Medicine, Health Care and Philosophy

, Volume 15, Issue 2, pp 115–127 | Cite as

Adherence, shared decision-making and patient autonomy

  • Lars Sandman
  • Bradi B. Granger
  • Inger Ekman
  • Christian Munthe
Scientific Contribution

Abstract

In recent years the formerly quite strong interest in patient compliance has been questioned for being too paternalistic and oriented towards overly narrow biomedical goals as the basis for treatment recommendations. In line with this there has been a shift towards using the notion of adherence to signal an increased weight for patients’ preferences and autonomy in decision making around treatments. This ‘adherence-paradigm’ thus encompasses shared decision-making as an ideal and patient perspective and autonomy as guiding goals of care. What this implies in terms of the importance that we have reason to attach to (non-)adherence and how has, however, not been explained. In this article, we explore the relationship between different forms of shared decision-making, patient autonomy and adherence. Distinguishing between dynamically and statically framed adherence we show how the version of shared decision-making advocated will have consequences for whether one should be interested in a dynamically or statically framed adherence and in what way patient adherence should be assessed. In contrast to the former compliance paradigm (where non-compliance was necessarily seen as a problem), using observations about (non-)adherence to assess the success of health care decision making and professional-patient interaction turns out to be a much less straightforward matter.

Keywords

Adherence Compliance Patient autonomy Patient best interest Shared decision-making 

References

  1. Adherence. 2011. Merriam-Webster. Encyclopædia Britannica. http://www.merriam-webster.com/dictionary/adherence. Retrieved 24 May 2011.
  2. Black, D.R., C.L. Blue, and D.C. Coster. 2001. Using social marketing to develop and test tailored health messages. American Journal of Health Behavior 25(3): 260–271.PubMedCrossRefGoogle Scholar
  3. Bosworth, H.B., M.K. Olsen, P. Gentry, M. Orr, T. Dudley, F. McCant, and E.Z. Oddone. 2005. Nurse administered telephone intervention for blood pressure control: A patient-tailored multifactorial intervention. Patient Education and Counselling 57(1): 5–14.CrossRefGoogle Scholar
  4. Bosworth, H.B., M.K. Olsen, A. Neary, M. Orr, J. Grubber, L. Svetkey, M. Adams, and E.Z. Oddone. 2008. Take control of your blood pressure (TCYB) study: A multifactorial tailored behavioral and educational intervention for achieving blood pressure control. Patient Education and Counselling 70(3): 338–347.CrossRefGoogle Scholar
  5. Broyle, L.M., A.M. Colbert, and J.A. Erlen. 2005. Medication practice and feminist thought: A theoretical and ethical response to adherence in HIV/AIDS. Bioethics 19: 362–378.CrossRefGoogle Scholar
  6. Chatterjee, J.S. 2006. From compliance to concordance in diabetes. Journal of Medical Ethics 32: 507–510.PubMedCrossRefGoogle Scholar
  7. Compliance. 2011. Merriam-Webster. Encyclopædia Britannica. http://www.merriam-webster.com/dictionary/compliance. Retrieved May 24, 2011.
  8. Conrad, P. 1985. The meaning of medications: Another look at compliance. Social Science and Medicine 20(1): 29–37.PubMedCrossRefGoogle Scholar
  9. Donovan, J.L., and D.R. Blake. 1992. Patient non-compliance: Deviance or reasoned decision-making? Social Science and Medicine 34(5): 507–513.PubMedCrossRefGoogle Scholar
  10. Ekman, I., M. Schaufelberger, K.I. Kjellgren, K. Swedberg, and B.B. Granger. 2007. Standard medication information is not enough: Poor concordance of patient and nurse perceptions. Journal of Advanced Nursing 60(2): 181–186.PubMedCrossRefGoogle Scholar
  11. Haynes, B.R., W.R. Taylor, and D.L. Sackett. 1979. Compliance in health care. Baltimore, MD: Johns Hopkins University Press.Google Scholar
  12. Holm, S. 1993. What is wrong with compliance? Journal of Medical Ethics 19(2): 108–110.PubMedCrossRefGoogle Scholar
  13. Juth, N. 2005. Genetic information. Values and rights. The morality of presymptomatic genetic testing. Doctoral dissertation. Göteborg: Acta Universitatis Gothoburgensis.Google Scholar
  14. Lutfey, K.E., and W.J. Wishner. 1999. Beyond “compliance” is “adherence”. Improving the prospect of diabetes care. Diabetes Care 22: 635–639.PubMedCrossRefGoogle Scholar
  15. Marland, G.R. 1998. Atypical neuroleptics: Autonomy and compliance? Journal of Advanced Nursing 29: 615–622.CrossRefGoogle Scholar
  16. Munthe, C. 2008. The goals of public health: An integrated, multi-dimensional model. Public Health Ethics 1(1): 39–52.CrossRefGoogle Scholar
  17. Mykhalovskiy, E. 2008. Beyond decision making: Class, community organizations, and the healthwork of people living with HIV/AIDS. Contributions from institutional ethnographic research. Medical Anthropology 27: 136–163.PubMedCrossRefGoogle Scholar
  18. Pitkala, K.H., T.E. Strandberg, and R.S. Tilvis. 2007. Interest in healthy lifestyle and adherence to medications: Impact on mortality among elderly cardiovascular patients in the DEBATE study. Patient Education and Counselling 67: 44–49.CrossRefGoogle Scholar
  19. Playle, J.F., and P. Keeley. 1998. Non-compliance and professional power. Journal of Advanced Nursing 27: 304–311.PubMedCrossRefGoogle Scholar
  20. Russell, S., J. Daly, E. Hughes, and C. op’t Hoog. 2003. Nurses and ‘difficult’ patients: Negotiating non-compliance. Journal of Advanced Nursing 43: 281–287.PubMedCrossRefGoogle Scholar
  21. Sandman, L. 2009. The concept of negotiating in shared decision-making. Health Care Analysis 17(3): 236–243.PubMedCrossRefGoogle Scholar
  22. Sandman, L., and C. Munthe. 2009. Shared decision making and patient autonomy. Theoretical Medicine and Bioethics 30(4): 289–310.PubMedCrossRefGoogle Scholar
  23. Sandman, L., and C. Munthe. 2010. Shared decision making, paternalism and patient choice. Health Care Analysis 18(1): 60–84.PubMedCrossRefGoogle Scholar
  24. Timms, N., and L. Lowes. 1999. Autonomy or non-compliance in adolescent diabetes? British Journal of Nursing 8:794–797, 800.Google Scholar
  25. Trostle, J.A. 1988. Medical compliance as an ideology. Social Science and Medicine 27(12): 1299–1308.PubMedCrossRefGoogle Scholar
  26. Vermeire, E., H. Hearnshaw, P. Van Royen, and J.J. Denekens. 2001. Patient adherence to treatment: Three decades of research. A comprehensive review. Journal of Clinical Pharmacological Therapy 26: 331–342.CrossRefGoogle Scholar
  27. WHO. 2003. Adherence to long-term therapies. Evidence for action. Geneva: World Health Organisation.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Lars Sandman
    • 1
  • Bradi B. Granger
    • 2
  • Inger Ekman
    • 3
    • 4
  • Christian Munthe
    • 4
    • 5
  1. 1.School of Health SciencesUniversity of BoråsBoråsSweden
  2. 2.Duke Heart CenterDurhamUSA
  3. 3.Institute of Health and Care Sciences, The Sahlgrenska AcademyUniversity of GothenburgGöteborgSweden
  4. 4.Centre for Person-Centred Care (GPCC)University of GothenburgGöteborgSweden
  5. 5.Department of Philosophy, Linguistics & Theory of ScienceUniversity of GothenburgGöteborgSweden

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