Adherence, shared decision-making and patient autonomy

@article{Sandman2012AdherenceSD,
  title={Adherence, shared decision-making and patient autonomy},
  author={Lars Sandman and Bradi B. Granger and Inger Ekman and Christian Munthe},
  journal={Medicine, Health Care and Philosophy},
  year={2012},
  volume={15},
  pages={115-127}
}
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… 

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  • Joshua T Landry
  • Medicine, Psychology
    Journal of evaluation in clinical practice
  • 2020
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References

SHOWING 1-10 OF 37 REFERENCES

Shared decision-making and patient autonomy

Different forms of shared decision-making are analysed in relation to five different aspects of autonomy and it is argued that both individually and jointly these aspects will support the models called shared rational deliberative patient choice and joint decision as the preferred versions from an autonomy perspective.

Shared Decision Making, Paternalism and Patient Choice

In the article, different versions of SDM are explored, versions compatible with paternalism and patient choice as well as versions that go beyond these traditional decision making models, including the Shared Rational Deliberative Joint Decision model.

Patient non-compliance: deviance or reasoned decision-making?

Medication practice and feminist thought: a theoretical and ethical response to adherence in HIV/AIDS.

It is proposed that one of these alternatives, medication practice, broadens the understanding of individuals' medication-taking behaviour, speaks to the inherent power inequities in the patient-provider interaction, and addresses the ethical shortcomings in the traditional construal.

The Concept of Negotiation in Shared Decision Making

It is suggested that the interaction between patient and professional in case of conflict is more accurately described in terms of an internal balancing of values like patient best interest, patient autonomy and patient adherence by the professional that is accepted by the patient.

Beyond Decision Making: Class, Community Organizations, and the Healthwork of People Living with HIV/AIDS. Contributions from Institutional Ethnographic Research

This article focuses on two aspects of the knowledge relations of coming to take pharmaceutical medications that transcend the conceptual and relational terrain of rational decision-making perspectives and investigates the knowledge-mediating activities of community-based organizations that help mitigate those disjunctures.

Non-compliance and professional power.

The non- compliance of patients with prescribed treatments is considered as a barrier to effective health care, and the maintenance of professional power and control is suggested as central to the debates surrounding non-compliance.

Medical compliance as an ideology.

Nurses and 'difficult' patients: negotiating non-compliance.

A patient-centred approach involves transferring power and authority away from health care professionals and towards patients, and is encouraged to take a leadership role by changing the way in which health care is delivered towards a focus on patients' lives.

Autonomy or non-compliance in adolescent diabetes?

Recommendations for nursing practice are made, taking into account the increasing need for autonomy and independence in adolescence, for teenagers with diabetes.