Non-completion Of Treatment Research Articles

Outcome reporting in neoadjuvant surgical trials: a systematic review of the literature and proposals for new standards.

The use of neoadjuvant therapy before surgery for gastrointestinal cancer is increasing; however, patients may not complete both treatment components. Understanding completion rates of each treatment stage is necessary for treatment evaluation and to inform decision-making. This study evaluates reporting for recent neoadjuvant surgical trials, focusing on treatment progression and other key outcomes. Systematic literature searches identified randomized and nonrandomized phase II and III studies evaluating neoadjuvant treatment and surgery for esophageal, stomach, and colorectal cancer, and colorectal liver metastases. Rates of reporting of failure to complete neoadjuvant treatment, nonprogression to surgery after neoadjuvant treatment, and nonresection at planned surgery were assessed. For each measure, reporting was categorized as "full," "partial," and "absent" according to predefined criteria, and reasons for nonprogression at each stage of treatment were examined to inform proposed standards. Of 9854 abstracts, 123 papers were reviewed and 62 articles were included, reporting outcomes for 9126 patients. Details of noncompletion of neoadjuvant treatment and nonprogression to surgery were completely absent in 21 (33.9%) and 19 (30.6%) studies, respectively. Reporting of nonresection at planned surgery was also deficient, with 21 (33.9%) studies providing no information about this outcome. Reasons for noncompletion and nonprogression were similar and included disease progression, treatment toxicity, and patient choice. Common reasons for nonresection were locally advanced disease and the discovery of unsuspected metastases. Reports of recent neoadjuvant surgical trials often fail to include treatment progression and other key outcomes. These findings support the need for minimum reporting standards.

Defence styles in a sample of forensic patients with personality disorder.

Ego defences, often considered central to clinical work, have received surprisingly little attention in the forensic literature. In this exploratory study, 114 male inpatients completed the Defence Style Questionnaire (DSQ) following their admission to a specialist personality disorder (PD) service. Change in DSQ scores over time was examined using mixed effects models for those (n = 48) remaining in treatment for at least 18 months. Defensive functioning at baseline was less mature in comparison with non-clinical norms, with two other non-forensic PD samples, and with a male paedophile sample, but was unrelated to criminal history. Axis II severity was negatively associated with overall defensive functioning (ODF). Antisocial PD was positively associated with a maladaptive defence style. Borderline PD was negatively associated with self-sacrificing defences. Avoidant PD was negatively associated with both self-sacrificing and adaptive styles. Non-completion of treatment was predicted by low ODF scores and high maladaptive defence style scores at baseline. ODF improved significantly over time in treatment and was predicted by strong antisocial and weak schizotypal PD pathologies. Defence style, as measured by the DSQ, appears to have the potential to inform assessment and measure change in this group of offenders.

Factors associated with noncompletion of latent tuberculosis infection treatment in an inner-city population in Edmonton, Alberta.

A limited number of studies have been published that examine treatment completion rates and interventions used to increase treatment completion within an inner-city population. The purpose of the present study was to determine the rate of latent tuberculosis infection (LTBI) treatment completion in an inner-city population in Edmonton, Alberta, and to identify factors that correlated with treatment completion. A retrospective chart review was conducted involving patients who started LTBI treatment between January 1, 2005 and December 31, 2010 in Edmonton's inner city. A total of 77 patients started treatment and 57 (74%) patients completed LTBI treatment. Homelessness was the only variable that was significantly associated with incomplete treatment (OR 8.0 [95% CI 1.4 to 45.6]) and it remained significant when controlling for drug use (adjusted OR 6.5 [95% CI 1.1 to 38.8]). While the present study demonstrated treatment completion rates comparable with or better than those described in the general population, it highlighted the need for continued emphasis on interventions aimed at improving outcomes within homeless populations.

Can a peer-based intervention impact adherence to the treatment of latent tuberculous infection?

To assess the effectiveness of a peer-based intervention on adherence to and completion of latent tuberculous infection (LTBI) treatment. Patients prescribed self-administered LTBI treatment were enrolled in a randomized controlled trial of an experimental, peer-based adherence support intervention. Primary outcomes were treatment adherence and completion. Adherence was assessed through self-report, electronic monitoring devices and clinic visits. Of 250 participants, 70% were male; 71% were Black and 20% Latino; the mean age was 40 years; 67% were foreign-born and 39% were married. No significant baseline differences were noted between the intervention groups. Treatment completion was 61% in the intervention group compared to 57% in the controls (P = 0.482). The corresponding completion rate for other clinic patients was 44%. Foreign birth, marriage and history of mental illness were associated with non-completion of treatment after controlling for the intervention group; increased completion rates were found among foreign-born married persons and older participants. A substantial difference in adherence rates was observed between the intervention groups. Adherence among non-completers decreased early, while adherence among completers remained constant. The peer-based intervention was not significantly associated with LTBI treatment completion, but was associated with greater adherence. Findings suggest the importance of interventions to support adherence that target early non-adherence with LTBI treatment, particularly in the first 2 months, when there is a substantial risk of default.

Factors Associated With the Non-completion of Conventional Anti-Tuberculosis Treatment in Peru

BackgroundThe non-adherence to tuberculosis treatment is associated with increased infection, antibiotic resistance, increased costs and death. Our objective was to identify factors associated with lack of completion of conventional treatment for tuberculosis in Peru. Patients and methodsAn unmatched case–control study in patients diagnosed with tuberculosis from 2004 to 2005 who completed treatment until September 2006. The cases were defined as patients who discontinued treatment for ≥30 consecutive days, while the controls were defined as those who completed treatment without interruption. The factors were identified by logistic regression, calculating odds ratios (OR) and 95% confidence intervals (CI). ResultsWe studied 265 cases and 605 controls. The non-adherence to treatment in our study was associated with the male sex (OR=1.62; CI: 1.07–2.44), having felt discomfort during treatment (OR=1.76; CI: 1.19–2.62), a prior history of non-compliance (OR=7.95; CI: 4.76–13.27) and illegal drug use (OR=3.74; CI: 1.25–11.14). Also, if we consider the interaction of previous non-adherence history and poverty, the risk of non-completion increases (OR=11.24; CI: 4–31.62). Conversely, having been properly informed about the disease (OR=0.25; CI: 0.07–0.94) and being able to access health-care services within office hours (8am–8pm) (OR=0.52; CI: 0.31–0.87) were associated with better adherence. ConclusionsThe non-compliance with anti-tuberculosis treatment was associated with non-modifiable factors (male sex, previous non-compliance) and with others whose control would improve compliance (malaise during treatment, illegal drug use and poverty). Likewise, providing access to the health-care system and improving the information given about tuberculosis should be the priorities.

Tuberculosis control in a highly endemic indigenous community in Brazil

In Latin America, indigenous populations have high rates of non-completion of TB treatment and case fatality and have been defined as a priority group for investments. To evaluate TB control, a retrospective cohort study was performed to identify factors predictive of non-completion of treatment and mortality in an indigenous and non-indigenous population between 2002 and 2008 in Dourados, Brazil. A 90% reduction in non-completion of TB treatment was observed in the indigenous population after DOTS (directly observed treatment, short course) implementation (20% vs 2%). In the non-indigenous population, the number of patients not completing TB treatment continued to increase. Non-indigenous TB patients had 4.5 times higher mortality than indigenous TB patients (9% vs 2%). In multivariate analysis, non-indigenous race [odds ratio (OR) 2.33, 95% CI 1.32–4.10] was associated with non-completion of TB treatment, and HIV-positive status (OR 5.58, 95% CI 2.38–13.07) was associated with mortality. Implementation of DOTS in the indigenous populations in Dourados showed a significant reduction in non-completion of TB treatment. Nevertheless, a high rate of TB in children and young adults indicates the continuous transmission and maintenance of the epidemic in this community. Among the non-indigenous population, the TB case fatality rate is closely linked to the HIV prevalence.

Treatment readiness, treatment engagement and behaviour change

Non-completion of treatment is a common occurrence in correctional contexts. Non-completion compromises service cost-efficiency, impacts adversely on staff and service user morale and may limit the effectiveness of therapy. Attention needs to be paid to enhancing offenders' readiness for treatment, and developing and maintaining their engagement. In this paper, we state that research and practice in offender treatment readiness and engagement need to be driven in four major ways: (1) the construction of models of engagement that are theoretically based and empirically evidenced that can underpin assessments and treatments; (2) the development of psychometrically robust assessments of treatment readiness, motivation and engagement that can be used to select offenders for treatment or measure change over time; (3) the design, implementation and evaluation of pre-treatment preparation procedures that can promote treatment engagement and completion; and (4) the development of strategies that address barriers to engagement as an integral part of treatment. This special issue contains contributions from leading researchers on the assessment of engagement, effects of engagement and non-engagement on outcomes, offenders' reasons for non-completion of treatment programmes, and the development of a measure of offenders' current concerns and life aspirations. These studies will improve research and practice in offender treatment readiness and engagement, and this could lead to better outcomes in terms of reduced re-offending.

Predictors and Correlates of Completing Behavioral Parent Training for the Treatment of Oppositional Defiant Disorder in Pediatric Primary Care

This study examined the role of pretreatment demographic and clinical predictors of attendance as well as barriers to treatment and consumer satisfaction on attendance at therapist-led parent training with 86 families of children ages 3 to 6 years conducted in pediatric primary care settings. Only socioeconomic status (SES) and minority group membership were significantly associated with not completing treatment. Using optimal data analysis procedures, high SES correctly predicted treatment completion 83.6% of the time. Being from a low SES, minority group family correctly predicted noncompletion of treatment 72.7% of the time, but being from a low SES, white family predicted treatment completion 80% of the time. Since barriers to treatment, such as stressors, obstacles to treatment, and treatment demands were unrelated to attendance in the present study, other factors related to social class and minority status that could contribute to better consumer satisfaction and treatment attendance must be investigated.

A comparison of women who continue and discontinue treatment for borderline personality disorder

AbstractBackground Treatment non‐completion is a significant problem for personality disorder treatment services.Aims We investigated differences between treatment continuers and treatment discontinuers of a tertiary specialist service for people with borderline personality disorder. The two groups were compared on: (1) personality disorder severity; (2) motivation for therapy; (3) mood; and (4) social problem solving.Method Patients' personality disorders were examined using the International Personality Disorder Examination. Three self‐report questionnaires were administered at the start of treatment: the Treatment Motivation Questionnaire, the Hospital Anxiety and Depression Scale (HADS), and the Social Problem Solving Inventory‐Revised.Results Of 14 outpatients recruited to the service during 2005 to 2007, seven continued and seven discontinued treatment. Those who did not continue with therapy had more complex personality disorder profiles, were more externally motivated for treatment and were less internally motivated for treatment. All patients scored high on the HADS. Problem‐solving abilities were apparently intact, but adversely affected by a negative problem orientation. Treatment discontinuers spent, on average, three times longer in hospital than continuers.Conclusion Engaging people with complex personality disorders, low internal motivation for therapy and negative problem orientation is a challenge for services. Non‐completion of treatment is associated with more days in hospital and higher service costs. Copyright © 2009 John Wiley & Sons, Ltd.

Investigating urban–rural disparities in tuberculosis treatment outcome in England and Wales

The purpose of this study was to compare the occurrence of tuberculosis (TB) and the outcome of treatment between TB patients living in urban and rural areas. Cases of TB reported from 2001 to 2003 in England and Wales were assigned to a rural or urban area classification. The outcome of interest, non-completion of treatment, was investigated to determine the odds ratio for urban vs. rural residence. The effects of age, sex, ethnicity, place of birth, time since arrival in the United Kingdom, disease site, isoniazid resistance and previous diagnosis were adjusted for by multivariable logistic regression. Crude odds ratios showed a significantly higher level of treatment non-completion in rural areas. These results became non-significant (OR 1.02, 95% CI 0.83-1.26, P=0.82) after adjusting for the confounding effects of ethnic group and age. In England and Wales residence in a rural location is not an independent determinant of TB treatment outcome failure.

Predicting Non-Completion of Treatment for Latent Tuberculous Infection

Treatment of latent tuberculosis (TB) infection (LTBI) is essential for the elimination of TB in the United States, but treatment is often not completed. Little is known about patients' reasons for not completing treatment. We hypothesized that certain health beliefs, lifestyle, and clinic- and regimen-related barriers to provision of care could predict non-completion of LTBI treatment. We administered a survey in English, Chinese, or Spanish to patients with LTBI at the first TB clinic visit. Using chi(2) and logistic regression analysis, we assessed demographics, TB risk factors, and survey responses as predictors of non-completion of 6 mo of isoniazid. 217 patients, 90% foreign-born, completed the survey, and 28.6% of which finished at least 6 mo of isoniazid under usual clinic conditions. Multivariate analysis identified two independent predictors of non-completion: low risk perception of progressing to active TB without LTBI treatment (odds ratio [OR], 0.31 [0.13-0.72], 95% confidence interval [CI]), p = 0.007, accounting for 20% of non-completers, and not wanting venipuncture (OR, 0.43 [0.22-0.85], 95% CI), p = 0.015, accounting for 37% of non-completers. Another 18% shared both predictors; thus these two predictors accounted for 75% of non-completers in total. Patients assess LTBI treatment risks and inconveniences relative to low perceived benefits at treatment outset. Predictors of LTBI treatment non-completion are identifiable at the first visit. Targeting TB high-risk individuals, minimizing inconveniences, further education, and use of diagnostic tests with improved specificity for TB may address these concerns.

Comparing two theories of health behavior: A prospective study of noncompletion of treatment following cervical cancer screening.

Some women receiving abnormal cervical screening tests do not complete recommended treatment. A prospective study (N = 660) investigated the value of conceptualizing attendance at colposcopy for treatment as either (a) an active problem-solving response to a health threat, motivated by attitudes toward an abnormal result, as implied by self-regulation theory (H. Leventhal, D. Meyer, & D. Nerenz, 1980); or (b) as a behavior motivated by attitudes toward clinic attendance, as implied by the theory of planned behavior (TPB; I. Ajzen, 1985). Responses to questionnaires containing variables specified by these models were used to predict women's subsequent attendance or nonattendance for treatment over the following 15 months. Although the TPB offered superior prediction of intentions and completion of treatment, discriminant function analyses showed that consideration of both models was important in distinguishing between those who attended all their appointments as scheduled, attended after being prompted, or ceased attending. Implications for measurement and theory in health protection are discussed.

Predictors of Treatment Acceptance and Completion in Anorexia Nervosa

There have been very few randomized controlled treatment studies of anorexia nervosa. To evaluate factors leading to nonacceptance and noncompletion of treatment for 2 specific therapies and their combination in the treatment of anorexia nervosa. Randomized prospective study. Weill-Cornell Medical Center, White Plains, NY; University of Minnesota, Minneapolis; and Stanford University, Stanford, Calif. Patients One hundred twenty-two patients meeting DSM-IV criteria for anorexia nervosa. Treatment with cognitive-behavioral therapy, fluoxetine hydrochloride, or their combination for 1 year. Dropout rate and acceptance of treatment (defined as staying in treatment at least 5 weeks). Of the 122 randomized cases, 21 (17%) were withdrawn; the overall dropout rate was 46% (56/122) in the remaining patients. Treatment acceptance occurred in 89 (73%) of the 122 randomized cases. Of the 41 assigned to medication alone, acceptance occurred in 23 (56%). In the other 2 groups, acceptance rate was differentiated by high and low obsessive preoccupation scores (rates of 91% and 60%, respectively). The only predictor of treatment completion was high self-esteem, which was associated with a 51% rate of treatment acceptance. Acceptance of treatment and relatively high dropout rates pose a major problem for research in the treatment of anorexia nervosa. Differing characteristics predict dropout rates and acceptance, which need to be carefully studied before comparative treatment trials are conducted.

Attachment Predicts Treatment Completion in an Eating Disorders Partial Hospital Program Among Women With Anorexia Nervosa

The goal of this study was to examine if attachment theory can provide a framework for understanding treatment completion in an eating disorders partial hospital program among women with anorexia nervosa (AN). Attachment was measured using the Attachment Styles Questionnaire (Feeney, Noller, & Hanrahan, 1994). As hypothesized, self-reports of high avoidant attachment predicted noncompletion of treatment for those with AN binge-purge subtype (ANB). However, this relationship did not emerge for those with AN restricting subtype (ANR). Also as hypothesized, self-reports of high anxious attachment predicted completing treatment for those with ANB but not for those with ANR. For completers with ANB and ANR, the program was helpful in increasing body weight and lowering drive for thinness, body dissatisfaction, interpersonal problems, and depression. Attachment avoidance, characterized by devaluing one's need for relationships, may be a contraindication for group-based partial hospital treatment of ANB. Attachment anxiety, characterized by high preoccupation with relationships, may facilitate remaining in treatment for those with ANB.

Use of Intermittent Rifampin and Pyrazinamide Therapy for Latent Tuberculosis Infection in a Targeted Tuberculin Testing Program

To determine the rates of hepatotoxicity and treatment completion associated with intermittent rifampin and pyrazinamide (RZ) therapy for latent tuberculosis infection, we evaluated a cohort of patients from a targeted tuberculin testing site in Tennessee. From 4 February 2000 through 9 November 2001, a total of 423 patients with latent tuberculosis infection received directly observed preventive therapy (DOPT) with RZ given twice weekly for 2 months. Most of the patients were young, Hispanic males who had recently immigrated to the United States. During treatment, hepatotoxicity developed in 29 patients (6.9%; hereafter referred to as "case patients"), and peak alanine aminotransferase (ALT) levels that were >10 times the upper limit of normal were noted in 18 case patients. Of the case patients, 14 had asymptomatic hepatotoxicity, and 2 required hospitalization; none of the case patients died. Hepatotoxicity developed after the receipt of 12 doses in more than half of the case patients, and 4 case patients received all 16 doses. The risk of RZ-associated hepatotoxicity was independently associated with older age (odds ratio [OR], 1.07 per year; P=.01). In total, 352 patients (83.2%) completed RZ therapy. The strongest predictors for noncompletion of RZ treatment were the development of a clinical symptom (OR, 9.73; P<.001) and older age (OR, 1.08 per year; P=.001). Despite the use of DOPT, intermittent dosing, and vigilant monitoring throughout therapy, RZ was associated with an unacceptable risk of hepatotoxicity.

Non-completion of active orthodontic treatment.

Over a 1-year period, all patients attending a consultant orthodontist's new patient clinics in North Derbyshire and whose treatment plans involved active appliance treatment, were accepted into a prospective longitudinal study. In all 294 patients were included in the study. Subsequent to the consultant's new patient clinic the patients' active treatments were undertaken in the Hospital, General, or Community Dental Services. Four years after the commencement of the study, 207 patients had completed active treatment and 50 had non-completed during active treatment. This gave an overall non-completion rate (NCR) of 19.5 per cent for the study. Of the 50 patients who did not complete treatment during active treatment 23 (46 per cent) non-completed during the first 6 months of active treatment. A predictive model of non-completion of active orthodontic treatment (NCT) over time is suggested.

Non-completion of active orthodontic treatment.

This paper reports a retrospective study of patient factors which might be associated with failure to complete orthodontic treatment in a hospital and in a specialist practice. Case records of patients commencing treatment were examined and targeted for further investigation by mailed questionnaires. There was a statistically significant difference in the discontinuation rate between the two groups of patients. Precise reasons for the differences could not be isolated, but did not appear to be related to the age of the patient at the start of treatment.

Attrition in Batterers' Counseling: The Role of Social and Demographic Factors

This study was designed to assess the extent to which social and demographic characteristics predict noncompletion of therapy by spouse batterers. Characteristics that were significantly associated with noncompletion of treatment were employment status, relationship to victim, timing of abuse, arrest record, alcohol problems, motivation to terminate violent behavior, age, income, and age of partner. In combination, however, these factors only improve prediction of noncompletion by about 12 percent over what would be obtained by chance. Although not measured in this study, the anticipated responses of either the criminal justice system or the batterer's mate to termination of treatment are hypothesized to be key determinants of attrition.

Adherence in a behavioral alcohol treatment program.

This report examines the correlates of early treatment termination by patients being treated for alcohol abuse or dependence. All of the study subjects were participants in a controlled experimental investigation of the differences in clinical outcome and treatment cost of extended inpatient and partial hospital treatment. A large number of clinical variables demonstrated no difference between groups, except for the greater likelihood of a DSM III Axis I diagnosis of alcohol abuse or dependence in the treatment completers. In contrast, three of four system variables differentiated completers from noncompleters. Patients treated by hospital-employed psychiatrists, in contrast to private psychiatrists, were more likely to complete the program; 4 sequential months in the middle phase of the study were associated with noncompletion of treatment; and patients who were detoxified on the preferentially designated unit were more likely to receive some specialized alcohol treatment. The authors interpret these data to indicate that treatment adherence is influenced by factors affecting the cohesiveness of the treatment delivery system. The failure of patient characteristic variables to predict treatment adherence may well be a result of their comparative insignificance in relation to system variables.