A qualitative study on the patient's narrative in the progression of chronic venous disease into a first venous leg ulcer: a series of events

Abstract

Summary Background A venous leg ulcer (VLU) has a significant negative impact on quality of life. Prevention of a VLU is not yet imbedded in clinical practice because risk factors for developing a first VLU are not well known. Objectives To explore further the progression of chronic venous disease (CVD) into a first VLU from the patient's perspective. Methods A qualitative study using semistructured interviews was conducted among male and female patients with a VLU. Patients from primary and secondary care, under and over 50 years of age, and with first and recurrent VLUs were included. The interviews were transcribed and analysed using a narrative approach to a thematic analysis. Transcripts were organized in chronological order and an iterative process was used to code the transcripts. Results Four key themes and the connections made between them emerged from the 11 narratives on the progression of CVD towards a first VLU: ‘comorbidity’, ‘mobility’, ‘work and lifestyle’ and ‘acknowledgment of CVD’. Comorbidity was linked to reduced mobility and late acknowledgment of CVD. Comorbidity also affected work and lifestyle and vice versa. Work and lifestyle affected mobility and was linked to the acknowledgment of CVD. Conclusions A reduction in mobility as a result of comorbidity and work and lifestyle occurred before the VLU developed. Patients did not recognize symptoms of CVD and did not acknowledge the chronicity of CVD. Healthcare professionals should be aware of reductions in mobility and the knowledge deficit in patients with CVD. What's already known about this topic? Not all patients with chronic venous disease (CVD) develop a venous leg ulcer (VLU). A patient's quality of life decreases significantly when a VLU develops. Risk factors for the development of a first VLU in patients with CVD are not well known, unlike risk factors for other chronic wounds like diabetic foot ulcer and pressure ulcers. What does this study add? The patient's narrative towards the development of a first VLU, a series of events. Insight into the events (comorbidity, mobility, work and lifestyle) that patients themselves link to the development of a VLU. Insight into the patients’ acknowledgment of CVD in the progression of CVD towards a first VLU. What are the clinical implications of this work? More awareness is needed of CVD symptoms among patients and healthcare providers, as well as more awareness for prevention of a VLU in clinical practice. New insights (for further studies) are needed into the concept of mobility and the development of a VLU. Improved patient education and follow‐up are needed for patients with CVD. Linked Comment: Magin. Br J Dermatol 2020; 183:207–208.

Patient Explanation of Adherence and Non-Adherence to Venous Leg Ulcer Treatment: A Qualitative Study

“…The consequences of non-adherence to treatment recommendations include chronicity of VLUs, increased recurrence rate ( Finlayson et al, 2018 ), infection ( Bui et al, 2019 ) and secondary squamous cell carcinoma ( Reich-Schupke et al, 2015 ). Disease progression ( Meulendijks et al, 2020 ) and associated complications exacerbate wound pain ( Leren et al, 2020 ), increase wound exudate, and reduce patients’ mobility, which in turn contributes to disease progression ( Meulendijks et al, 2019 ), leads to premature disability ( Mallick et al, 2020 ), and inadvertently influences patients’ quality of life ( Barnsbee et al, 2019 ). Management of these complications require complex interventions and highlights the need for optimal care for this underestimated condition.…”

Extracorporeal Shockwave Therapy for Chronic Venous Ulcers: A Randomized Controlled Trial

“…Therefore, such ulcers demand specialized care that may challenge patients and medical teams, as a major socioeconomic problem facing health care systems worldwide [2,3]. The management of ulceration is accordingly dependent on the associated causes, and it can include both conservative and surgical options.…”

Experiences of Venous Leg Ulcer persons following an individualised nurse-led education: protocol for a qualitative study using a constructivist grounded theory approach

“…Reasons for non-adherence are multidimensional, 20 including discomfort and pain associated with compression therapy 21 22 or conflicting advises by healthcare professionals, 23 and frequently lead back to misunderstanding the underlying causes of their VLUs 24 25 or the benefits of self-care activities such as walking or resting in an optimal position. 26 Knowledge deficit is a frequent hypotheses for why chronic venous disease develops into a first VLU 27 or a recurrence. 28 Conversely, adherence to compression therapy improves with participants' knowledge level.…”