Originally published as JCO Early Release 10.1200/JCO.2008.16.1901 on March 23 2009

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Prospective Study of Factors Predicting Adherence to Medical Advice in Men With Testicular Cancer

From the Academic Radiotherapy Unit, The Institute of Cancer Research and Department of Clinical Research Development, the Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, United Kingdom.

Corresponding author: Clare Moynihan, MSc, Institute of Cancer Research, Downs Rd, Sutton, Surrey SM2 5PT United Kingdom; e-mail: clare.moynihan{at}icr.ac.uk.

Purpose To identify predictive factors of adherence to medical advice, specifically the likelihood of attendance to a recommended follow-up regimen in patients with newly diagnosed testicular cancer.

Patients and Methods This was a prospective study measuring initially not only aspects of the doctor–patient interview, but also a range of demographic, psychological, social, and medical factors, and then recording attendance behavior on follow-up. All 209 new patients with testicular cancer referred between June 1992 and May 1995 were approached, and 184 men consented and completed questionnaires. The nonadherence end point (nonattender) was two failures to attend an outpatient appointment at least 1 month apart, despite a written reminder.

Results Thirty-two participants (17%) were classified as nonattenders. No significant differences were found between attenders and nonattenders in the majority of psychosocial and medical variables that might have predicted nonadherence to medical advice. There was a highly significant association between nonattendance and a patient's perception of an unsatisfactory affective relationship with his clinician (P = .005; hazard ratio, 3.1; 95% CI, 1.4 to 6.6).

Conclusion Patients who perceived an unsatisfactory affective relationship with their clinician that included an inability to trust the clinician and a perception that they were not being treated as "a person" were subsequently more likely to disregard medical advice regarding follow-up. Attention to the ways young men may wish to communicate with their clinicians is important, bearing in mind that they may not necessarily adhere to stereotypical images of masculine self-dependence.

Supported in part by the National Health Service Executive; NHS funding to the NIHR Biomedical Research Center; the Institute of Cancer Research; and Grant No. C46/A2131 from the Bob Champion Cancer Trust and Cancer Research UK Section of Radiotherapy.

The views expressed in this publication are those of the authors and not necessarily those of the National Health Service Executive.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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