A SCOPING STUDY TO DESCRIBE ‘FOR WHAT’ AND ‘HOW’ PATIENT CONTRACTS ARE BEING USED IN THE SCIENTIFIC LITERATURE FOR THE MANAGEMENT OF CHRONIC MEDICAL CONDITIONS

Abstract

Introduction: Prevalence of chronic conditions continues to rise in North America. Despite the lack of evidence supporting their use, patient contracts are commonly used by medical professionals to manage such conditions. To date, literature reviews on patient contracts has been limited to randomized controlled trials, with specific purposes and limited populations. The purpose of this study is to describe ‘for what’ and ‘how’ medical contracts are being used for the management of chronic medical conditions. Methods: In order to capture and describe the breadth of knowledge around medical contracts in the literature, a scoping review was conducted. This inclusive approach allowed for analytic reinterpretation of research activity, gaps in the literature to be identified and further avenues of inquiry to be opened. Database searches included Medline, EMBASE, AMED, PsycINFO, Cochrane, CINAHL and Nursing & Allied Health. Results: A total of 7,528 articles resulted from the original search. Seventy-six articles were included in the final review. Multiple types of studies were represented with limited follow-up durations. Extensive variety was seen for contract target population, clinical setting and co-interventions. Purposes for initiating contracts included: 1) behavior change and skill development, including goal development and problem solving; 2) altering beliefs and knowledge, including motivation and perceived self-efficacy; 3) improving interpersonal relationships and role clarification; 4) improving the quality and process of chronic care; and 5) altering objective and subjective health indices. In relationship to how contracts are used, their development, application of behavioral theory, inclusion of patient input, training for their use and implementation processes were inconsistently described. Conclusion: More research is required to determine if contracts are capable of accomplishing their intended purposes. Questions remain regarding their rationale, development and implementation.