Psychological Strategies to Promote Concordance

1. BJWC Conference Liverpool September 7th 2016 Psychological Strategies to Promote Concordance John McKinnon Senior Lecturer University of Lincoln

2. BJWC Conference Liverpool September 7th 2016 Spot the Difference √ Compliance - patient behaviours should match practitioner expectations and directions √ Adherence - the satisfactorily informed patientadheres to directed treatment √ Concordance - an egalitarian relationship leading to an agreed plan of treatment and care between patient and practitioner (Horne et al, 2005 ; Treharne et al, 2006)

3. BJWC Conference Liverpool September 7th 2016 Concordance √ Ottawa UN Convention on Human Rights. √ Partnership of Equals. √ Embraces Patient Centred Values and Behaviours √ Exploration of Harm and Benefits of Treatment Options √ Patient has new responsibilities √ Consent as a process, not an incident McKinnon (2011)

4. BJWC Conference Liverpool September 7th 2016 Concordance √ An Open Ended Relationship of Trust and Honesty √ Patient and Practitioner are able to Challenge each other √ Decision Making Capacity as a Continuum √ The Right to Autonomy with Success or Failure Cribb and Entwhistle (2011)

5. BJWC Conference Liverpool September 7th 2016 Concordance - the solution not the problem √ Service User Involvement and Confidence(Reed, 2011) √ Partnership Working, Health Outcomes and Resources (Coulter and Collins, 2011) √ Drug Consumption Rooms (Joseph Rowntree Foundation, 2006) √ Improved care through increased patient responsibility (Berg et al, 2007) √Organ Donation, Trust, and Honesty (Bellali and Papadatou,2007; Sque et al, 2008;Simpkin et al,2009)

6. BJWC Conference Liverpool September 7th 2016 Concordance - the solution not the problem √ Diabetes as a lived experience (Jacobson et al,1997; Crow,2004; Ijas- Kallio, 2010) √The Missing 30%(Krska,2005)

7. BJWC Conference Liverpool September 7th 2016 Concordance – the Antecedents √ Engagement √ Listening √ Valuing Patient Expertise √ Respecting Patient Values and Beliefs √ A Knowledge of Patient Biography √ A Willingness to Share One’s Expertise (McKinnon, 2011,2013)

8. BJWC Conference Liverpool September 7th 2016 Determinants of Non-Concordance with Tissue Viability Care and Treatment • Pain Intensity • Age • Wound Depth • Wound Size • The Meaning for the Patient (Miller et al.2011)

9. BJWC Conference Liverpool September 7th 2016 Psychology of Concordance – Information Processing (Platt,2011) • Deletion • Distortion • Generalisation

10. BJWC Conference Liverpool September 7th 2016 Psychology of Concordance – Information Processing (Platt,2011) We delete, distort and generalise on the basis of our • Values • Beliefs • Memories • Decisions

11. BJWC Conference Liverpool September 7th 2016 Psychology of Concordance- Seven Core Emotional Needs (Robbins, 1999) • Certainty- the outcomes and care pathways. • Variety- offering treatment options. • Social- living life around a wound. • Significance- motivation through involvement in clinical decision making. • Growth – seeing progress in wellbeing diaries. • Connection- through partnership working • Contribution- the feeling of one’s perspective being valued

12. BJWC Conference Liverpool September 7th 2016 Ten Points for Concordance in Tissue Viability(Anderson,2013) • Treat Pain- be proactive • Consider Patient Capacity and Experience • Be Realistic – compromise can be good • Don’t Try to do Everything at Once- fit, application, reminder, diaries and encouragement • Clinician Skill • See with Fresh Eyes- co-morbidities and colleagues • Social Isolation • Travel Difficulties- location, timing and structure of clinics • Compassion and Empathy • Communicate Effectively- aggravated and mitigated directives

13. BJWC Conference Liverpool September 7th 2016 In Conclusion ‘A patient has a life not just an ulcer’ Price (2008)