When a Teen Says "No" to Healthcare: What to Do

Teens feel like nothing is going to happen to them. It's the attitude of invincibility, which helps teens grow into adults while trying out new parts of the person they want to become. This becomes a real challenge for parents and health care providers when a prescribed plan of health care is determined for a teen.The teen may choose to skip appointments, discontinue medications or even stop therapy all together.

What causes a teen to not follow prescribed treatment?

Several factors are at play:

-Many times teens don't see the cause and effect of certain behaviors. Saying a behavior now will affect them when they are older means little to nothing. The idea of future or older is totally different for a teen than a parent or health care provider. To a teen 'old' may be 20's, which is a long time away, while to a parent or healthcare provider it's a very short time frame.

-Teens want to control their lives and non-compliance is a form of control. Add to the equation teens want independence from parents and other authority figures, it's easy to understand why teens choose not to follow health care treatments.

-Being one of the crowd or like other kids is also a big factor in a teen's life, no matter what they say. Peer pressure is very high and to do something other kids don't, well, it just isn't something some teens want to risk. Taking medications, following diets, adhering to activity restrictions brand a teen as different.

-Besides if the teen doesn't follow the prescribed health plan then 'nothing is wrong.' Denial can be very high.

So what can increase a teen's compliance with a prescribed health care plan?

-When possible minimize the disruption to a teen's routine. This means appointments that don't interfere with school or activities.

-Figure out if medications can be taken after school hours. If medications or treatments affect looks or function during school; is there another way or time to give them? Again the idea is to let the teen blend in with peers. This makes tools like an insulin pump, which doesn't require an injection during school hours an attractive option.

-Knowing the effects and side effects of medications can avoid the surprise factor with teens. Every medication has a side effect and knowing what to anticipate can make the difference between a medication being continued or 'forgotten.'

-Communication with the health care provider has been a key factor for many teens. When a good working relationship with the health care provider this can lead to an increased level of compliance.

There are many reasons a teen chooses to be non- compliant with a plan of care. This happens even if the parents or health care providers see as a serious or life threatening disease.

Dr Benjamin Gesundheit at the 4th International Conference on Teenage and Young Adult Cancer Medicine made the following suggestions to health care providers for increasing teen compliance with prescribed health care:

1. Discuss treatment goals with the patient and their family;

2. Provide regular written information and other reminders such as regular telephone calls;

3. Invite the patient and his or her family to share and define their roles within the treatment period;

4. Addressing the issue of compliance with the teenager and their family, and keeping the issue foremost in the minds of the team looking after the patient;

5. Ensuring those looking after the patient are positive and encouraging in their attitude.

Teens are going through many transitions as they grow and mature. Having an illness to cope with adds another issue to an already complicated period of life for a teen. Parents want the best for their children. Recognizing the need (I didn't say liking) the need for self-expression can help the parent cope with this trying time in their child's life. Being aware of the challenges a teen faces can make it easier for a parent and healthcare provider alike to find ways to encourage the teen to comply with their prescribed plan of care.