Alignment: a conceptual shift from adherence.

Developing a treatment plan with a patient is one of the cornerstones of clinical medicine. The current concept of adherence, a conceptual shift away from the notion of compliance, connotes an agreement to and implementation of a plan. There are, however, myriad causes that can impinge on whether or not a treatment plan is followed through. The current clinical usage of the word 'adherence' tends to focus on the ultimate behaviour of the patient, and as such the factors acting on the behaviour may escape attention. We propose the concept of treatment 'alignment'. The term 'alignment' conveys an image of the patient and clinician in the context of a range of factors that must 'line up' to maximise the chances of a treatment plan being successfully implemented.