Concordance: what it is and what it is not.

1. Tissue Viability Society Conference Newcastle 2018 Concordance: what it is and what it is not. Dr John McKinnon Senior Lecturer University of Lincoln

2. Tissue Viability Society Conference Newcastle 2018 Spot the Difference (Horne et al, 2005 ; Treharne et al, 2006; McKinnon; 2014) √ Compliance - patient behaviours should match practitioner expectations and directions √ Adherence - the satisfactorily informed patient adheres to directed treatment √ Concordance - an egalitarian relationship leading to an agreed plan between patient and practitioner √ Shared Decision - the decision making process which arises from concordance Making

3. Tissue Viability Conference Newcastle 2018 Concordance √ Ottawa 1986 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. Tissue Viability Conference Newcastle 2018 Concordance √ Narrow and Broad Models √ 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. Tissue Viability Conference Newcastle 2018 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. Tissue Viability Conference Newcastle 2018 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. Tissue Viability Conference Newcastle 2018 Concordance – the Antecedents √ Engagement √ Listening √ Valuing Patient Expertise √ Respecting Patient Values and Beliefs √ A Knowledge of Patient Biography √ Empathy √ A Willingness to Share One’s Expertise (McKinnon, 2011,2013)

8. Tissue Viability Conference Newcastle 2018 Determinants of Non-Concordance with Tissue Viability Care and Treatment √ The Variation in Research Findings √ Pain Intensity √ Age √ Wound Depth √ Wound Size √ Strength √ Dexterity √ Mobility √ The Meaning for the Patient (Miller et al.2011;Todd, 2018)

9. Tissue Viability Conference Newcastle 2018 Psychology of Concordance – Information Processing (Platt,2011) √ Deletion √ Distortion √ Generalisation

10. Tissue Viability Conference Newcastle 2018 Psychology of Concordance – Information Processing (Platt,2011) We delete, distort and generalise on the basis of our • Values • Beliefs • Memories • Decisions

11. Tissue Viability Conference Newcastle 2018 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. Tissue Viability Conference Newcastle 2018 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 and Clubs • Travel Difficulties- location, timing and structure of clinics • Compassion and Empathy • Communicate Effectively and Imaginatively - aggravated and mitigated directives

13. Tissue Viability Conference Newcastle 2018 In Conclusion ‘A patient has a life not just an ulcer’ Price (2008)