By DR. NILMA ELIAS SANTIAGO

Ask a patient with a chronic wound how they feel about it and they will tell you the emotional, psychological, financial, and physical toll the wound has created in their lives. Most of them will say something like having this wound has been a nightmare, a horrible experience, expensive, an emotional drain, a physical limitation, or I’m just tired of dealing with this wound.

Though patients may receive the most advanced and effective wound care treatments, more often than not, services are planned without considering their personal preferences, their community resources, and the stress any treatment plan might put on them and their caregivers.

Therefore, many patients with chronic wounds feel disconnected believing that their needs and wants are not aligned with those of their providers. Furthermore, the label of “non-compliant patient” can arise when the patient does not follow the clinician’s recommendations. However, the patient might just not adhere to the treatment recommendations if these are not financially, emotionally, and physically feasible and not necessarily because they are stubborn or difficult. Patients often receive specific instructions from their practitioners about how to manage their wounds.

Unfortunately, clinicians fail at times to ask if the recommendations provided align with the patient’s current lifestyle and living situation. What if the patient lives alone and cannot manage the wound, or is the sole caregiver of a family member not having extra time to do so? Or if the patient is working and has to go on medical leave, how will this affect their income and how will the wound medical expenses be covered? Most wound clinicians don’t even ask the patient these questions. Therefore, the clinician should establish a patient-centered wound care plan that aligns with the wants, needs, and personal situation of the patient without sacrificing the best possible outcomes.

Patient-centered care includes the values, needs, and desires of the patients. It is accomplished when the provider includes the patient in their healthcare discussions and decisions.

• Literature has established the following components of patient-centered care: establishing a therapeutic relationship; share responsibility and power with the patient; getting to know the person; empowering that person; trust, respect, and communication.
• When a clinician creates good rapport, patients gain trust allowing an open discussion about their wants, needs, and available treatments. Hence, the best possible outcomes can be achieved. Nevertheless, this can become utopia without a plan and realistic goals. The plan should include patient empowering and compassionate care; sensitivity to patient’s needs; partnership with the patient and other practitioners for interdisciplinary collaboration; effective case management and use of resources.
• Clinicians must never forget that the patient is part of the healthcare team, the most important member to be exact. When the patient is treated as a non-participant and passive member or his/her feelings and expectations are not taken into consideration, the outcomes are impacted. Patient-centered care in wound management can be very challenging. How can a clinician effectively accomplish this goal? The practitioner must have an honest discussion with the patient about what they need, what are the wound treatments available, what are the barriers to compliance, and the feasibility of the interventions proposed, including family support, and financial assistance. This means that the patient must actively participate in the conversation and be encouraged to ask the right questions. The conversation must include education about the etiology of the wound, the healing process, prognosis, types of treatment, the interdisciplinary team, nutrition, mobility, functional limitations, and community resources, especially when the patient cannot afford the best treatment options. This communication improves patient’s adherence to the clinician’s recommendations and health outcomes.
• Besides, the patient’s self-efficacy and accountability also improve.

Effective wound management requires a comprehensive plan incorporating patient-centered care. This will create a good understanding between the patient and the practitioner and strong relationships to ensure success. The best possible outcomes only occur with communication, collaboration, and partnership. The first partner must be the patient.

Dr. Nilma Elias Santiago is a physical therapist certified in wound care, lymphedema, and ostomy management. She is the owner of the Integumentary Physiotherapy Clinic. She can be reached at nelias@integumentarypt.com.

References

1. Constand, M.K., MacDermid, J.C., Dal Bello-Haas, V. et al. Scoping review of patient-centered care approaches in healthcare. BMC Health Serv Res 14, 271 (2014). https://doi.org/10.1186/1472-6963-14-271

2. Sharma T, Bamford M, Dodman D. Person-centred care: an overview of reviews. Contemp Nurse. 2015;51(2–3):107–120.

3. The Eight Principles of Patient-Centered Care. One View website. https://www.oneviewhealthcare.com/the-eight-principles-of-patient-centered-care/.

Updated March 15, 2015. Accessed March 6, 2020.

4. Finney Rutten LJ, Hesse BW, St Sauver JL, et al. Health Self-Efficacy Among Populations with Multiple Chronic Conditions: the Value of Patient-Centered Communication. Adv Ther. 2016;33(8):1440-1451. doi:10.1007/s12325-016-0369-7