Patient adherence or patient self-management in transplantation: an ethical analysis

Adherence of patients to transplantation regimens has been problematic. Patient self-management of the chronic diseases that frequently lead to transplantation is now the standard of practice, although that practice has been incompletely implemented. Through its focus on developing patients' skills and confidence in their ability to perform medical management, maintain important life roles, and manage the negative emotions that often accompany chronic conditions, patient self-management has the potential to support effective adherence of patients in an ethically satisfactory way. A professional decision to transplant should carry with it a commitment to help patients self-manage, including patients with low levels of literacy. Viewing adherence as patients' work to be accomplished within a framework of patient self-management offers an option for improving transplant outcomes. Testing this option is an important next step.