Page 195 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

170 Chapter 7. Concordance

unwillingness to follow the treatment regime. In addition,
nurses stated that patients might deliberately ignore the
treatment instructions they had been given in an attempt to
delay wound healing so as to prolong nursing visits (although
limited evidence on this viewpoint is available- see Chap. 8 ).
However, this tendency to see patients as being at fault when
treatment plans are not followed correctly has been criticized
for lacking the ‘spirit of co-operation’ necessary for good
concordance (Kyngäs et al. 2000 ). In contrast, the patients
themselves mentioned pain and discomfort as the main rea-
sons for not following treatment instructions, suggesting a
very different perspective on why treatment protocols were
discarded. The development of a therapeutic, non-judgmental
relationship would have allowed those patients to express
their concerns about the suggested treatment in an open and
honest way (Furlong 2001 ; Moffatt 2004a, b ), which would
allow the negotiation (by patient and clinician) of a more
acceptable treatment plan resulting in better concordance.
Thus a number of factors are though to influence patient
concordance and these are discussed in detail in this chapter.
In particular, the role of the clinician, and the importance of
good communication in enabling patient concordance with
medical advice and prescribed treatment is key; the implica-
tions of this for the consultation process are therefore
explored fully and recommendations for facilitation of patient
concordance with wound care are provided. However, it is
important to start this discussion by defining what is meant
by the term concordance, and two closely related terms that
are also used in the literature – compliance and adherence.

Defining the Terms Compliance,
Adherence and Concordance

The terms compliance, adherence and concordance have all
been used to refer to the extent to which a patient follows
treatment protocols. Sometimes they are used interchange-
ably, however whilst these terms are related, they are not
synonyms and each has a very specific meaning. Compliance