Beyond Compliance, Adherence, & Concordance – Supporting The Patient’s Implementation Of Optimal Treatment

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Coaching Patient Compliance

March 12th, 2007 at 7:28 pm · · Clinical Info, Enhancements · 2 Comments

Increasing Compliance By Coaching Patients To Participate In Their Healthcare

A review in the latest issue of The Cochrane Library indicates that coaching can increase the participation of some older patients’ (+65 years) in their healthcare.

The review found only three studies, involving a total of 433 patients, focused on assisting older patients to increase the effectiveness of doctor visits (many more such studies are available for younger patients). Further, two of those studies had too few patients for the reviewers to feel confident recommending the interventions used. The three studies dealt primarily with two kinds of pre-visit interventions:
1. Person-to-person coaching
2. Written materials

According to one study, 54 percent of patients had not identified specific issues to discuss before their visit to the doctor, and 80 percent did not bring a list of questions, problems or medications to the visit and asked no questions about their illness or tests or procedures. More than three-quarters of these patients did nothing whatsoever to prepare for their visits.

In another study, 45 patients were divided between an intervention group and a control group. Before seeing the doctor, those in the intervention group met with a medical student who questioned them and helped identify questions they had about their treatment. Fourteen of those 22 patients asked at least one question during their session with the doctor, compared with eight of 23 patients in the control group.

Coaching and other methods, however, were insufficient, according to one of the studies reviewed, to prompt the majority of older patients to become adequately involved in their doctor visits.

According to The Cochrane Review, it would be impractical to provide coaching for the entire population, but supplying coaching to hose specific groups of patients who could benefit most could result in a positive benefit to cost issue.

A key principle of the studies, according to lead author Raymond Wetzels, a general practitioner at the Radboud University Nijmegen Medical Center in the Netherlands, is that “more-involved patients tend to adhere to advice better.”


As usual, The Cochrane Review is careful not to make pronouncements without sufficient evidence from studies. While the secondary pieces about the Cochrane article seem to emphasize the positive, i.e., that coaching and written materials may increase patient involvement in treatment, the evidence is that even the immediate beneficial effect, which might decay over time, is demonstrated in only a minority of patients.

Further, while there is evidence that patients who are more involved in treatment tend to exhibit higher rates of adherence, much less is known about the impact on compliance when patients, especially older patients, are mentored to become more involved in treatment.

Primary Source
Wetzels R et al. Interventions for improving older patients’ involvement in primary care episodes. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD004273. DOI: 10.1002/14651858.CD004273.pub2.

Secondary Source
Coaching Can Help Older Adults Speak Up at Medical Visits
Joan Hennessy, Health Behavior News Service February 15, 2007

Tags: Clinical Info · Enhancements

2 responses so far ↓

  • 1 Trisha Torrey // Mar 15, 2007 at 11:22 am

    I cheer the idea of coaching patients, whether or not they are elderly. But I also understand the outcome of the Cochrane study.

    Behaviors developed over a 65+ year lifetime will not easily be changed. The elderly have spent that lifetime believing their doctors are God, and expecting that all medical decisions will be made for them, and in their best interest. Asking them to shift their mindsets, to really accept the reality of today’s too-often dysfunctional system of healthcare in order to take on that responsibility themselves, is like asking doctors to diagnose without a stethoscope or blood pressure monitor. They just don’t have the tools and are reticent to take the plunge.

    That does not mean, however, that doctors shouldn’t try to help them. I suspect the 80/20 rule will apply here, and the benefits to at least the 20 percent of learning to advocate for themselves can be profound.

    Trisha Torrey

  • 2 Oh Say can you C? Compliance, Colonoscopy and more « Every Patient’s Advocate // Mar 17, 2007 at 7:53 am

    [...] Thursday, I posted a comment to a blog called AlignMap that is aimed at medical professionals (OK – so I eavesdropped) and showcases patient Compliance – issues that surround patients following a doctor’s instructions.  Issues such as: Do they or don’t they? Will they or won’t they?  Can we expect them to? And what if they don’t? etc etc.  The website and blog belong to Dr. Allan Showalter, a psychiatrist in clinical practice who has followed and written on the topic for years.  The blog I responded to regards a question about whether doctors should Coach elderly persons to comply.  Here’s the post and comment. [...]