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Treatment burden and treatment fatigue as barriers to health.
Open accessAbstract
Effective management of chronic diseases involves sustained changes in health behavior, which often requires substantial effort and patient burden. As treatment burden is associated with reduced adherence across several chronic conditions, its assessment and treatment are important clinical priorities. The balance between patient demands and capacity (e.g., coping resources) may be indexed by patients' subjective experience of treatment fatigue. We present a modified workload-capacity model that incorporates evidence that treatment fatigue may 1) be caused by increased workload due to treatment burden (e.g., intensity, complications) and 2) undermine adherence. Emerging technology-based interventions may be well-suited to reduce treatment burden, prevent treatment fatigue, and increase treatment adherence.
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“The term “treatment fatigue” has been researched in the context of HIV and type 1 diabetes, but it has not yet received attention in psychiatry.21”
From Establishing irremediable psychiatric suffering in the context of medical assistance in dying in the Netherlands: a qualitative study (2022) · cites this paper as [21]
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“Larger-than-expected reductions in resting and nonresting energy expenditure that occur with weight loss (ie, metabolic adaptation), compensatory changes in other homeostatic regulators of body weight, and patients' behavioral fatigue in adhering to diet and activity recommendations may contribute to the 5% to 10% weight reduction plateau observed with behavioral therapy.[23][24][25]”
From Effect of Subcutaneous Semaglutide vs Placebo as an Adjunct to Intensive Behavioral Therapy on Body Weight in Adults With Overweight or Obesity: The STEP 3 Randomized Clinical Trial (2021) · cites this paper as [24]
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“To date, research on treatment burden and treatment fatigue has largely centered on health behaviors such as medication adherence (Claborn et al., 2015) and exercise compliance in patients with chronic disease (Dobkin et al., 2005, 2006; Heckman et al., 2015).”
From Perception of Physical Demand, Mental Demand, and Performance: A Comparison of Two Voice Interventions for Parkinson's Disease (2022) · cites this paper as Heckman et al., 2015
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“Moreover, more is not always better, as patients may experience negative effects of overburden and treatment fatigue.30”
From Requests for Medical Assistance in Dying by Young Dutch People With Psychiatric Disorders (2025) · cites this paper as [30]
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Cites
Kirk, J. M. W., MacDonald, A., Lavender, P., Dean, J. M., & Rubin, G. (2017) · Biomedicine Hub · doi:10.1159/000480347 · Cited by 3,902
Interventions for enhancing medication adherence
Nieuwlaat, R., Wilczynski, N., Navarro, T., Hobson, N., Jeffery, R., Keepanasseril, A., Agoritsas, T., Mistry, N., Iorio, A., Jack, S., et al. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000011.pub4 · Cited by 2,945 · cited 1×
“Despite 182 randomized controlled trials (RCTs) of interventions designed to increase medication adherence, there is no clear solution [2].”
BackgroundFree, C., Phillips, G., Galli, L., Watson, L., Felix, L., Edwards, P., Patel, V., & Haines, A. (2013) · PLoS Medicine · doi:10.1371/journal.pmed.1001362 · Cited by 1,766
Assessing Psychosocial Distress in Diabetes
Polonsky, W. H., Fisher, L., Earles, J., Dudl, R. J., Lees, J., Mullan, J., & Jackson, R. A. (2005) · Diabetes Care · doi:10.2337/diacare.28.3.626 · Cited by 1,575
An opportunity cost model of subjective effort and task performance
Kurzban, R., Duckworth, A., Kable, J. W., & Myers, J. (2013) · Behavioral and Brain Sciences · doi:10.1017/s0140525x12003196 · Cited by 1,381
Why self-control seems (but may not be) limited
Inzlicht, M., Schmeichel, B. J., & Macrae, C. N. (2014) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2013.12.009 · Cited by 1,026
Mobile Health Technology Evaluation
Kumar, S., Nilsen, W. J., Abernethy, A., Atienza, A., Patrick, K., Pavel, M., Riley, W. T., Shar, A., Spring, B., Spruijt-Metz, D., et al. (2013) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2013.03.017 · Cited by 900
Shippee, N. D., Shah, N. D., May, C. R., Mair, F. S., & Montori, V. M. (2012) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2012.05.005 · Cited by 728
Mohr, D. C., Burns, M. N., Schueller, S. M., Clarke, G., & Klinkman, M. (2013) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2013.03.008 · Cited by 693
A Smartphone Application to Support Recovery From Alcoholism: A Randomized Clinical Trial
Gustafson, D. H., McTavish, F. M., Chih, M.-Y., Atwood, A. K., Johnson, R. A., Boyle, M. G., Levy, M. S., Driscoll, H., Chisholm, S. M., Dillenburg, L., et al. (2014) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2013.4642 · Cited by 692
Cited by
Sorted by citations
Nahum-Shani, I., Smith, S. N., Spring, B. J., Collins, L. M., Witkiewitz, K., Tewari, A., & Murphy, S. A. (2018) · Annals of Behavioral Medicine · doi:10.1007/s12160-016-9830-8 · Cited by 2,171
“Intervention fatigue A state of emotional or cognitive weariness associated with intervention engagement [13].”
BackgroundInfluentialDavies, M., Færch, L., Jeppesen, O. K., Pakseresht, A., Pedersen, S. D., Perreault, L., Rosenstock, J., Shimomura, I., Viljoen, A., Wadden, T. A., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(21)00213-0 · Cited by 1,419
Wadden, T. A., Bailey, T. S., Billings, L. K., Davies, M., Frias, J. P., Koroleva, A., Lingvay, I., O’Neil, P. M., Rubino, D. M., Skovgaard, D., et al. (2021) · JAMA · doi:10.1001/jama.2021.1831 · Cited by 1,114
Kosiborod, M. N., Bhatta, M., Davies, M., Deanfield, J. E., Garvey, W. T., Khalid, U., Kushner, R., Rubino, D. M., Zeuthen, N., & Verma, S. (2023) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.14890 · Cited by 127
“Reducing medications used to treat obesity-related comorbidities lowers the treatment burden and may improve adherence to therapy.(34,35) The findings presented here generate the hypothesis that improvements in BP and lipid levels with semaglutide may translate into clinically meaningful changes that allow a reduction…”
BackgroundGruet, M. (2018) · Frontiers in Physiology · doi:10.3389/fphys.2018.01285 · Cited by 82
“It is also worth noting that cognitive failure has recently been demonstrated as an important predictor of elevated perceived fatigability (evaluated by the Fatigue Assessment Scale at baseline and then at 6 and 12 months) in patients with sarcoidosis (Hendriks et al., 2018).”
BackgroundConroy, D. E., Hojjatinia, S., Lagoa, C. M., Yang, C.-H., Lanza, S. T., & Smyth, J. M. (2019) · Psychology of Sport and Exercise · doi:10.1016/j.psychsport.2018.06.011 · Cited by 71
“Treatment fatigue is an important consideration for these models because fatigue can blunt intervention effects on behavior and health outcomes over time (Bekiroglu, Lagoa, Murphy, & Lanza, 2017; Heckman et al., 2015).”
Cross, S. P., Karin, E., Staples, L. G., Bisby, M. A., Ryan, K., Duke, G., Nielssen, O., Kayrouz, R., Fisher, A., Dear, B. F., et al. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100506 · Cited by 57
“suggest that a higher ratio of workload over capacity can lead to ‘treatment fatigue’ which can ultimately lead to poor treatment adherence and associated negative outcomes (Heckman et al., 2015).”
BackgroundNeCamp, T., Sen, S., Frank, E., Walton, M. A., Ionides, E. L., Fang, Y., Tewari, A., & Wu, Z. (2020) · Journal of Medical Internet Research · doi:10.2196/15033 · Cited by 55
“Treatment fatigue is pervasive in mHealth [7] and for individuals with heavy workloads [9].”
BackgroundInfluentialNahum-Shani, I. B., Ertefaie, A., Lu, X., Lynch, K. G., McKay, J. R., Oslin, D. W., & Almirall, D. (2016) · Addiction · doi:10.1111/add.13743 · Cited by 49
“Second, providing nomore intervention than needed will reduce treatment burden, hence improve treatment adherence [42].”
A systematic literature review looking for the definition of treatment burden
Alsadah, A. H., Merode, T. V., Alshammari, R., & Kleijnen, J. (2020) · Heliyon · doi:10.1016/j.heliyon.2020.e03641 · Cited by 52
“Two (Gallacher et al., 2013b; Heckman et al., 2015) were usable in multiple diseases only.”
BackgroundHobson, J., Al‐khouja, A., Curley, P., Meyers, D. J., Flexner, C. W., Siccardi, M., Owen, A., Meyers, C. L. F., & Rannard, S. P. (2019) · Nature Communications · doi:10.1038/s41467-019-09354-z · Cited by 43
Cross, S. P. M., & Álvarez‐Jiménez, M. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1382726 · Cited by 46
Heckman, B. W., MacQueen, D. A., Marquinez, N. S., MacKillop, J., Bickel, W. K., & Brandon, T. H. (2017) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000197 · Cited by 39
Self-citationUnderstanding Sustained Retention in HIV/AIDS Care and Treatment: a Synthetic Review
Roy, M., Czaicki, N., Holmes, C., Chavan, S., Tsitsi, A., Odeny, T., Sikazwe, I., Padian, N., & Geng, E. (2016) · Current HIV/AIDS Reports · doi:10.1007/s11904-016-0317-9 · Cited by 35
Coningsby, I., Ainsworth, B., & Dack, C. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-07980-w · Cited by 41
“This supports similar findings that the burden associated with having and managing a comorbidity can impede resources and motivation to manage one’s type 2 diabetes [36], particularly when the disease and treatment burdens are greater for the comorbid condition than the burdens of type 2 diabetes [37, 38].”
ResultLogistic burdens of cancer care: A qualitative study
Dona, A. C., Jewett, P. I., Hwee, S., Brown, K. A., Solomon, M., Gupta, A., Teoh, D. G. K., Yang, G., Wolfson, J. A., Fan, Y., et al. (2024) · PLoS ONE · doi:10.1371/journal.pone.0300852 · Cited by 34
Just-in-time adaptive intervention to promote fluid consumption in patients with kidney stones.
Conroy, D. E., West, A. B., Brunke-Reese, D., Thomaz, E., & Streeper, N. M. (2020) · Health Psychology · doi:10.1037/hea0001032 · Cited by 34
“In contrast, the greatest risk from delivering excessive reminder notifications due to false negative detections is likely notification fatigue (Cole-Lewis et al., 2019; Heckman et al., 2015).”
BackgroundThe assessment and management of quality of life of older adults with diabetes mellitus
Kassem, L. S., & Aron, D. C. (2020) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2020.1737520 · Cited by 35
Nyitray, A. G., Nitkowski, J., McAuliffe, T. L., Brzezinski, B., Swartz, M. D., Fernández, M. E., Deshmukh, A. A., Ridolfi, T. J., Lundeen, S. J., Cockerham, L. R., et al. (2023) · International Journal of Cancer · doi:10.1002/ijc.34553 · Cited by 30
“Days to screening engagement, median (IQR) 9 (6-14) n/a 20 (10-36) n/a”
Bisby, M. A., Balakumar, T., Scott, A. J., Titov, N., & Dear, B. F. (2023) · Psychological Medicine · doi:10.1017/s003329172300260x · Cited by 27
Dashputre, A. A., Gatwood, K. S., & Gatwood, J. D. (2020) · Journal of Managed Care & Specialty Pharmacy · doi:10.18553/jmcp.2020.26.2.186 · Cited by 27
Moreno, P., Coloma, A., Torregrosa, J., Montero, N., Francos, J. M., Codina, S., Manonelles, A., Bestard, O., García-Barrasa, A., Melilli, E., et al. (2020) · Clinical Transplantation · doi:10.1111/ctr.13988 · Cited by 26
Antiepileptic drug adherence in children in southern Ethiopia: A cross sectional study
Dima, S. A., & Shibeshi, M. S. (2022) · PLoS ONE · doi:10.1371/journal.pone.0263821 · Cited by 29
“This could be due to provision of inadequate information about the course of the illness and its possible prognosis at key points during the course of epilepsy treatment [40], the side effects of antiepileptic drugs taken for a prolonged period of time [21], or simply adherence fatigue from several years of drug admin…”
Backgroundvan Veen, S. M. P., Ruissen, A. M., Beekman, A. T. F., Evans, N., & Widdershoven, G. A. M. (2022) · Canadian Medical Association Journal · doi:10.1503/cmaj.210929 · Cited by 25
“21 Clinicians may already be attentive to treatment fatigue in current clinical practice, but more research on this topic could provide new insights and result in better care for patients with treatment - resistant psychiatric disorders.”
Cross, S. P. M., Nicholas, J., Mangelsdorf, S. N., Valentine, L., Baker, S. T. E., McGorry, P. D., Gleeson, J., & Álvarez‐Jiménez, M. (2023) · JMIR Formative Research · doi:10.2196/49846 · Cited by 26
Biran, N., Kouyaté, R. A., Yücel, E., McGovern, G. E., Schoenthaler, A., Durling, O. G., Unawane, R., Schutt, A., & Panjabi, S. S. (2020) · JMIR Formative Research · doi:10.2196/18982 · Cited by 22
“They also stated that consistently reported, longitudinal symptom data would help them make better decisions about how to manage long-term disease- and treatment-related symptom burden and help combat treatment fatigue, a psychological symptom associated with prolonged treatment engagement, which could increase durati…”
BackgroundHardman, R., Begg, S. J., & Spelten, E. R. (2021) · PLoS ONE · doi:10.1371/journal.pone.0255802 · Cited by 25
“Without observed capacity benefits, this may discourage people from engaging in treatment work [44].”
BackgroundAutomatic analysis of treadmill running to estimate times to fatigue and exhaustion in rodents
Zaretsky, D. V., Kline, H. L., Zaretskaia, M. V., & Rusyniak, D. E. (2018) · PeerJ · doi:10.7717/peerj.5017 · Cited by 24
Heckman, B. W., Dahne, J., Germeroth, L. J., Mathew, A. R., Ana, E. J. S., Saladin, M. E., & Carpenter, M. J. (2018) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000338 · Cited by 26
“Effective stress management is paramount (Baker et al., 2004) as stressors reliably increase motivation to smoke (Heckman et al., 2013, 2015).”
Self-citationShapiro, M. O., Allan, N. P., Raines, A. M., & Schmidt, N. B. (2023) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-022-10002-y · Cited by 21
“, amount of time required) and access to care due to a lack of trained therapists are among the most cited barriers to treatment for anxietyand depression-related conditions (Gunter & Whittal, 2010; Heckman et al., 2015; Wolitzky-Taylor et al., 2019).”
BackgroundHamad, A. A., Amer, B. E., Abbas, N. B., Alnajjar, A. Z., & Meshref, M. M. (2023) · Neurological Sciences · doi:10.1007/s10072-023-07119-7 · Cited by 22
Sinha, C. B., Bakshi, N., Ross, D. C., & Krishnamurti, L. (2018) · PLoS ONE · doi:10.1371/journal.pone.0199375 · Cited by 19
Haag, D., Kumar, D., Gruber, S., Hofer, D. P., Sareban, M., Treff, G., Niebauer, J., Bull, C. N., Schmidt, A., & Smeddinck, J. D. (2025) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3706598.3713307 · Cited by 37
“This limits adaptability and can quickly lead to JITAIs being repetitive, potentially disrupting the user’s impression of receiving personalized support and possibly leading to reduced efficacy and increasing disengagement [29].”
Goodwin, B. M., Olney, C. M., Ferguson, J. E., Hansen, A. H., Eddy, B., Goldish, G. D., Morrow, M. M. B., & Vos-Draper, T. L. (2021) · Assistive Technology · doi:10.1080/10400435.2020.1862938 · Cited by 18
“, burnout, state of emotional or cognitive weariness) ebbs and flows throughout the intervention (Heckman et al., 2015; King et al., 2014).”
BackgroundXu, Z., & Smit, E. S. (2023) · Digital Health · doi:10.1177/20552076231183543 · Cited by 18
“According to prior work, intervention engagement and retention is also a dynamic system that contains the interplay among affective, cognitive, and behavioral states.63 Besides the demands of time and effort, individuals’ attitudes toward themselves and the intervention; their daily life tasks, moods, and symptoms; an…”
BackgroundInfluentialThomas, M. L., Treichler, E. B. H., Bismark, A. W., Shiluk, A. L., Tarasenko, M. A., Zhang, W., Joshi, Y. B., Sprock, J., Cardoso, L., Tiernan, K. N., et al. (2018) · Schizophrenia Research · doi:10.1016/j.schres.2018.06.024 · Cited by 20
“Although implementing cognitive training into residential care settings is appealing, adding a time-intensive intervention to an existing treatment program risks exhausting patients' motivational and energy resources, and may therefore reduce patients' engagement in other important treatment activities (Heckman et al.…”
BackgroundEffectiveness of Switching Smoking-Cessation Medications Following Relapse
Heckman, B. W., Cummings, K. M., Kasza, K. A., Borland, R., Burris, J. L., Fong, G. T., McNeill, A. D., & Carpenter, M. J. (2017) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2017.01.038 · Cited by 17
“Adherence regimens vary across SCMs, which may influence perceptions of treatment burden/fatigue, noncompliance, and ultimately relapse.(32) Noncompliance is commonly observed,(31) so perhaps switchers had better outcomes because they”
Self-citationKim, H., & Son, H. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16224502 · Cited by 18
“These factors may result in chronic emotional exhaustion, a type of fatigue [86,87].”
BackgroundYsrraelit, M. C., Fiol, M. P., Peña, F. R. V., Vanotti, S., Terrasa, S., Tran, V.-T., Montori, V. M., & Correale, J. D. (2019) · BMC Neurology · doi:10.1186/s12883-019-1441-0 · Cited by 18
Bandiera, C., Locatelli, I., Courlet, P., Cardoso, E., Zaman, K., Stravodimou, A., Dolcan, A., Sarivalasis, A., Zurcher, J.-P., Aedo-Lopez, V., et al. (2023) · Cancers · doi:10.3390/cancers15010316 · Cited by 18
“A longer time since diagnosis has previously been reported as a determinant of nonadherence to OAT [5,38,39], which may be caused by treatment fatigue [40], a lower perceived need for OAT over time and a lower perceived susceptibility to the disease.”
BackgroundDiop, A., Gupta, A., Mueller, S., Dron, L., Harari, O., Berringer, H., Kalatharan, V., Park, J., Mésidor, M., & Talbot, D. C. (2024) · Pharmaceutical Statistics · doi:10.1002/pst.2365 · Cited by 16
Nkoka, O., Munthali-Mkandawire, S., Mwandira, K., Nindi, P., Dube, A. L. N., Nyanjagha, I., Mainjeni, A., Malava, J., Amoah, A. S., Mclean, E. M., et al. (2024) · PLOS Global Public Health · doi:10.1371/journal.pgph.0002955 · Cited by 11
Dorsey, J. D., Hill, P., Moran, N., Azzari, C. N., Reshadi, F., Shanks, I., & Williams, J. D. (2019) · Journal of Consumer Affairs · doi:10.1111/joca.12274 · Cited by 14
The treatment burden of long-term home noninvasive ventilation
Spurr, L. (2021) · Breathe · doi:10.1183/20734735.0291-2020 · Cited by 14
“0291-2020 quality of life (QoL) and non-adherence [9, 10].”
BackgroundCampbell, R. F., Morriss‐Roberts, C., Durrant, B., & Cahill, S. (2019) · Journal of Foot and Ankle Research · doi:10.1186/s13047-019-0360-z · Cited by 13
“Although Mila was engaged in rehabilitation, the insinuation of treatment fatigue was present in her discourse because of the negligible benefit physiotherapy was having on reducing her pain [41].”
BackgroundDevelopment and initial validation of a cessation fatigue scale
Mathew, A. R., Heckman, B. W., Meier, E. M., & Carpenter, M. J. (2017) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2017.01.047 · Cited by 13
“We previously described a workload-capacity model of treatment burden and fatigue to account for non-adherence to treatment recommendations often observed among patients with chronic health conditions (Heckman et al., 2015).”
BackgroundSelf-citationRequests for Medical Assistance in Dying by Young Dutch People With Psychiatric Disorders
Schweren, L. J. S., Rasing, S. P. A., Kammeraat, M., Middelkoop, L. A., Werner, R., Mérelle, S. Y. M., Garcia, J. M., Creemers, D. H. M., & van Veen, S. M. P. (2025) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2024.4006 · Cited by 11
Ng, G. W., Gan, K. F., Liew, H., Ge, L., Ang, G. Y., Molina, J. A. D. C., Sun, Y., Prakash, P. S., Harish, K. B., & Lo, Z. J. (2024) · The International Journal of Lower Extremity Wounds · doi:10.1177/15347346241233962 · Cited by 12
“38,39 Conversely, factors which resulted in greater treatment adherence included PAD as a comorbidity, as well as foot pain and severity of DFU in the patient.”
Bisby, M. A., Barrett, V., Staples, L., Nielssen, O. B., Dear, B. F., & Titov, N. (2024) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2024.102882 · Cited by 11
Dysphagia Rehabilitation Using Digital Technology: A Scoping Review
Hwang, N., Yoon, T., Chang, M., & Park, J. (2025) · Journal of Evidence-Based Medicine · doi:10.1111/jebm.70009 · Cited by 14
Longer duration of smoking abstinence is associated with waning cessation fatigue
Heckman, B. W., Cummings, K. M., Stoltman, J. J. K., Dahne, J., Borland, R., Fong, G. T., & Carpenter, M. J. (2018) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.11.011 · Cited by 14
Self-citationThe Effect of Chia Seeds on High-Density Lipoprotein (HDL) Cholesterol
Dickens, B., Sassanpour, M., & Bischoff, E. L. (2023) · Cureus · doi:10.7759/cureus.40360 · Cited by 11
“Pills may sometimes help your health, but many people are just tired of eating one pill after another; they are often expensive and full of side effects [1].”
BackgroundNomeikaitė, A., Geležėlytė, O., Berger, T., Andersson, G., & Kazlauskas, E. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100686 · Cited by 10
“Moreover, adherence may be reduced by the fatigue that the user experiences due to the treatment burden (Heckman et al., 2015).”
BackgroundBekalu, A. F., Yenit, M. K., Tekle, M. T., & Birarra, M. K. (2022) · Frontiers in Clinical Diabetes and Healthcare · doi:10.3389/fcdhc.2022.977216 · Cited by 10
“Finally, it may lead to disease progression associated with acute and chronic complications, enhancing exposure to polypharmacy (19, 47).”
BackgroundClaborn, K., Miller, M. B., Meier, E. M., & Carbone, S. L. (2017) · Journal of the Association of Nurses in AIDS Care · doi:10.1016/j.jana.2017.02.008 · Cited by 10
“Reducing treatment burden while increasing capacity to effectively manage health behaviors may decrease TRF and lead to better disease management throughout the life course (Heckman et al., 2015).”
BackgroundLi, L., Tran, D. C., Zhu, H., Balimane, P. V., Willett, G. D., Zhao, P., Gerrard, S. E., Vogelsong, K. M., Wang, Y., & Seo, S. K. (2020) · The Annual Review of Pharmacology and Toxicology · doi:10.1146/annurev-pharmtox-031120-015212 · Cited by 10
Geusens, F., van Uytsel, H., Ameye, L., Devlieger, R., Jacquemyn, Y., Holsbeke, C. V., & Bogaerts, A. (2024) · Health Promotion Perspectives · doi:10.34172/hpp.42528 · Cited by 9
“34 These potential explanations should be further explored in qualitative research, but our results do suggest that mHealth interventions may be less interesting to reach women with prior mental health struggles.”
BackgroundHassen, M., Mekonnen, D., & Muhammed, O. S. (2022) · Scientific Reports · doi:10.1038/s41598-022-23700-0 · Cited by 9
Hashiguchi, L. O., Cox, S. E., Edwards, T., Castro, M. C., Khan, M. S., & Liverani, M. (2023) · BMC Health Services Research · doi:10.1186/s12913-023-10015-7 · Cited by 9
“Maintaining diabetic self-care practices is particularly challenging in the context of multiple comorbidities [25, 26], especially TB which can cause physical and economic hardship and requires long-term, daily observed treatment [27].”
BackgroundHobson, J., Curley, P., Savage, A. C., Al‐khouja, A., Siccardi, M., Flexner, C. W., Meyers, C. L. F., Owen, A., & Rannard, S. P. (2019) · Nanoscale Advances · doi:10.1039/c9na00529c · Cited by 9
Richardson, K., Huber, J. E., Kiefer, B., & Snyder, S. (2022) · American Journal of Speech-Language Pathology · doi:10.1044/2022_ajslp-22-00026 · Cited by 9
Using mental contrasting to promote flow experiences at work: A just-in-time adaptive intervention
Bartholomeyczik, K., Knierim, M. T., Weinhardt, C., & Oettingen, G. (2024) · Computers in Human Behavior Reports · doi:10.1016/j.chbr.2024.100488 · Cited by 10
“This positive effect of the static compared to the adaptive prompt seems to contradict the assumption that static interventions cause intervention fatigue, thereby decreasing interventional effectiveness (Heckman et al., 2015; Nahum-Shani et al., 2018).”
Amegbletor, D. Y., Goldberg, D., Pope, D. A., & Heckman, B. W. (2023) · Primary Care Clinics in Office Practice · doi:10.1016/j.pop.2023.05.006 · Cited by 9
Self-citationChristiansen, J., Lasgaard, M., Pedersen, S. S., Pedersen, M. H., & Friis, K. (2024) · International Journal of Behavioral Medicine · doi:10.1007/s12529-024-10263-9 · Cited by 11
“Similarly, a high perceived treatment burden may pose a barrier to maintaining good health [20].”
BackgroundDashputre, A. A., Gatwood, K. S., Schmidt, J., & Gatwood, J. D. (2019) · Journal of Oncology Pharmacy Practice · doi:10.1177/1078155219875206 · Cited by 8
“treatment burden) has been repeatedly identified as a factor negatively impacting adherence to oral medications.(15,16,28,29) Studies focused on medication adherence in chronic conditions, such as diabetes, hypertension, and hyperlipidemia, have consistently observed a negative association of increased comorbidity/med…”
BackgroundPractical Care Support During the Early Recovery Period After Acute Coronary Syndrome
Hajduk, A. M., Hyde, J. E., Waring, M. E., Lessard, D., McManus, D. D., Fauth, E. B., Lemon, S. C., & Saczynski, J. S. (2016) · Journal of Applied Gerontology · doi:10.1177/0733464816684621 · Cited by 8
“Overwhelmed patients often exhibit poor adherence to recommendations for disease management and self-care (Heckman, Mathew, & Carpenter, 2015; Vijan, Hayward, Ronis, & Hofer, 2005), which in turn may negatively affect clinical and quality of life outcomes (Chow et al., 2010; Rasmussen, Chong, &…”
Weinberger, A. H., Pang, R. D., Ferrer, M., Kashan, R. S., Estey, D. R., Segal, K. S., & Esan, H. (2021) · Psychology of Addictive Behaviors · doi:10.1037/adb0000672 · Cited by 8
Akyüz, F., An, Y., Begun, J., Aniwan, S., Bui, H. H., Chan, W. P. W., Choi, C. H., Chopdat, N. A. I., Connor, S. J., Desai, D., et al. (2024) · Intestinal Research · doi:10.5217/ir.2024.00089 · Cited by 7
“48 ; and (4) early exhaustion of biologics options due to loss of response (33%), as described earlier.”
BackgroundConroy, D. E., Yang, C., Lanza, S. T., Smyth, J. M., & Lagoa, C. M. (2020) · JMIR mhealth and uhealth · doi:10.2196/14270 · Cited by 8
“Treatment fatigue describes “psychological fatigue associated with treatment engagement” [14].”
BackgroundHojjatinia, S., Lee, A. M., Hojjatinia, S., Lagoa, C. M., Brunke-Reese, D., & Conroy, D. E. (2022) · Annals of Behavioral Medicine · doi:10.1093/abm/kaac051 · Cited by 7
“Failure to deploy person-specific decision rules could lead to less effective interventions and potential treatment fatigue by users [30].”
BackgroundOttesen, T. D., Wickersham, J. A., Lawrence, J. C., Antoniak, S., Zezuilin, O., Polonsky, M., Antonyak, S., Rozanova, J., Дворяк, С., Pykalo, I., et al. (2024) · PLoS ONE · doi:10.1371/journal.pone.0305086 · Cited by 7
Li, S., Psihogios, A. M., McKelvey, E. R., Ahmed, A., Rabbi, M., & Murphy, S. A. (2020) · Current Opinion in Systems Biology · doi:10.1016/j.coisb.2020.07.002 · Cited by 9
“Suboptimal EMA engagement may be due to high user burden from excessive prompts/requests to complete EMA [25–27], increasing boredom with a repetitive mHealth tool [28], and competing demands from other frequently used apps, life responsibilities (e.g., school/work), and disease management tasks.”
BackgroundStudies of Medication Adherence
Lauffenburger, J. C., Acri, T., & Gross, R. (2019) · Pharmacoepidemiology · doi:10.1002/9781119413431.ch38 · Cited by 6
Logistic and time burdens reported by gynecologic and breast cancer survivors
Dona, A. C., Ambo, A., Jewett, P. I., Brown, K. A., Parsons, H., Gupta, A., Teoh, D. G. K., Blaes, A. H., & Vogel, R. I. (2025) · BMC Women s Health · doi:10.1186/s12905-025-03826-9 · Cited by 6
Luken, A., Rabinowitz, J. A., Wells, J. L., Sosnowski, D. W., Strickland, J. C., Thrul, J., Kirk, G. D., & Maher, B. S. (2024) · JMIR Formative Research · doi:10.2196/48954 · Cited by 6
“…estimates [20] and may capture the delay discounting rate with fewer items than the MCQ. Repeatedly administering the MCQ may fatigue participants [21], but a continuous indifference point measure may allow researchers to quickly reach data saturation (eg, obtaining consistent delay discounting…”
BackgroundMuhammed, O. S., Hassen, M., Taye, M., Beyene, E., Nasir, B. B., & Tamiru, M. T. (2024) · Scientific Reports · doi:10.1038/s41598-024-54609-5 · Cited by 6
Operationalizing Engagement With an Interpretation Bias Smartphone App Intervention: Case Series
Ramadurai, R., Beckham, E. E., McHugh, R. K., Björgvinsson, Þ., & Beard, C. (2022) · JMIR Mental Health · doi:10.2196/33545 · Cited by 5
“Intervention fatigue (emotional or cognitive weariness attributed to the intervention) [15], lack of accountability, and low alliance with app interventions have been highlighted as the reasons for disengagement [16].”
BackgroundPatient Adherence Following Knee Surgery: Evidence-Based Practices to Equip Patients for Success
Rucinski, K. J., Njai, A., Stucky, R. C., Crecelius, C. R., & Cook, J. L. (2023) · The Journal of Knee Surgery · doi:10.1055/a-2154-9065 · Cited by 8
Hu, S., Wu, D., Wu, J., Zhang, Y., Bøgelund, M., Pöhlmann, J., & Pollock, R. F. (2023) · Patient Related Outcome Measures · doi:10.2147/prom.s400389 · Cited by 7
“22,24,28 Process attributes that distinguish the various IV iron formulations, namely the number and duration of infusions required to correct iron deficits and the risk of side effects such as hypophosphatemia leading to osteomalacia, have not yet been investigated.”
Canadian Patients’ Preferences in Topical Psoriasis Care: Insights From the PROPEL Surveys
Vender, R. B., Gooderham, M., Guenther, L., Kyritsis, D., Rao, J., Kowalczyk, A., & Ashkenas, J. (2018) · Journal of Cutaneous Medicine and Surgery · doi:10.1177/1203475418773736 · Cited by 6
Adaptive Intervention Designs in Substance Use Prevention
Hall, K. L., Nahum-Shani, I. B., August, G. J., Patrick, M. E., Murphy, S. A., & Almirall, D. (2019) · Advances in prevention science · doi:10.1007/978-3-030-00627-3_17 · Cited by 6
Schafer, M., Lachman, J. M., Zinser, P., Calderón, F., Han, Q., Facciolà, C., Clements, L., Gardner, F. E. M., Ronnie, G. H., & Sheil, R. (2024) · JMIR Formative Research · doi:10.2196/58611 · Cited by 5
Saenjun, P., Vongsirimas, N., & Klainin‐Yobas, P. (2025) · BMC Public Health · doi:10.1186/s12889-025-25357-6 · Cited by 9
“This finding supports the treatment burden model and capacity theory [90], which suggest that comorbidities complicate treatment regimens and deplete the resources needed for effective self-management.”
Yogesh, M., Parmar, A. J., Hirani, M. M., Babaria, D. L., & Damor, N. C. (2024) · Cureus · doi:10.7759/cureus.58800 · Cited by 5
“Comorbidities and social dependence increase with age and can optimally supersede individuals’ perceived ability to self-manage health conditions without external assistance [13].”
BackgroundThe Role of Digital Care Pathway for Epilepsy on Patients’ Treatment Burden: Clinicians’ Perspective
Polus, M., Keikhosrokiani, P., Uusimaa, J., Komulainen‐Ebrahim, J., Annunen, J., Khan, S., Behutiye, W., Vieira, P., & Isomursu, M. (2024) · Communications in computer and information science · doi:10.1007/978-3-031-59080-1_19 · Cited by 5
Conceptualizing Treatment Burden among People with Type 2 Diabetes
Bitterfeld, L., & Reed, S. M. (2024) · Nursing Forum · doi:10.1155/2024/9974083 · Cited by 5
Vera-Ponce, V. J., Zuzunaga-Montoya, F. E., Vásquez-Romero, L. E. M., Loayza-Castro, J. A., Sanchez-Tamay, N. M., & Carrillo, C. I. G. D. (2025) · Endocrine and Metabolic Science · doi:10.1016/j.endmts.2025.100222 · Cited by 5
Tiered Service Architecture for Remote Patient Monitoring
Chandak, S., Thapa, I., Bambos, N., & Scheinker, D. (2024) · IEEE International Conference on e-Health Networking, Applications and Services (Healthcom) · doi:10.1109/healthcom60970.2024.10880780 · Cited by 4
“From the patient’s perspective, under intensive monitoring, the patient experiences a higher “loss of quality of life” cost or “invasiveness” cost, since intensive monitoring would normally be more invasive to their personal lifestyle and can result in treatment fatigue [9].”
Using Smartphone Survey and GPS Data to Inform Smoking Cessation Intervention Delivery: Case Study
Luken, A., Desjardins, M. R., Moran, M. B., Mendelson, T., Zipunnikov, V., Kirchner, T., Naughton, F., Latkin, C. A., & Thrul, J. (2023) · JMIR mhealth and uhealth · doi:10.2196/43990 · Cited by 5
“For an ecological momentary intervention, the cumulation of intervention delivery at both efficient and inefficient times and appropriate and inappropriate locations could lead to intervention burden, which may undermine intervention effectiveness and adherence [41].”
Deegan, O., Fullen, B. M., Hearty, C., & Doody, C. (2023) · Disability and Rehabilitation · doi:10.1080/09638288.2023.2274875 · Cited by 5
“…in treatment interventions has been suggested as a further factor which may influence individuals adherence to treatment. heckman et al. [42] reviewed the treatment burden and treatment fatigue associated with chronic care management and the effect on treatment adherence and concluded…”
Association of somatic comorbidity and treatment adherence in patients with psychotic disorder
Leijala, J., Kampman, O., Suvisaari, J., & Eskelinen, S. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.03.039 · Cited by 5
Allergic Rhinitis is Associated with Increased Suicidality: A Systematic Review and Meta-Analysis
Høj, S., Nielsen, F. K., Chawes, B., Backer, V., Linneberg, A. R., Thomsen, S. F., Sigsgaard, T., & Meteran, H. (2025) · Clinical Reviews in Allergy & Immunology · doi:10.1007/s12016-025-09061-2 · Cited by 5
Does the Wide Reach of the “Trauma-informed” Model Exceed its Narrow Grasp?
Pišl, V., Meerman, S. T., FRANCES, A. J., & Batstra, L. (2025) · Culture Medicine and Psychiatry · doi:10.1007/s11013-025-09938-z · Cited by 4
“From a clinical perspective, unnecessary questioning may lead to treatment fatigue (Heckman et al., 2015).”
Exploring the Disease Experience in Women with PCOS: A Qualitative Content Analysis
Kim, M., & Yi, S. J. (2025) · Healthcare · doi:10.3390/healthcare13243243 · Cited by 16
“This experience is similar to “treatment fatigue” reported among individuals with other chronic illnesses [51], where the burden of long-term treatment leads to decreased adherence, dis-Healthcare continuation of health behaviors, and reduced self-efficacy [52].”
Choi, S. J., Hung, P.-Y., Liu, M. Z., Dempsey, W., Newman, M., & Klasnja, P. (2025) · Journal of Medical Internet Research · doi:10.2196/75792 · Cited by 4
“A recurring challenge in current mHealth interventions is achieving sustained user engagement, which is often corroded by treatment fatigue [14,73,74].”
Palmer, A. M., Sutton, S. K., Correa, J. B., Simmons, V. N., & Brandon, T. H. (2021) · PLoS ONE · doi:10.1371/journal.pone.0247867 · Cited by 4
“Although this may reflect the mastery and automaticity of abstinence-related skills, it is also possible that stressors, triggers, negative affect, and other temptations to smoke could promote the development of “cessation fatigue” [13, 14].”
BackgroundBruin, E. K.-D., Muntingh, A., Bourguignon, E., Hoogendoorn, A., Maarsingh, O., van Balkom, A. V., Batelaan, N., van Straten, A., & van Meijel, B. (2022) · JMIR Mental Health · doi:10.2196/25441 · Cited by 4
“One explanation for the relatively low usage could be simply that the patients experienced treatment fatigue [34].”
BackgroundThomas, S. T., Sav, A., Thomas, R., Cardona, M., Michaleff, Z. A., Titus, T. T., & Dobler, C. C. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-064447 · Cited by 4
Alighieri, C., Mouton, T., Allemeersch, F., & Lierde, K. M. V. (2024) · American Journal of Speech-Language Pathology · doi:10.1044/2024_ajslp-24-00158 · Cited by 4
Balasubramanian, N., Palaniappan, U., Balaji, M., & Nandakumar, N. (2025) · Journal of Health Organization and Management · doi:10.1108/jhom-01-2024-0001 · Cited by 4
Metadata
- Authors
- Heckman, B. W., Mathew, A. R., & Carpenter, M. J.
- Affiliations
- Medical University of South Carolina (US)
- Corresponding author
- Heckman, Bryan W
- Venue
- Current Opinion in Psychology
- Publisher
- Elsevier BV
- Published
- 2015-10
- Volume
- 5
- Pages
- 31-36
- ISSN
- 2352-250X (ISSN-L)
- PMC
- PMC4465180
- OpenAlex
- W2069363844
- Cited by
- 179
- References
- 46
- Citations by year
- 2026: 21 · 2025: 32 · 2024: 30 · 2023: 20 · 2022: 18 · 2021: 11 · 2020: 15 · 2019: 10 · 2018: 12 · 2017: 4 · 2016: 6
- FWCI
- 1.22
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Current Opinion in Psychology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (T32 DA007288, F32 DA036947)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- treatment burden, treatment fatigue, medication adherence, chronic disease management, coping resources, health behavior change, patient burden
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