Page 207 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

182 Chapter 7. Concordance

the future trajectory of their health outcomes (Mechanic
1992 ). Communication during the consultation is therefore of
prime importance for determining patient satisfaction.
Wolf et al. ( 1978 , 1981) measured specific parts of a consul-
tation, to determine what actually resulted in patient satisfac-
tion. Wolf and his colleagues found that there were four
specific aspects of the consultation that appeared to be
instrumental in influencing patient satisfaction, three of
which related specifically to the communication process:

• satisfaction with treatment

• communication comfort – satisfaction with the doctors’
ability to make it easy to talk about their problems
• rapport – satisfaction with the warmth and friendliness in
the atmosphere during the consultation

• distress relief – satisfaction with the doctors’ ability to
relieve the patients of their worries
Whilst Wolf’s study concerned consultations by medics,
the evidence suggests that patient satisfaction focuses on the
same elements whether the consultation is carried out by a
medic or another health care professional such as a nurse
(Poulton 1996 ). Like Wolf, Poulton also found that patient
satisfaction was related to feeling they could confide in the
clinician, feeling listened to and understood, improved under-
standing of their illness and its treatment.
It seems therefore that patients are more satisfied with
health care when the consultation is patient-centred (Little
et al. 2001 ) – that is it focuses on them as an individual, not just
their illness (Mallinger et al. 2005 ) and this is an approach that
has been advocated widely in wound care (Reddy et al. 2003a , b ;
Bale and Jones 2006 ; Van Rijswijk and Gray 2012 ). Furthermore
there is well documented evidence that the patient centred
approach is a highly effective way of increasing concordance
(Lindsay 2000 ). Patient centred care has been described and
defined in a number of different ways, however there are three
key features of a patient centred consultation:

• the clinician’s ability to elicit the patient’s concerns;

• the consideration of the patients’ psychosocial needs;