Patient-centred concerns

Recommendations

Address patient-centered Concerns
1 Provide patient-focused education about diabetes and its management to all patients at risk of diabetic foot ulcer to reduce the risk of diabetic foot complications. Level of Evidence
Not Assessed
2 Document pain and treat as required. Level of Evidence
Not Assessed
3 Provide education that empowers patients and encourages self management. Level of Evidence
Not Assessed
4 Follow principles of adult education in designing educational interventions: interactive; based on individual experience, needs and abilities; and focused on developing solutions. Level of Evidence
Not Assessed
5 Reinforce education regularly. Level of Evidence
Not Assessed


Background

Adjusting to the impact of a chronic wound may be compared to adjusting to the impact of a chronic condition, such as changes after a stroke. A diabetic foot ulcer affects mobility and all activities of daily living, requires time and effort and may be associated with an embarrassing odour. Care of a diabetic foot ulcer may take over the patient’s life and become the patient’s ‘job.’ Multiple medical appointments, transportation, financial issues, and social isolation can all affect quality of life. Patients may be very worried about wound healing and afraid of amputation, and they may feel angry or frustrated with physical limitations and uneasy with the changes in their lives.

Education of people with diabetes about their condition and its management and about the importance of appropriate foot care provides the knowledge for self-management and prevention or reduction of diabetic complications. An educational focus on solutions assists patients to regain a feeling of control in their lives, to participate in their own care and to develop self-management skills.

Evidence supports the benefits of education as part of risk reduction for people with diabetes. Education improves foot-care knowledge and behaviour. Patients with a higher risk of ulceration benefit significantly from education and regular reinforcement of learning. The risk of amputation has been demonstrated to be three times greater among patients with diabetes who received no formal diabetes education. After wound closure has been achieved, education should focus on self-monitoring and prevention.

Educational interventions should follow the principles of adult learning. Education should therefore be interactive and evidence based. The learner’s experiences and needs should form the basis of the education, and the focus of the education should be developing solutions, tailored to individual abilities. Psychosocial, socioeconomic and cultural differences between patients should be considered when designing education.

References

Essential Publications
1 Quality of Life for Patients with Diabetic Foot Ulcers Quality Indicator
 Type: Correlation study
Goodridge D, Trepman E, Sloan J, Guse L, Strain LA, McIntyre J, Embil JM. Quality of life of adults with unhealed and healed diabetic foot ulcers. Foot Ankle Int. 2006 Apr;27(4):274-80.
This publication reviews the literature and presents a detailed analysis of the effect of diabetic foot ulcers on quality of life. It outlines the importance of preserving quality of life through effective treatment of diabetic foot ulcers.
2 Quality of Life for Patients with Diabetic Foot Ulcers Quality Indicator
 Type: Prospective Correlation study
Ribu L, Hanestad BR, Moum T, Birkeland K, Rustoen T. Health-related quality of life among patients with diabetes and foot ulcers: association with demographic and clinical characteristics. J Diabetes Complications. 2007 Jul-Aug;21(4):227-36.
This publication examines the impact of diabetic foot ulcers on Health-Related Quality of Life (HRQoL). The results demonstrated that patients with healed ulcers had a greater HRQoL than patients with persisting ulcers, demonstrating the importance of effective foot ulcer care.
3 Evaluating Patient-Centered Outcomes in Diabetic Foot Ulcer Treatment Quality Indicator
 Type: Longitudinal study (1 group)
Jeffcoate WJ, Chipchase SY, Ince P, Game FL. Assessing the outcome of the management of diabetic foot ulcers using ulcer-related and person-related measures. Diabetes Care. 2006 Aug;29(8):1784-7.
This study is unique in that it measures treatment through both ulcer-related outcomes (size, healing rate) and patient-related outcomes (survival, amputation, being free from ulcers). The results demonstrate that ulcer-related outcomes may underestimate morbidity and mortality associated with diabetic foot ulcers, and that patient-centered concerns must be emphasized further.


Enablers for practice

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