Assessing wound measurement within a high-risk foot ulcer clinic for people with diabetes - clinical and patient perspectives
IntroductionAround a third of people with diabetes will develop a foot ulcer requiring specialist podiatry treatment during their lifetime. The formation of a foot ulcer for people with diabetes is a consequence of chronic hyperglycaemia, which causes poor wound healing and damage to nerves and blood vessels. This study has two aims. The first was to describe wound healing trajectories from baseline (Day 0), to wound closure, for wounds that had healed within six months. Our hypothesis was that a clinical marker exists, such as a certain time point along the wound healing trajectory, which is associated with subsequent rapid healing. The second aim was to understand patient perceptions associated with wound images and how discussion about images might optimise self-care, as few studies have explored this aspect of clinical care. Images undertaken as part of routine clinical care, enables patients to visualise their foot ulcers, maybe for the first time. Both patient and podiatrist can jointly view the current foot ulcer image on a computer screen and compare this with an earlier electronic image, to gauge wound healing progression. These images thus have the potential to provide a communication medium for facilitating patient self-management discussions. MethodsThis study consisted of two parts. Part 1 included an exploratory retrospective analysis of wound healing as measured by surface area metrics, from 103 individual patients who had attended the high-risk foot ulcer clinic over the previous three years.Part 2 focused on descriptive qualitative research of semi-structured interviews of patients attending the high-risk foot ulcer clinic, studying their perceptions of wound imaging, including clinical utility, during routine clinic appointments. Interviews were audio-recorded and transcribed, thereby allowing thematic analysis of participant responses and identification of themes. Results and findingsPart 1 results determined wound healing trajectories for the 103 individual patient wounds, showed no identifiable time point, after which there would be no deterioration in wound healing. A greater than 50% reduction in wound surface area at four weeks has previously been described as a marker of wound healing success, however only 61.2% of healed wounds in this study met this parameter. Analysis of 31 patient interviews for Part 2 described participants’ positive reactions to being able to visualise and discuss their wound images. This visualisation and discussion led to valuable insights and enhanced understanding of clinical aspects of wound healing. Patient engagement increased with the self-care advice around wound healing, provided by the podiatrists and other specialist clinicians. Patients also considered that these discussions positively impacted on their health literacy. ConclusionThe study showed that sharing and discussing wound images helps advance patient education and understanding. In doing so, the patient can feel more included in their care and more likely to participate in self-care. The study also shows that real-world wound healing trajectories do not provide the podiatrist or patient with certainty around length of time needed to complete wound healing, thus it can be difficult to answer the patient’s question “when will my wound fully heal”. In conclusion, in-clinic discussions of wound images can enhance wound healing opportunities.
Advisor: Lunt, Helen; Seaton, Philippa
Degree Name: Master of Health Sciences
Degree Discipline: Centre for Postgraduate Nursing Studies
Publisher: University of Otago
Keywords: Diabetes; Diabetic foot ulcers; wound healing; electronic wound imaging; patient perceptions; collaborative care; self management; New Zealand; Aotearoa
Research Type: Thesis