Tugenberg Toni, Ware Norma C, Wyatt Monique A
Department of Social Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA.
AIDS Patient Care STDS. 2006 Apr;20(4):269-74. doi: 10.1089/apc.2006.20.269.
Constructive relationships between clinicians and patients being treated for HIV/AIDS are critical to treatment success. Trust, caring, and expertise have all been cited as important components of such relationships. As-yet unexamined, however, is the impact of the urgency patients sense in their clinicians concerning proper adherence to antiretroviral medications. Qualitative interviews (total, 214) from a study of adherence to highly active antiretroviral therapy (HAART) for active illegal drug users (n = 52) provided data for the analysis. Among other topics, interviews examined patients' perspectives on relationships with their providers. Study participants experienced their physicians as insisting on perfect adherence. Fearing disapproval if they disclosed missing doses, interviewees chose instead to conceal adherence information. Apprehensions about failing at perfect adherence led some to cease taking antiretrovirals over the course of the study. Well-intentioned efforts by clinicians to emphasize the importance of adherence can paradoxically undermine the very behavior they are intended to promote. Adherence can be approached in ways that inspire honesty and openness and build trust in the treatment relationship, laying the groundwork for a collaborative approach to solving problems in taking antiretroviral medications as prescribed.
临床医生与接受艾滋病毒/艾滋病治疗的患者之间建立建设性的关系对于治疗成功至关重要。信任、关怀和专业知识都被认为是这种关系的重要组成部分。然而，患者感受到的临床医生对正确服用抗逆转录病毒药物的紧迫感所产生的影响尚未得到研究。一项针对活跃吸毒者（n = 52）的高效抗逆转录病毒治疗（HAART）依从性研究中的定性访谈（共214次）为该分析提供了数据。在其他主题中，访谈考察了患者对与医疗服务提供者关系的看法。研究参与者觉得他们的医生坚持要求完美的依从性。受访者担心如果透露漏服剂量会遭到不满，于是选择隐瞒依从性信息。对无法做到完美依从性的担忧导致一些人在研究过程中停止服用抗逆转录病毒药物。临床医生强调依从性重要性的善意努力可能会自相矛盾地破坏他们原本想要促进的行为。可以通过激发诚实和开放并在治疗关系中建立信任的方式来处理依从性问题，为采取协作方式解决按规定服用抗逆转录病毒药物的问题奠定基础。
