Medical compliance and the clinician-patient relationship: a review.

Abstract A 4-category classification of research on elements of provider-patient interaction that appear related to compliance behavior is presented. The first category describes research on pedagogical techniques employed by practitioners to inform patients in detail of the patient behaviors prescribed to deal with the medical problem. This category contains studies of both correlational and experimental design that support the hypothesis that greater provider explicitness regarding needed patient behaviors is associated with better patient follow-through. The second category of research deals with studies that indicate an association between extensive clinician-patient sharing of expectations about appropriate behaviors in the dyad and good patient compliance. In this category, research has not yet proceeded beyond correlational and descriptive research designs to experimental design. The third category contains studies that reveal links between the patient's assumption of responsibility for his own therapy and compliance. In this division the supporting research is both correlational and experimental. The final category contains research linking positive and supportive tone of the clinician-patient interaction with good patient adherence. Research design in this category has not yet reached the experimental level of development. The concepts and results of research in each category are quite promising. Randomize trials of methods of intervention derived from each category seem called for, though favorable results in different settings, with different combinations of treatments are by no means yet assured.