Page 193 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

168 Chapter 7. Concordance

Summary

Different terms have been used to describe patient behaviour
when advised by a practitioner to take medication or make
significant changes to their lifestyle. Compliance refers to the
patient following the practitioner’s orders obediently without
question, whilst adherence implies that the patient follows
the request with more negotiation. More recently the term
concordance has been used to describe treatment related
behaviour, particularly in the UK. Concordance implies
a complete power balance between the clinician and the
patient in which they work on equal terms to reach an agree-
ment regarding treatment. Rates of non-concordance vary,
depending on the nature and duration of the illness as well
as a number of patient variables. However, non-concordance
in chronic wounds is similar to other chronic illnesses, stand-
ing at around 50 %. According to Ley’s ( 1989 ) cognitive
hypothesis model, concordance is predicted by the patient’s
understanding of the information provided during the con-
sultation, how well they can recall this information, and over-
all satisfaction with the consultation. The way information
is communicated can have an impact on the way the patient
recalls and understands what has been communicated. To
ensure that information is communicated effectively it should
be clear, simple and jargon free. Furthermore, using more
than one mode of communication will enhance patient recall
(for example using written as well as spoken information). A
patient’s health beliefs and perceptions about the causes and
consequences of their wound may also influence treatment
concordance. In addition social support can also have a posi-
tive influence on concordance, however the most effective
support seems to be that provided by family and peers. The
clinician can also provide social support to the patient, how-
ever, the most successful type is informative or educational
support. Finally, there is an important link between patient-
centred consultations and good concordance; clear commu-
nication within a therapeutic, non-judgmental relationship
appears to hold the key to good concordance (see Box 7.1).