Adherence vs. Compliance

I agree that there is only a slight difference in the meaning of compliance and adherence.  They mean almost the same thing but not quite.  Complying to an order, is slightly different from adhering to it.  From a patient perspective, speaking to a patient,  I would prefer using adherence.

I do not believe that there is only a slight difference in meaning between these two terms – and I've tried to provide a view that is held by many nurses outside of our group of language and informatics experts:

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I think we are missing an important fact in our discussion – that is there is no one concept or term in any of our standardized languages that has created more controversy than “noncompliance”. As nursing leaders who are to represent the global nursing community to SNOMED we have an obligation to consider the views of ALL nurses, just simply our own ideas.

I’ve be an active member of the holistic/integrative nursing community for more than 3 decades and I also represent many nursing faculty/scholars who find the term ‘noncompliance’ completely outside the domain of professional nursing. Why? That’s because compliance suggests that an individual is not following directions, orders or advice given by another. When used in a health care setting, the term refers to any situation where the nurse (or health care provider) tells a patient/client what to do and the patient/client chooses not to comply with that order. Many nurses reason our patients/clients can not be denied their right to self-determination and autonomy. When we make a decision that these patients/clients have a problem we need to correct because they do not choose the treatment plan we’ve ‘ordered’ for them, we are are violating our nursing ethical codes. Further, these nurses also reason that when we observe behaviours that indicate noncompliance, we likely have devised a treatment plan that disregards the patient/client’s social circumstances or cultural beliefs.

I worry that these concerns have driven literally thousands of nurses away from use of any standardized language and has resulted in many faculty in my country not teaching or researching this content. We have many nurses who are skeptical about anyone’s ability to capture nursing activities in computerized health records, in some locations these are the majority of nurses.

One thing we have the power to do here is at least provide these colleagues of ours an alternative term to document those situations where a patient/client as agreed to a treatment plan and requests our help/guidance in following the regimen. That term is “adherence” and its use in practice is “non-adherence to the agreed-upon treatment plan” (with emphasis here on the notion of ‘agreed-upon). *

I urge us to act on behalf of nurses who are not within our ranks as informaticians and developers of standardized terms as well as acting on behalf of those who are. For the future of our profession, we need to address ALL so that nursing as a discipline and profession may (hopefully) stand as a more unified group than we are today.

*Please also note that the NANDA-I taxonomony retired the use of noncompliance in 2018, citing the lack of the term’s use in the then current nursing literature, and among other concerns, the conflicts of its use and the Affordable Care Act (ACA) in the US that protects patient rights.

A more patient focussed term is 'concordance' which is semantically slightly different different again but reflects the direction of clinical practice being more patient directed rather than a more paternalistic approach.  Medicines concordance and adherence: involving adults and ...