The Network office receives at least three or four calls a month from facility staff regarding patients who are not coming for treatment or are not staying for their full treatment times. These challenging situations don’t come with easy answers but really need to take an individualized approach. The Interdisciplinary Team is required to “focus on identifying the potential causes of the non-adherence and addressing those causes.” Understanding why a patient is missing treatments is the first step to addressing the issue, thus a re-assessment should be initiated to determine the root cause.

One of the first steps staff can take to address missed treatments is re-thinking your language and removing the word “noncompliance” from your vocabulary. According to Merriam-Webster the definition of noncompliance is – failure or refusal to comply with something (such as a rule, regulation, law or term of a contract).  Synonyms include: disobedience, unruliness, bad behavior, misbehavior, misconduct, troublemaking, rebellion, and defiance. If you look at the synonyms you can see how use of the word may unintentionally influence your approach to the patient. If you must label the behavior, using the term adherence may be more patient-centered as it does not imply judgement. Adherence is defined as the extent to which patients are able to follow the recommendations for prescribed treatments. By using this term, you can refocus your assessment on what may be impacting their ability to follow their treatment recommendations rather than labeling the behavior as bad or defiant.

The Network has developed a couple of resources to help staff to work through the challenge of non-adherence and to help educate patients.

When Patients Don’t Come to Dialysis

Five Why’s Root Cause Analysis- Missed and Shortened Treatments

Minutes Matter- Patient Resource

Patient Engagement Showcase- My Treatment Section