Page 196 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Defining the Terms Compliance, Adherence 171

was the term used during early work that investigated
whether or not patients followed their practitioner’s instruc-
tions. Compliance has been defined as ‘the extent to which
the patient’s behaviour matches the prescriber’s recommen-
dations’ (Horne et al. 2005 ). The term compliance implies
that the patient will follow the clinicians orders without any
question; its use is therefore declining because of an implied
lack of patient involvement.
Indeed, the term compliance has been heavily criticised
in the literature for its paternalistic view of the practitioner–
patient relationship, in which the patient is perceived as pas-
sive and expected to obey the clinician’s orders (Snelgrove
2006 ). Many clinicians feel uneasy about the use of the label
compliance, as it places all blame for departures from pre-
scribed treatment on the patient (Russell et al. 2003 ). For
example, labelling the patient as non-compliant, suggests
deliberate, deviant behaviour. Thus the term compliance does
not allow the clinician to distinguish between patients who
have intentionally decided not to take medication and those
who have perhaps misunderstood what the treatment requires
and as a result have not followed the prescribed treatment
correctly. It has therefore been argued that the notion of com-
pliance fails to take sufficient account of the social context of
patients’ lives (Russell et al. 2003 ) and the patient perspective
on treatment (Snelgrove 2006 ).
This shift in perspective regarding compliance is part of
a much broader change in models of patient care (DOH

2010 ; Coulter and Collins 2011 ). Thus in the past 20 or so
years there has been an increasing move from clinician–
patient consultations which are heavily dominated by the
practitioner, who instructs the patient in ‘what to do’, to
consultations which are more patient-centred. Patient (or
person) centred care is a model of care in which patients
are seen as equal partners in the planning and evaluation of
their care, in order to ensure they have the most appropri-
ate treatment plan for their needs. As a result, there is more
emphasis on patients being encouraged to ask questions and
the consultation focusing on a patient’s individual needs. The
term adherence has been used to reflect this shift in thinking.