SUMMARY
Patients are often unable to reliably assess their symptoms. Consequently, beliefs about
what symptoms mean and emotional responses to their detection are crucial to the
effect they have on health behaviour including consulting health care professionals.
Beliefs about symptoms such as perceived seriousness and perceived effectiveness of
available treatment mediate the effects of personality (e.g. neuroticism and conscien -
tiousness) on health behaviour including adherence. Most medical interventions rely
on patient adherence. Yet non-adherence is high. Patients are non-adherent for
different reasons but patients’ understanding, recall and satisfaction with health care
all predict adherence. Key aspects of relating to patients determine patient satisfaction.
Doctors’ own satisfaction with their work and patient social support (especially
practical support) predict adherence. In general, studies suggest that we can improve
adherence although it may be challenging to do so for longer-term treatments to an
extent that enhanced health outcomes follow.
Patient satisfaction, adherence and health outcomes are related to consultation
management. Reaching an agreed plan with patients is important and has been
referred to as ‘concordance’. The Calgary-Cambridge consultation model identifies
six key stages, while Pendleton et al.(1984) specify seven key tasks to be completed
in consultations with patients. Patient-centredness and especially listening to patients’
concerns is crucial to patient satisfaction. A positive, direct style, communicating
expertise, is also important, especially for patients with a physical problem that can be
treated with medication. For chronically ill patients perspective taking needs to be
combined with empowering strategies, which help patients take more control of the
consultation and their health. Evidence suggests that interventions can be successful
in empowering patients’ involvement in consultations.
Use of complementary or alternative medicine (CAM) is widespread but doubts
remain about the effectiveness of such therapies, especially when placebo effects are
controlled for and clinical outcomes are used. Large placebo effects have been observed
but the impact of placebo responding on clinical outcomes may be limited to certain
health problems including pain relief. A variety of processes underpin observed
placebo effects including classical conditioning of drug responses. Patient expectations
and stress reduction are likely to play an important role in the psychological and
physiological benefits observed in placebo conditions. Adhering to treatment can
bolster such expectations, which may account for the beneficial effects of adherence
to placebo treatments.
People with long-term physical illness tend to be older and to be more intensive
users of health care services. The challenge for people with LTIs is to adapt to their
illness, adopt the most effective coping strategies and to maintain high self-efficacy and
a good quality of life. Emotional responses to the illness are likely to affect quality of
life and in some cases longevity. Consequently, cognitive and emotional care is critical
to efficacious and cost-effective services. Psychological interventions have much to
offer. For example, cognitive interventions focusing on cognition and emotion and
behavioural interventions focusing on behaviour change and enhanced quality of life
have been found to be effective in pain management.
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