Patients must cooperate with recommendations if the recommendations are to be effective. Being able to educate, persuade, and motivate patients enhances the effectiveness of health care professionals. This is true regardless of the treatments' efficacy, the professionals' knowledge, or the professionals' good intentions.
This chapter discusses factors that affect compliance, and summarizes ideas and conclusions from the extensive literature on compliance with medical and psychological treatments (DiMatteo & DiNicola, 1982). It also presents considerations about conducting a professional practice. This chapter's guidelines and considerations apply to most settings in which practitioners provide biofeedback. Prudent professionals aware of these factors adjust their behaviors toward patients accordingly. We can all strive to change our behaviors and office environments so as to improve our effectiveness.
The term "compliance" is complex and suggests an approach to patient care that implies a duty by patients to follow practitioners' orders blindly (DiMatteo & DiNicola, 1982). Other terms include "adherence," "cooperation," "collaboration," and "therapeutic alliance." The term "compliance" is still a commonly employed term and is the one used by DiMatteo and DiNicola (1982). However, they correctly point out that compliance should not "imply varying power relationships between the practitioner and patient" (p. 8).
"Adherence" involves holding fast to a plan, and is thus the behavior of supporting or following ideas and recommendations (Buchmann, 1997). "Compliance" is sometimes thought of more as a willingness to follow or consent. However, both compliance and adherence are processes and goals, and they are very often treated interchangeably (although sometimes distinguished). For example, sometimes compliance is thought of as less voluntary and adherence as more voluntary; thus some prefer the term "adherence," as it does not connote coercion (Erlen, 1997). As Erlen (1997) concludes, changing the terminology is like changing window dressing: The end result and the process toward achieving that goal may not change. Erlen (1997) discusses various ethical questions involved in compliance, including whether the patient or the health care provider knows best, and whether and how providers listen, assess, ask, and plan for patients. Recommended therapy plans often require significant lifestyle changes that providers need to consider. However, overzealousness or coercive efforts by health care professionals when patients are less than ideally compliant can result in demeaning, counterproductive communications.
Do our patients understand and accept our recommendations? Do they feel comfortable to admit their lack of understanding and acceptance? Do they always tell us the truth? Sug-