Increasing patient involvement in the diabetic foot pathway

NewsBot · May 26, 2016

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Increasing patient involvement in the diabetic foot pathway: a pilot randomized controlled trial.
McBride E et al
Diabet Med. 2016 May 25. doi: 10.1111/dme.13158

AIMS:
This pilot study aimed to explore whether the use of an intervention to increase shared decision-making (Decision Navigation) in patients with a diabetic foot ulcer increased decision self-efficacy and foot treatment adherence.
METHODS:
Fifty-six patients with a diabetic foot ulcer were randomized to receive Decision Navigation (N = 30) or usual care (N = 26). Primary outcomes included decision self-efficacy, adherence to foot treatment as reported by the participant and adherence to foot treatment as reported by the clinician. Secondary outcomes included foot ulcer healing rate, health-related quality of life, decisional conflict and decision regret.
RESULTS:
Despite participants rating Decision Navigation as very helpful, mixed analyses of variance revealed no differences in decision self-efficacy or adherence between those receiving Decision Navigation and those receiving usual care. There were no differences between groups with regards to the secondary outcomes, with the exception of decision conflict which increased over time (12 weeks) for those receiving Decision Navigation.
CONCLUSIONS:
An intervention that facilitated patient involvement in treatment decisions did not have any impact on decisional confidence or adherence to foot treatment. This does not provide support for the suggestion that personalized care can improve health-related outcomes at this progressed stage of the patient's disease trajectory. We suggest that the diabetic foot population may benefit from interventions aimed at increasing motivation to engage with care pathways, centred on challenging personal controllability beliefs.
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NewsBot · May 10, 2019

Diabetic Foot and Self-awareness of This Entity
Irma Aide Barranco-Cuevas et al
JAMMR, 29(9): 1-5, 2019; Article no.JAMMR.48860

Aims: To determine the relationship between the diabetic foot stages and the self-awareness
about self-care of the feet in patients attending first level medical facility.
Study Design: This is a descriptive, cross sectional study.
Place and Duration of Study: This study was conducted in Unit Number 57 of the Family
Medicine in the Mexican Institute of Social Security in Puebla, Mexico between January and June
of 2017.
Methodology: We included 360 patients whom we surveyed to correlate between the level of
knowledge about self-care of the feet in diabetic patients and its stages. We used a questionnaire
in which the variables included gender, age, level of education, occupation, marital status, number
of years since they were diagnosed with diabetes mellitus type 2, stage of the diabetic foot and
level of knowledge related to this entity. Descriptive statistics and X2 were used
Results: We included 360 patients who met the inclusion criteria. Their average age was 55.75
years, the average number of years with the diagnosis of diabetes mellitus was 6.07. There was a
significant statistic association between the level of knowledge and the stage of the diabetic foot P
= .049 a value of P= .05 was considered statistically significant.
Conclusion: There is an association between the stage of the diabetic foot and the knowledge
about the self-care of the feet among patients.
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NewsBot · Jul 2, 2019

Optimising Wellbeing in Patients with Diabetic Foot Ulcers.
McIntosh, Caroline; Ivory, John D.; Gethin, Georgina; MacGilchrist, Claire
EWMA Journal . May2019, Vol. 20 Issue 1, p23-28. 6p. 1 Chart.

Abstract: Background Living with diabetic foot ulceration (DFU) can have a significant impact on a person's physical and psychological health. Clinicians involved in the treatment of DFU patients should possess sufficient knowledge and understanding of the total impact of living with a DFU, including an awareness of an individual's wellbeing. Aim To provide an overview of the current literature with regard to wellbeing in patients affected by DFU by considering current outcome measures used to assess domains of wellbeing in this population. Findings The psychological, physical, spiritual, and cultural domains of wellbeing all impact an individual's overall wellbeing. There is no one standardised tool available that assesses all four domains of wellbeing specific to those with DFU. It is important for clinicians to be aware that all members of the multidisciplinary team have a responsibility to consider the importance of wellbeing assessment and to be mindful of suggested approaches. Conclusions There is a need for a reliable and valid measurement tool to assess overall wellbeing in people living with DFU. Implications for clinical practice This review highlights the importance of the inclusion of wellbeing assessment in optimising wound care for individuals with DFU.
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NewsBot · Jun 17, 2020

Effect of Family Empowerment on HbA1c Levels and Healing of Diabetic Foot Ulcers
Rasnah Appil, MN, Elly Lilianty Sjattar, PhD, Saldy Yusuf, PhD, ...
The International Journal of Lower Extremity Wounds June 11, 2020

Objective. To evaluate the effectiveness of family empowerment through educational interventions against HbA1c level and healing progress of diabetic foot ulcers. Method. A quasi-experimental design was employed involving 33 participants from 4 wound care clinics in Makassar, eastern Indonesia. The intervention group consisted of 17 participants and their families; the control group was composed of 16 participants who received nonstructural education. Family empowerment was measured by the Indonesian version of the Family Empowerment Scale instrument. Glycemic control was evaluated with HbA1c levels, and the wound healing process was evaluated on the Diabetic Foot Ulcers Assessment Scale. Result. After 3 months, Family Empowerment Scale scores improved, particularly in the subdomain of family knowledge (16.59 ± 3.92 vs 13.38 ± 1.26; P = .005) and attitude (3.65 ± 0.93 vs 2.75 ± 0.45; P = .002). After 3 months of intervention, HbA1c decreased (from 10.47 ± 2.44% to 8.81 ± 1.83%), compared with the control group (P = .048). Meanwhile, an independent t test further revealed that the wound healing process tended to be better with the intervention group (4.71 ± 7.74) compared with the control group (17.25 ± 17.06), with P = .010 at the third month. Conclusion. Family-based education intervention creates family empowerment to control HbA1c levels and accelerate wound healing of diabetic foot ulcer.
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NewsBot · Aug 4, 2023

Collaboration and partnership in a five-level engagement framework for diabetic foot ulcer management: a patient-oriented scoping review
Virginie Blanchette et al
Can J Diabetes. 2023 Jul 10;S1499-2671(23)00163-6

Background: The management of diabetic foot ulcers (DFUs) is complex, and patient engagement is essential for DFU healing, but it often comes down to the patient's consultation. Therefore, we sought to document patients' engagement in terms of collaboration and partnership for DFUs in five levels (direct care, organizational, policy level, research, and education), as well as strategies for patient engagement using an adapted engagement framework.

Methods: We conducted a scoping review of the literature from inception to April 2022 using the Joanna Briggs Institute method and a patient-oriented approach. We also consulted DFU stakeholders to obtain feedback on the findings. The data was extracted using PROGRESS+ factors for an equity lens. The effects of engagement were described using Bodenheimer's quadruple aims for value-based care.

Results: Of 4,211 potentially eligible records, 15 studies met our eligibility criteria, including 214 patients involved in engagement initiatives. Most studies were recent (9/15 since 2020) and involved patient engagement at the level of direct medical care level (8/15). Self-management (7/15) was the principal way to clinically engage the patients. None of the studies sought to define the direct influence of patient engagement on health outcomes.

Discussion: Very few described patients' characteristics. Engaged patients were typically men from high-income countries, in their fifties, with poorly controlled type 2 diabetes. We found little rigorous research of patient engagement at all levels for DFUs.
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