BETHESDA, Md--Compliance problems cost millions of lives each year
because patients fail to show up for screening, fail to come in for
follow-up visits, dont stick to their medications, or revert to
unhealthy behavior, said Suzanne M. Miller, PhD, director of
Psychosocial and Behavior Medicine, and senior member, Division of
Population Science, Fox Chase Cancer Center.
"Unfortunately, simply educating people about effective new
methods for cancer prevention or control doesnt translate into
better health for patients," Dr. Miller said at the American
Society of Preventive Oncology annual meeting. "This is
especially true for people whose bodies havent done them any
How do patients feel and think when facing the threat of cancer?
Discovering the different coping styles of cancer patients and
tailoring messages to them can increase adherence at every stage, she said.
Dr. Miller broadly characterizes people as either "monitors"
or "blunters" in the face of perceived threats.
"Monitors are highly attentive and sensitized, and tend to
amplify threats," she said. "Blunters avoid and minimize
the same threats. Understanding the effects of coping styles on
patient adaptation can help physicians increase compliance."
Monitors, she said, may be told "abnormal Pap smear" but
hear "cervical cancer." They report greater concerns,
perceive greater risk, are less confident of a solution, are more
depressed and anxious, and show poorer pain management. They need
more reassurance, more time support, and more hand-holding. "They
are the sort of people who make an oncologists beeper go off
in the middle of the night with endless questions that never seem to
be answered to their satisfaction," she said.
Blunters, on the other hand, are less attentive to threats, showing
little urgency as threats arise. Their distraction tendencies produce
even more blunting behavior as real risk increases.
Both coping styles can result in noncompliance, she said. Blunters
may underestimate the risks they face and fail to show up for
appointments. Monitors may overestimate the same risks out of
fear--and also fail to come in.
Doctors should probe patients to find the profile of barriers to
action, then tailor their approach with that in mind, Dr. Miller
said. She has developed a 3-minute monitor/blunter scale to
differentiate the two styles in patients:
Sample Question and Responses From the Monitor-Blunter Style Scale (MBSS)
Vividly imagine that you are afraid of the dentist and have to get
Responses 1 and 2 indicate a monitoring style. Responses 3 and 4
A simple postdiagnostic follow-up phone call can be more effective
when pitched to the patients own cognitive style, she said. For
example, blunters can be told that they can still have problems in
the absence of symptoms and that it is important they should follow
the physicians advice. For monitors, Dr. Miller suggests
lowering the threat level by emphasizing the value of early detection