The Effect of Customer Empowerment on Adherence to Expert Advice

Poor patient adherence to medication is a global problem with enormous health and economic consequences. The pharmaceutical industry, for example, loses an estimated $564 billion per year, globally, due medication non-adherence[1]. A solution often proposed to reduce therapy non-adherence is to empower patients to make their own decisions. Empowered patients are more likely to participate actively in their treatment decisions and to develop a better understanding of their illness, reducing non-adherence to doctors’ therapy advice.

In this study, we surveyed 11,735 respondents in 17 countries in order to better understand the relationship between empowerment and adherence, the largest study on the topic we are aware of. We show that there are also important drawbacks of patient empowerment. In particular, it is crucial to distinguish informational empowerment (transferring more information to the patient) from decisional empowerment (leaving the final choice of a therapy in the hands of the patient). While informational empowerment, if initiated at the request of the patient, improves therapy adherence, decisional empowerment actually hurts therapy adherence for two reasons. On the one hand, many patients find decisional empowerment cognitively and emotionally taxing, which worsens information processing (e.g. tends to increase forgetfulness and other drivers of unintentional non-adherence). On the other hand, decisional empowerment triggers patient overconfidence in their ability to make treatment-related decisions, resulting in patients deliberately deviating from their doctors' advice.

We also discuss cross-national differences in the effects of patient empowerment on therapy non-adherence and offer implications of our findings for doctors, patients, the pharmaceutical industry and public health officials.

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