Improving adherence in adolescents with hemodialysis-dependent end-stage renal disease
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The goal of the current study was to examine the feasibility of implementing a six-module, multi-component, adherence-enhancing intervention with two adolescent hemodialysis patients. Single-subject, case study design was utilized, and baseline and treatment data are presented for the participants. Patients’ responses to the intervention were mixed. During the treatment phase, one participant showed marked improvements in adherence to medications after training on overcoming cognitive barriers to adherence. She and her mother both reported high levels of responsibility for her medical care throughout the study. The other participant had high baseline levels of adherence, but this was due almost exclusively to his mother’s responsibility for the medical regimen. He and his mother reported that he assumed almost no responsibility for adherence behavior. He demonstrated worse adherence in the latter half of baseline which continued during the majority of the treatment sessions. These reductions in adherence coincided with his mother’s increased frustration with his not assuming responsibility for his care and his high oppositional behavior. She decreased her responsibility for his care and withdrew from the study after the third treatment module. However, she allowed her son to continue to participate. The role of adolescent and parent regimen responsibility in response to treatment are explored. Additional possible explanations for differential responses to the treatment are discussed. Limitations, future directions, and clinical implications of the research are addressed.