by Mary Silva
Forget beakers and Petri dishes, microscopes and mice. Scientific studies today are as likely to be conducted in clinics, around conference room tables or on laptops as they are in the laboratory.
Dr. Meghan McGrady is using concepts developed to understand consumer spending to gain new insights into the moment-of-decision motivations that affect whether teens follow strict medication regimens.
That is certainly the case for Meghan McGrady, PhD, a researcher in the Division of Behavioral Medicine and Clinical Psychology, whose insights into behavior could be as important to creating better outcomes as discovering the latest gene pathway.
McGrady wants to know what motivates young people to take their prescribed medications – or not. She works with young people who have high-stakes illnesses, such as kidney transplants, diabetes, or cancer. In the face of such serious conditions, you would think sticking to a medication regimen would not be a problem. You would be wrong.
MEDICATION MUST FIT LIFESTYLE
“More so than for many other age groups, adolescents who feel taking a medication doesn’t fit into their daily lives may not be motivated to be adherent,” says McGrady, who became interested in working with adolescents during her clinical internship at Cincinnati Children’s.
“They are trying to figure out who they are and what they want,” she says. “They may not always see how a strict medication regimen fits into their plans for the future.”
She wants to figure out how to remedy that, starting with young people who have cancer. Her first step was a pilot study that asked adolescents and young adults ages 15 to 31 what influenced their decision to take their medications.
“We asked, ‘What makes you decide ‘Yes, I am going to take it or no, I’m not’? What factors are changing your decision in the moment?”
Responses ranged from not wanting to be inconvenienced when out with friends to the hope that skipping three or four doses would not be harmful since “I’ve already had so much chemotherapy.”
NO SINGLE SOLUTION
What McGrady learned was that solving the problem of treatment adherence in this age group will require a multi-faceted approach.
“What’s motivating to one adolescent or young adult may be irrelevant to another,” she says. “Because we are hypothesizing that motivation is a key driver of adherence, it’s crucial that we understand what motivates a given individual.”
She has used her study findings to apply for a National Institutes of Health Career Development Award that will use behavioral economic methods – techniques developed to understand what drives consumer preferences such as what car to buy – to ask young patients what motivates them to take their medications.
Based on their responses, she will develop a tool that could be used by the patient’s medical team to match the right medication regimen to the patient.
“If we could administer the tool in clinic, it would help the medical team know what they could do to motivate these patients,” McGrady says.
The Economics of Adherence
Cincinnati Children’s colleagues Meghan McGrady, PhD, and Kevin Hommel, PhD, published a review in October 2013 in Pediatrics confirming that chronically ill children with poor adherence spend more time in the hospital and emergency room.
McGrady now hopes to show that interventions targeting psychosocial difficulties like non-adherence also reduce costs. Her ongoing study compares overall healthcare costs for cancer patients who did receive psychosocial services to those who did not.
“It’s important for psychologists to understand how we can contribute to the goal of cost reduction,” McGrady says. “We’ve done a good job of showing how our interventions can improve outcomes, but our economic analyses have lagged behind.”