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Chapter 7
Concordance
Box 7.1: Key Points
• Concordance has been suggested to be the ‘single
most important modifiable factor that compromises
treatment outcome’ (WHO 2003 );
• Non-concordance rates in chronic wounds is around
50 %;
• Compliance and adherence are alternative labels for
patient behaviour in regard to prescribed treatment,
however these have lost favour in recent years because
of the paternalistic view of medicine which they embody;
• Ley’s Cognitive Hypothesis Model ( 1989 ) suggests that
patient understanding and recall of information pro-
vided during a consultation, and satisfaction with their
care, will influence patient treatment concordance;
• Other factors that impact on concordance include a
patient’s health beliefs, illness perceptions, and social
support;
• Using a patient centred approach, which takes a
patient’s beliefs, lifestyle and needs into account
when developing a treatment plan has been advo-
cated to enhance concordance;
• The patient-clinician relationship is therefore cen-
tral: clear communication within a therapeutic, non-
judgmental relationship appears to hold the key to
good concordance.
D. Upton, P. Upton, Psychology of Wounds and Wound Care 167
in Clinical Practice, DOI 10.1007/978-3-319-09653-7_7,
© Springer International Publishing Switzerland 2015
