Immunosuppressive Drugs and Young Adults: A Difficult Combination

Background: In our center we encounter serious problems with a number of young adult (18-25yrs) renal transplant recipients that are non-compliant to the medication regime. This could well be one of the reasons for the significantly worse unadjusted 10 years kidney graft survival in this patient group compared to that in recipients > 25 years: 47.2% versus 64.0%. This paper focuses on the attitudes and behavior of young adults towards compliance with the immunosuppressive drugs. Method: We used Q-methodology to identify attitude profiles associated with noncompliant behavior. Adolescent renal transplant recipients (n=25) sorted a set of 37 statements (Q-set) along a continuum of preferences to reveal categories of individuals who shared common viewpoints. The same Q-set was also used as a topic list for an in-depth interview. In this paper, we focus on the interview results of four statements, related to compliance with immunosuppressive drugs. Each interview was fully written down, using the software program Atlas. Ti (R) for coding and labeling. Results: Almost half of respondents (40%) think that forgetting medication will not lead to serious consequences. They feel they took so much medication over the years that they had developed a certain reserve immunity against rejection. Others state that they had become indifferent after experiencing that nothing happened' after forgetting their medication. Most adolescents declare having no problems taking their medication when going out with friends. They do not feel ashamed, but some lose track of time and simply forget taking medication when they are out with friends. Remarkably, 18 of the 25 young adults (72%) admit to not always taking their medication on time. When they sleep late, only 7 of them set the alarm clock in order to take their medication as prescribed. Conclusion: Using the Q-set statements as interview topics triggered young adults to ventilate their opinion and reveal their medication practice. Confronting statements on cards appeared to be very useful in communicating with adolescents about difficult subjects such as non-compliance. This helps caretakers in the outpatient clinic to explore and discuss reasons for non-adherence to immunosuppressive drugs. Many young adults are not very accurate in taking medication on time, and 40% even think nothing bad will happen when they forget their immunosuppressive drugs. Healthcare professionals should be aware of this grossly underestimated problem.