A health scare, but not enough to change their ways

A heart attack or a cancer diagnosis is usually life-changing, yet many people do little afterwards to alter their lifestyle or behavior in ways that might reduce their future risk.

Various studies have been cropping up lately, all with the same conclusion. One can’t help connecting the dots and wondering what it bodes for the long-term health picture.

The bigger question ┬áhere, though, isn’t “what.” It’s “why.”

The latest study comes from Canada, where researchers found that even when people had a history of coronary heart disease or stroke that put them in a higher risk group, they weren’t much more likely than the general population to adopt three key changes associated with reducing their risk of a second heart attack or stroke: smoking cessation, regular physical activity and a healthy diet.

The study used epidemiological data on more than 154,000 individuals from 17 countries. Of the 7,500 participants who reported a previous history of heart attack or stroke, about 18 percent continued to smoke and 60 percent didn’t follow the recommendations for a healthier diet.

Not surprisingly, those who lived in higher-income countries fared better on all three measures.

Here’s another study, this time from the cancer front: Researchers who looked at survivors of melanoma, the most serious form of skin cancer, found that about one in four skipped the use of sunscreen and 2 percent continued to visit tanning salons.

The study results “blew my mind,” Dr. Anees Chagpar, the study’s author, told CBS News.

Other studies have found that cancer survivors are just as likely as everyone else to be overweight and inactive, even though these two factors are tied to a higher risk of recurrence for certain forms of cancer.

Is this a huge collective failure of patients to heed the so-called teachable moment in health care? Or does it signal something deeper?

I suspect it’s the latter. As anyone who has attempted to adopt a healthier lifestyle can attest, changing your ways is often very difficult. It takes a high degree of motivation and support to persevere, and the stress of a serious health event can add complicating factors that might not be addressed or even recognized.

Depression, for example, is common among heart attack survivors, yet the possibility of post-heart attack depression is rarely discussed with these patients. Multiple studies have found that among those who develop depression after their heart attack, the majority are undiagnosed and untreated. That they may struggle and fail to adopt healthier lifestyle habits should not be surprising.

One survivor, responding to a frank entry on the Heart Sisters blog about depression and heart attack survival, put it this way: “Physically I am not the same person and don’t think I ever will be. Everyday life details are not important to me anymore. I see myself stepping further and further behind and no one understands.”

Ditto for the physical and mental toll of cancer treatment, which can leave survivors with long-lasting fatigue, cognitive impairment, nerve damage and more. Although efforts are underway to improve survivorship care in the U.S., progress is slow and uneven, leaving many survivors – perhaps the majority – still under the radar.

The health care system itself hasn’t completely figured out who should handle the “teachable moment.” Should it be the cardiologist? The oncologist? The primary care doctor? A rehab nurse? In the meantime, opportunities to talk to patients about making behavior changes are being missed.

Then there’s the question of who pays to help people change their habits after a major health event – and I’m assuming here that many will need some support, even if it’s only minimal.

It takes staff and resources to provide the education that may be necessary, and reimbursement is often low. Although many health insurance plans include coverage for smoking cessation, there’s considerable variation in what they offer, and some states don’t cover tobacco cessation at all for their Medicaid enrollees.

We could ask people to pay out of pocket for their patient education, nutritional counseling, depression screening and tobacco quit services, but this doesn’t mean they can afford it or that they would make it a financial priority – or, indeed, that they would recognize they might need all of these.

Maybe the whole notion that a health scare should be enough to make people change their ways is flawed. It might be motivation only for some. For others, the motivating factor may be something very different. If we hold the tsk-tsk’ing long enough, we might start to figure out what really lies behind the seeming lack of lifestyle change and what can be done to have a more positive impact.

2 thoughts on “A health scare, but not enough to change their ways

  1. Thanks Anne for this insightful overview of such a complex topic (and also for including a link to my Heart Sisters article on post-heart attack depression).

    I suspect that under-diagnosed depression is compounded by the awareness of what one SHOULD be doing to regain one’s health (quit smoking, eat healthy, exercise every day) during a period when just managing to wash your hair is almost too much to contemplate – so we feel even worse because we are not doing what everybody knows must be done in order to be a “good” patient.

    And the worse we feel, the less we feel like shopping for healthy veggies or looking up heart-smart recipes or taking those brisk walks we know we SHOULD be doing.

    Even the decision to quit smoking requires a clearly specific motivation – hard enough at the best of times when one is not recuperating from a cardiac event or a serious illness!

    Did you catch Dr. James Salwitz’s intriguing post this week called “Why Is The Doctor ANGRY?” – http://sunriserounds.com/why-is-the-doctor-angry/ This article had a profound effect on me – because I suddenly “got” why the patient he was so angry with did what he did (and I suspect Dr. S got it, too – although it didn’t make him feel one bit better!)

    Thanks again, Anne. Keep up the fine work you do.

    • Thank you, Carolyn!

      I think a lot of this is a reflection of how the health care system has traditionally operated – good at intervening and saving people’s lives but not so good at helping them live better after a major diagnosis. The patient has been “fixed” and is expected to move on, even when they have no clue how they’re supposed to do that and may be further hampered by depression, long-term aftereffects or other issues, especially when the issues go unrecognized and/or unaddressed.

      I recently signed up for an American Cancer Society study designed to measure the effectiveness of an online workshop in helping survivors live better. I was lucky enough to be randomly assigned to the workshop group, and I’m pretty excited about participating. After 18 years you’d think I had the survivor thing all figured out, but I haven’t.

      While it’s encouraging to see more awareness of the importance of supporting and educating people after a major health event, there’s unfortunately a long ways to go, and meanwhile patients are paying the price.

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