Healthcare delivery


require additional reassurance and supportive conversations before feeling comfortable participating more actively in their care. Evidence from wound care research highlights that patient engagement is influenced by a combination of psychological, physical and social factors rather than motivation alone.7 Recognising these influences allows clinicians to move beyond simple explanations of “un- willingness to participate” and instead explore the individual circumstances shaping a patient’s response to treatment. Seen more broadly, reluctance is not just a barrier but maybe a sign that more support, information or reassurance is needed.


The risk of labelling Language plays an important role in shaping how clinicians interpret patient behaviour. Terms such as “non-compliant” or “difficult patient” can become embedded in clinical documentation and professional discussions, often serving as convenient shorthand when treatment has not progressed as expected. However, these labels may obscure the circumstances underlying a patient’s behaviour and influence how clinicians approach subsequent interactions. Experimental research has shown that stigmatising language in clinical documentation can transmit bias by negatively influencing subsequent clinicians’ attitudes towards a patient and their clinical decision making.13 When a patient is described as “non- compliant”, clinicians may approach future encounters expecting resistance or assuming that further attempts to encourage engagement will be unsuccessful. This may reduce opportunities to explore individual barriers, provide education or involve the patient in shared decision making. Labels can


also affect the patient’s experience of care. Individuals who feel judged or misunderstood may become less willing to discuss their concerns openly, particularly when previous attempts to explain difficulties have been interpreted as unwillingness to cooperate. In venous leg ulcer management, treatment commonly requires sustained engagement over weeks or months. Labelling a patient as “non- compliant” may therefore have consequences beyond a single consultation, influencing subsequent encounters before the reasons for their behaviour have been explored. These assumptions may adversely affect


the therapeutic relationship and the patient’s participation in care.7


For example, removal


or inconsistent use of compression may be recorded as a failure to follow advice without documenting associated pain, difficulties with application, disruption to everyday life or concerns about treatment.10,14


More precise


documentation describes the observed behaviour and its context, enabling subsequent clinicians to respond to the patient’s needs rather than to an established judgement. Reframing behaviour as information


rather than judgement encourages a more constructive clinical response. Instead of asking why a patient has failed to follow advice, clinicians can explore what factors may be making treatment difficult to implement. This shift from labelling to curiosity aligns closely with modern approaches to personalised care, where understanding the patient’s perspective is central to effective engagement.8 Ultimately, the language clinicians use can either reinforce barriers or help create opportunities for partnership. By moving away from labels and towards open, exploratory conversations, clinicians can better understand


the realities patients face and work collaboratively to identify solutions that support both safety and participation in care.


Curiosity as a clinical skill Moving from a clinician-led model of care to one grounded in partnership requires a shift not only in language but also in clinical mindset. Adopting a more inclusive approach encourages clinicians to explore the patient’s perspective before drawing conclusions about their behaviour. Instead of presuming that reluctance indicates a lack of motivation, clinicians should pose open ended questions to facilitate discussion about potential challenges patients may be experiencing. Simple questions such as “How are you finding the compression?”, “What has been difficult about applying the hosiery?” or “What worries you most about managing this yourself?” can help uncover concerns that might otherwise remain unspoken (Fig 1). This shift aligns closely with principles of


shared decision making and personalised care, which emphasise understanding the patient’s experiences, priorities and preferences when developing treatment plans.8


When patients


feel heard and understood, they are often more willing to discuss difficulties openly and consider potential solutions. This conversational approach is consistent


with motivational interviewing, which uses open questions, reflective listening and collaborative exploration to understand ambivalence and help individuals identify their own reasons and capacity for change.15,16


Open questions


allow patients to describe their experiences and concerns in their own words, rather than requiring them to defend or justify their behaviour.


Table 1: From compliance to concordance: How terminology reflects changing relationships between patients and clinicians.


Curiosity also helps clinicians identify opportunities for practical support. A patient who struggles to apply compression hosiery may benefit from an application aid, an adjustable wrap system, additional education or assistance from a family member or carer. Other patients may simply need reassurance about the safety and purpose of compression therapy, or support in selecting a garment they find comfortable and acceptable in appearance. By considering these factors, clinicians can tailor care plans to suit each patient’s abilities and situation, rather than relying on a one size fits all approach. Although strong compression remains central to venous leg ulcer management, differences in patients’ clinical needs, physical capabilities, treatment preferences and ability to use particular systems mean that a single method will not be suitable for everyone. A recent network meta-analysis found that differences in healing effectiveness between


October 2026 I www.clinicalservicesjournal.com 49


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