• Erin Gallagher, Elizabeth Alvarez, Lin Jin, Dale Guenter, Lydia Hatcher, and Andrea Furlan.
• Assistant Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont. erin.gallagher@medportal.ca.
• Can Fam Physician. 2022 May 1; 68 (5): e169e177e169-e177.

ObjectiveTo describe how and why patient contracts are used for the management of chronic medical conditions.Data SourcesA scoping review was conducted in the following databases: MEDLINE, Embase, AMED, PsycInfo, Cochrane Library, CINAHL, and Nursing & Allied Health. Literature from 1997 to 2017 was included.Study SelectionArticles were included if they were written in English and described the implementation of a patient contract by a health care provider for the management of a chronic condition. Articles had to present an outcome as a result of using the contract or an intervention that included the contract.SynthesisOf the 7528 articles found in the original search, 76 met the inclusion criteria for the final review. Multiple study types were included. Extensive variety in contract elements, target populations, clinical settings, and cointerventions was found. Purposes for initiating contracts included behaviour change and skill development, including goal development and problem solving; altering beliefs and knowledge, including motivation and perceived self-efficacy; improving interpersonal relationships and role clarification; improving quality and process of chronic care; and altering objective and subjective health indices. How contracts were developed, implemented, and assessed was inconsistently described.ConclusionMore research is required to determine whether the use of contracts is accomplishing their intended purposes. Questions remain regarding their rationale, development, and implementation.Copyright © 2022 the College of Family Physicians of Canada.

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