Page 199 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

174 Chapter 7. Concordance

Understanding

Satisfaction Concordance

Memory

Figure 7.1 Ley’s cognitive hypothesis model (Adapted from Ley
(1981))

This perspective explains concordance by focusing on the
communication between clinician and patient, with the most
important part of this communication concerning the transfer
of knowledge from expert to layperson. According to Ley’s
model, concordance will depend on both the clinician’s skill as
a communicator and the cognitive skills of the patient. Poor
concordance is therefore often a product of failure to under-
stand or recall instructions and advice, rather than a deliber-
ate strategy of avoidance. Indeed, research from wound care
practice has highlighted lack of patient understanding as one
reason for poor concordance (e.g. Flanagan et al. 2001 ; Hallett
et al. 2000 ). Furthermore, studies have shown that:
• Patients forget much of what the doctor tells them –
according to Kessels ( 2003 ) 40–80 % of the medical infor-
mation clinicians offer is forgotten immediately;
• Instruction and advice are forgotten more readily than
other kinds of information (Kessels 2003 );
• The more patient is told, the lower the proportion correctly
recalled (McGuire 1996 );
• Patients remember what they are told first and what they
think is most important – information about diagnosis for
example tends to be viewed as more important than
information related to treatment (Kessels 2003 ).

According to Kessels ( 2003 ) there are three factors which
can influence how likely a patient is to forget treatment