Page 200 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Models of Concordance 175

instructions. The first of these relates to the mode of commu-
nication which is used. For example, if patients are provided
with both oral and written information, the more likely they
are to remember to follow those instructions (McDonald
et al. 2002 ). This is because information that is received by
more than one sense is more likely to be registered within
memory and retained for a longer period of time. Furthermore,
the written instructions will act as a memory aid, a resource
which can be returned to as and when necessary. Written
instructions do however present difficulties to patients with
literacy problems and other options to support the oral infor-
mation provided by a clinician have therefore been explored.
One method which seems to be beneficial for patients with
low education is the use of illustration. For example, cartoons
have been used to improve patient concordance with wound-
care advice after treatment in an emergency department.
Those patients who received the cartoon instructions showed
better understanding of what was required of them and bet-
ter concordance (Delp and Jones 1996 ).
The second factor which may increase patient forgetfulness
and so decrease concordance also concerns communication.
This time however, the focus is on the behaviour of the clini-
cian – for example the over use of medical jargon. There is
substantial evidence that ineffective communication between
patients and health care providers is a major determinant
of poor treatment concordance (Levinson and Chaumeton
1999 ). Furthermore, communication is often the aspect of care
with which patients are least satisfied (Aharony and Strasser
1993 ). For example, Stewart et al. ( 2000 ) found that 44 % of the
burns patients he interviewed reported not understanding the
instructions they were given in the use of pressure garments;
90 % of their consultants, however, believed the instructions
were clear and the patients had understood. It is suggested
that the personal backgrounds of health care providers and
the norms, beliefs, and practices intrinsic to their professional
training, affect their communication and interaction with
patients, which ultimately affects the treatment they provide
(Bates et al. 1997 ).