Evidence for person-centred care in chronic wound care: A systematic review and recommendations for practice

Abstract

Background Chronic wounds affect an estimated 2.21 per 1000 population. They are a significant source of morbidity and affect individuals physically, psychologically, socially and financially. Person-centered care is one approach to improve patient outcomes in wound care as it values patients' perspectives, beliefs and autonomy and considers the person as a whole within the cultural context in which care is provided. Aim We aimed to review the evidence on the use of person-centered care (PCC) in chronic wound care management and provide recommendations for practice and future research. Method Using a systematic review methodology, we searched six databases for full-text papers from 2009–2019 published in peer-reviewed journals with no limits on language. Results Eighteen articles on studies involving 3149 patients from nine countries were identified. Studies were conducted under three broad intervention categories: healthcare professional education (n=1); patient education (n=14) and telemedicine (n=3). Studies were equally focused on prevention and treatment of chronic wounds. Significant improvements were reported in patient knowledge, pain and self-care behaviours. Only two studies evaluated the impact on wound healing and one study estimated the cost of implementing person-centered care. Conclusions The evidence base to support PCC in wound management is developing and based on our review has shown improved outcomes in areas of pressure ulcer prevention, patient satisfaction, patient knowledge and quality of life, but clinical outcomes such as wound healing were less well explored. Further research with more objective outcome measures are required.

Impact of structured educational interventions on the prevention of pressure ulcers in immobile orthopedic patients in India

“…Provision of information booklet, workshops, and lectures were the modes of delivery of intervention used in these studies. [ 17 21 22 ]…”

“…[17–20] Mostly, these studies reported among patients with spinal cord injury or degenerative neurological diseases. [ 21 22 ] The evidence on the effect of educational interventions in reducing PU incidence is also low. [ 23 ]…”

Areas of nursing competence in acute wound care: A focus group study

“…In wound care, autonomy can, for example, mean that the patient can choose what kind of dressings they prefer to use. Holistic wound care and patients' autonomy have also been highlighted in the literature -especially in the context of person-centred care, which aims to improve not only clinical outcomes, such as wound healing, but also the patient's quality of life and level of satisfaction ( Gethin, Probst, Stryja, Christiansen & Price, 2020 ). In practice, the focus is on the patient as a whole, not on the wound in isolation, and staff work with patients to tailor the care to their needs ( Lindsay et al, 2017 ).…”

Health literacy in people with venous leg ulcers: a protocol for scoping review

“…Both general and VLUspecific HL may affect VLU outcomes through affecting patient's adoption of health behaviours. Improvements in general and specific HL may improve patient knowledge and understanding of the benefits of adhering to VLU self-management recommendations [25][26][27] and support patients to adopt healthy behaviours in line with the agreed plan. For example, when choosing compression hosiery, patients may rely on HL to critique the options based on their analysis of comfort 28 which may be opposed to achieving maximum therapeutic benefit.…”

“…The management plan should be developed in collaboration with patients in a standard consultation 1 26 because shared decision making is paramount for a faster healing outcome. 27 An informed patient can participate as an essential partner in the VLU management process. 28 The patient’s role is complementary to their healthcare professional’s role, as they monitor symptoms, adhere to compression and adopt health behaviours, following the advice of health professionals.…”