Page 210 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Conclusion 185

Consultation with patients should not be viewed as a one
off, but rather an on-going dialogue. Furthermore, it is impor-
tant to remember that the more complex a regimen is, the
more likely it is a patient will not show full concordance
(Bender 2002 ), thus it is vital that a complex treatment
regime is discussed and planned in light of what the patient
does on a daily basis (McDonald et al. 2002 ). Moreover, the
clinician must bear in mind that whilst a patient may show
concordance with one set of treatment recommendations,
they may well refuse to engage with another. However, inter-
actions with patients should not be treated as opportunities
to reinforce treatment instruction, but rather as a time for
heath care professionals and patients to share their knowl-
edge and experience of wounds and their care, in order to
reach a joint treatment plan (Bissell et al. 2004 ). Finally, the
clinician should remember that it is beholden upon them to
maintain their own concordance with a treatment plan;
Goreki et al. ( 2009 ) identified a dissonance between the
needs of patients with a pressure ulcer and clinical and nurs-
ing needs, which led to patients feeling their needs were less
important and that they were being a nuisance when asking
for assistance. In contrast however, if health care profession-
als were able to agree symptoms and treatment plans though
joint decision making with patients, providing clear
communication about treatments this allowed the patient to
feel in control, which ultimately led to better concordance.

Conclusion

This chapter has discussed the different factors that contrib-
ute to concordance behaviours. These include characteristics
of the patient, such as health beliefs, illness perceptions and
previous treatment experiences. However, through good
communication during a non-judgmental consultation, a
clinician who is familiar with these issues can increase the
likelihood that the patient will show concordance to treat-
ment. Thus the relationship between the clinician and the
patient is probably the most important influence on the
extent of patient concordance.