Relational dynamics involved in therapeutic discordance among prescribers and patients: a grounded theory study

Díaz Crescitelli, Matías Eduardo, Hayter, Mark ORCID: https://orcid.org/0000-0002-2537-8355, Artioli, Giovanna, Sarli, Leopoldo and Ghirotto, Luca (2022) Relational dynamics involved in therapeutic discordance among prescribers and patients: a grounded theory study. Patient Education and Counseling, 105 (1). pp. 233-242. ISSN 0738-3991

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Official URL: https://doi.org/10.1016/j.pec.2021.05.041

Abstract

OBJECTIVE: No studies have explored the negative process of concordance: discordance in prescribing-medication-taking. This study provides a deeper understanding of discordance as a co-constructed process among patients and prescribers. METHODS: To explore the question "what psychological and relational processes are involved when therapeutic discordance among prescribers and receivers occurs?" a constructivist Grounded Theory study was carried out through semi-structured interviews with patients and their medical doctors. RESULTS: The final sample of our study was composed of 29 participants: 16 receivers and 13 prescribers. "Neglecting the relationship", the core category, shapes the therapeutic discordance and connects three main conceptual phases: signing a non-negotiating contract, acting alone, and establishing a superficial relationship. CONCLUSION: Our grounded theory conceptualization contributes to the concordance-related debate by evidencing the processes among prescribers and receivers in interwoven actions. It offers another dimension to how notions of compliance, adherence and concordance have been theorized to date. PRACTICE IMPLICATIONS: More than one interaction with receivers is recommended. If there are hints that conflict potentially is compromising the relationship, prescribers should involve intermediaries. Setting aside for a moment, evidence-based justification for treatments and trying to understand prescribers' motivations may boost a positive change.

Item Type:	Article (Article)
Peer-reviewed:	Yes
Date Deposited:	22 May 2024 11:36
Publisher:	Elsevier
Additional Information:	For copyright reasons, full-text access is not available through this repository.
Divisions:	Faculties > Health and Education
Subject terms:	Science & Technology, Social Sciences, Life Sciences & Biomedicine, Public, Environmental & Occupational Health, Social Sciences, Interdisciplinary, Social Sciences - Other Topics, Therapeutic discordance, Concordance, Adherence, Compliance, Prescriber and patient relationship, Medication-taking, Cancer, Futility, Grounded theory, Qualitative research, TREATMENT ADHERENCE, CONCORDANCE, TRUST, CARE, COMMUNICATION, TERMINOLOGY, PREFERENCES, STRATEGIES, MANAGEMENT, CONFLICT, Humans, Drug Prescriptions, Grounded Theory, Adherence, Cancer, Compliance, Concordance, Futility, Grounded theory, Medication-taking, Prescriber and patient relationship, Qualitative research, Therapeutic discordance, Drug Prescriptions, Grounded Theory, Humans, Science & Technology, Social Sciences, Life Sciences & Biomedicine, Public, Environmental & Occupational Health, Social Sciences, Interdisciplinary, Social Sciences - Other Topics, Therapeutic discordance, Concordance, Adherence, Compliance, Prescriber and patient relationship, Medication-taking, Cancer, Futility, Grounded theory, Qualitative research, TREATMENT ADHERENCE, CONCORDANCE, TRUST, CARE, COMMUNICATION, TERMINOLOGY, PREFERENCES, STRATEGIES, MANAGEMENT, CONFLICT, Humans, Drug Prescriptions, Grounded Theory, Adherence, Cancer, Compliance, Concordance, Futility, Grounded theory, Medication-taking, Prescriber and patient relationship, Qualitative research, Therapeutic discordance, Drug Prescriptions, Grounded Theory, Humans, 11 Medical and Health Sciences, 17 Psychology and Cognitive Sciences, Public Health, 11 Medical and Health Sciences, 17 Psychology and Cognitive Sciences, Public Health
URI:	https://e-space.mmu.ac.uk/id/eprint/631305
DOI:	https://doi.org/10.1016/j.pec.2021.05.041
ISSN	0738-3991
e-ISSN	1873-5134

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