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 Work with the patient and, if appropriate, carer in partnership to make informed choices, agreeing a plan that respects patient preferences, including their right to refuse or limit their treatment.

 Identify and respect the patient with regards to diversity, values, beliefs and expectations regarding their health and treatment with medicines.

 Routinely assess adherence in a non‐judgmental way and understand the different reasons that non‐adherence may occur (this may be intentional or non‐intentional) and how best to offer support.

 Build a therapeutic relationship with the patient that encourages two‐way effective communication.

 With the patient and carer, explore satisfactory outcomes for the patient/carer.

Source: Adapted RPS (2016)

Concordance, adherence and compliance are terms that reflect fundamentally different approaches to care. When applied in its strict scientific definition, compliance is a useful term; however, it can also infer ‘nurse or doctor knows best’ and may be interpreted as condescending whereby patients do as they are told or advised. Compliance describes a patient's behaviour and concordance implies a process. It is appropriate, therefore, to refer to non‐compliant patients, but not to non‐concordant patients. The relationship between the patient and the health professional is non‐concordant, not the patient. NICE (2009) have determined that adherence presumes an agreement between the prescriber and patient about the prescriber's recommendations. Adherence to medicines is defined as the extent to which the patient's action matches the agreed recommendations. When there is non‐adherence, this has the potential to limit the benefits of medicines resulting in a lack of improvement, or a deterioration in health and wellbeing. The economic costs, suggest NICE (2009), are not only limited to wasted medicines but will also include the knock‐on costs that arise from increased demands for healthcare if the person's health deteriorates.

Honouring individual choices and beliefs are the hallmarks of professional healthcare providers (NMC, 2018a). Being aware of the individual's values, acceptance of these values and asking or seeking clarification are essential if the person is to be respected. This can also have a positive impact on medicine adherence.