From the Guidelines
Ghosting, or the act of abruptly cutting off all communication with someone without explanation, is primarily driven by factors such as lack of trust, active drug and alcohol use, active mental illness, lack of patient education, and lack of reliable access to primary medical care or medication, as identified in the context of HIV treatment adherence 1.
Contributors to Ghosting
The contributors to ghosting can be understood through the lens of factors that influence treatment adherence in chronic disease management. These include:
- Patient demographics, such as older age, female sex, and socioeconomic or cultural background, which may undermine health literacy 1
- Complex comorbidities, such as psychiatric or neurological disorders, substance abuse, or terminal illness, which can raise questions about the applicability or appropriateness of existing guidelines 1
- Patient-related beliefs, attitudes, and preferences, such as unwillingness to accept a diagnosis or take medication for an asymptomatic disease 1
- Patient nonadherence, which can be multifactorial and exacerbated by provider factors, such as poor communication skills 1
- Lifestyle factors, such as smoking, poor diet, and physical inactivity, which can raise the bar for achieving clinical targets and contribute to clinical inertia 1
Key Factors
Lack of trust between the clinician and patient is a critical factor in ghosting, as it can lead to poor adherence and clinical inertia 1. Other key factors include:
- Active drug and alcohol use, which can impair judgment and decision-making 1
- Active mental illness, such as depression, which can affect motivation and adherence 1
- Lack of patient education and inability to identify medications, which can lead to confusion and nonadherence 1
- Lack of reliable access to primary medical care or medication, which can create barriers to treatment and contribute to ghosting 1
Implications
Understanding the contributors to ghosting can help clinicians develop strategies to improve treatment adherence and reduce clinical inertia. By addressing the underlying factors that contribute to ghosting, clinicians can work to establish trust, improve communication, and promote patient engagement in care 1.
From the Research
Contributors to Ghosting
The contributors to ghosting, also known as stealth or undetectable condition, can be attributed to several factors, including:
- Increased workload and speed of communication, which can lead to a greater incidence of ghosting or perceived ghosting 2
- Increased workload and productivity expectations, which can cause individuals to abruptly end communication without explanation 2
- Increased workload and information volume, which can disrupt effective communication and lead to ghosting 2
- Therapist's own problems or a major event in their personal life, which can cause them to cease communication with their patient without prior notice 3
- Finding the patient too difficult to work with, which can lead to therapist-initiated termination of treatment 3
- Other-oriented motives, such as avoiding hurting the other person's feelings, which can drive ghosting behaviors 4
- Underestimation of the extent to which ghosters care about ghostees, which can lead to misunderstandings and relational consequences 4
Relational and Motivational Implications
The relational and motivational implications of ghosting include:
- Ghosters caring about the well-being of ghostees more than ghostees realize 4
- Ghosting being a way to end a tie while avoiding hurting ghostees' feelings 4
- Greater other-oriented motives leading to a higher likelihood of ghosting others 4
- Ghostees missing out on opportunities for future help exchange due to their underestimation of the extent to which ghosters care about them 4