Depression Inventory at the outset of dialysis treatment. The Family Environment Scale and Beck Depression Inventory were repeated at three and six months after the start of hemodialysis. Patients were then rated on their fluid, dietary, and medication compliance using routine weight-change and serum potassium and phosphorus levels. Results indicated that while all patients were compliant with restrictions on potassium intake, there was a considerable incidence of noncompliance with weight and phosphorus limitations, with weight noncompliance associated with elevations on scales reflecting a tendency towards seeking external satisfaction of emotional needs while phosphorus noncompliance was associated with the need to assert personal autonomy and control over events. Patients noncompliant with both indices were very similar to consistently compliant patients and their scores on scales related to the likelihood of poor adaptation to chronic illness and treatment were higher than those shown by patients noncompliant with one or the other compliant measure, at a level approaching statistical significance. Statistically significant differences were found between compliant and noncompliant patients on a number of personality variables in both types of noncompliance, as well as between patients who died during treatment and those who survived. The results indicate that noncompliance is not a unitary process in hemodialysis patients, involving different coping styles based on independence/dependency conflicts and the degree to which denial is used defensively.