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Concordance

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Psychology of Wounds and Wound Care in Clinical Practice

Abstract

Different terms have been used to describe patient behaviour when advised by a practitioner to take medication or make significant changes to their lifestyle. Compliance refers to the patient following the practitioner’s orders obediently without question, whilst adherence implies that the patient follows the request with more negotiation. More recently the term concordance has been used to describe treatment related behaviour, particularly in the UK. Concordance implies a complete power balance between the clinician and the patient in which they work on equal terms to reach an agreement regarding treatment. Rates of non-concordance vary, depending on the nature and duration of the illness as well as a number of patient variables. However, non-concordance in chronic wounds is similar to other chronic illnesses, standing at around 50 %. According to Ley’s (1989) cognitive hypothesis model, concordance is predicted by the patient’s understanding of the information provided during the consultation, how well they can recall this information, and overall satisfaction with the consultation. The way information is communicated can have an impact on the way the patient recalls and understands what has been communicated. To ensure that information is communicated effectively it should be clear, simple and jargon free. Furthermore, using more than one mode of communication will enhance patient recall (for example using written as well as spoken information). A patient’s health beliefs and perceptions about the causes and consequences of their wound may also influence treatment concordance. In addition social support can also have a positive influence on concordance, however the most effective support seems to be that provided by family and peers. The clinician can also provide social support to the patient, however, the most successful type is informative or educational support. Finally, there is an important link between patient-centred consultations and good concordance; clear communication within a therapeutic, non-judgmental relationship appears to hold the key to good concordance (see Box 7.1).

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  1. Faculty of Health, University of Canberra, Canberra, Aust Capital Terr, Australia

    Dominic Upton

  2. Institute of Health and Society, University of Worcester, Worcester, UK

    Penney Upton

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Upton, D., Upton, P. (2015). Concordance. In: Psychology of Wounds and Wound Care in Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-09653-7_7

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  • DOI: https://doi.org/10.1007/978-3-319-09653-7_7

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