Page 209 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

184 Chapter 7. Concordance

Implications for Practice

Concordance relies to a great extent on patient satisfaction
with the consultation process, thus in order to achieve good
concordance it is necessary to develop a therapeutic, non-
judgmental relationship with patients living with a wound
(Moffatt 2004a , b ). As a part of this process the clinician
needs to ensure they:

• Understand the patient’s attitudes, knowledge and beliefs
about their illness, its causes and consequences;
• Understand the patient’s lifestyle, and how treatment will
be fitted into this, discussing any modifications that might
be necessary – either to lifestyle or treatment regime;

• Understand the patient’s beliefs about the recommended
treatment protocol, which includes being aware of any
previous episodes of failed treatment that might impact on
the patient’s expectations;
• Identify the degree to which the patient wishes to be
involved in their care, including the adoption of self-care
treatment plans;

• Engage the patient in decision making about the choice of
treatment if they wish to be involved in this process;

• Undertake assessment of the psychosocial factors that can
affect concordance including pain, stress, depression and
social support and include this knowledge in treatment
planning;

• Communicate clearly, keeping information as simple (but
accurate) as possible and avoid the use of jargon;
• Discuss the most important instructions and information
at the beginning of the consultation;
• Provide any information or instructions in more than one

medium, choosing those that are most appropriate for the
patient’s knowledge and skills (e.g. written and spoken,
pictorial and spoken);
• Monitor the patient’s understanding of, and concordance
with the agreed treatment regime by asking questions to
ensure recall is accurate;

• Provide prompts and reminders about treatment and
encourage self-monitoring of progress.