Adherence, shared decision-making and patient autonomy
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.
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The between-group difference in cumulative QALYs was 0.007 (95% CI -0.22 to 0.04), statistically nonsignificant (SE=.02, t=-0.46, P=.65), and fell below the minimal clinically relevant difference for the EQ-5D of 0.074.
“The 0.007 [95% CI: -0.22 to 0.04] between-group difference in cumulative QALYs was statistically nonsignificant (SE = .02, t = -0.46, P = .65) and fell below the established threshold for the minimal clinically relevant difference for the EQ-5D of 0.074 [46].”
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- Authors
- Sandman, L., Granger, B. B., Ekman, I., & Munthe, C.
- Affiliations
- University of Borås (SE)
- Duke Medical Center (US)
- University of Gothenburg (SE)
- Corresponding author
- Sandman, Lars
- Venue
- Medicine Health Care and Philosophy
- Published
- 2011-06-17
- Volume
- 15
- Issue
- 2
- Pages
- 115-127
- ISSN
- 1386-7423 (ISSN-L)
- 1572-8633
- OpenAlex
- W2064177412
- Cited by
- 150
- References
- 38
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 17 · 2023: 8 · 2022: 18 · 2021: 2 · 2020: 8 · 2019: 8 · 2018: 15 · 2017: 9 · 2016: 19 · 2015: 15 · 2014: 4 · 2013: 9 · 2012: 5
- FWCI
- 6.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Medicine Health Care and Philosophy (publishedVersion)
- PubMed (publishedVersion)
- Borås Academic Digital Archive (University of Borås) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Keywords
- medication adherence, shared decision-making, patient autonomy, paternalism, patient preferences, professional-patient interaction
- MeSH terms
- Choice Behavior, Decision Making, Humans, Patient Compliance, Patient Participation, Personal Autonomy, Patient Preference
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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