The challenges of managing complex lymphoedema/chronic oedema in the UK and Canada

Abstract

This article explores the professional challenges of treating patients with complex/severe forms of chronic oedema/lymphoedema with compression therapy. Four focus groups were held, two in the UK and two in Canada, to examine the challenges faced by practitioners in their everyday practice. A number of challenges were identified by participants in both countries and include the changing profile of lymphoedema/chronic oedema and how increasing complexity is outpacing the development of services and research-based guidelines. Focus groups also highlighted a lack of public awareness, poor professional knowledge, delayed diagnosis and inappropriate treatment as having a significant impact on practice. Other practice-related issues include a poor understanding of treatment options among practitioners, a lack of evidence-based practice as well as difficulties associated with managing psychosocial problems and of ensuring concordance with treatment. In Canada, services tend to be more rural and remote than in the UK, autonomous specialist practice is less developed and practitioners were generally less confident and felt more vulnerable than their UK colleagues. There is a need for integrated, multi-disciplinary services in both countries, with improved education and training, as well as the development of cost-effective compression bandaging systems that can make a major contribution to meeting the challenges of contemporary lymphoedema practice.

A qualitative national focus group study of the experience of living with lymphoedema and accessing local multiprofessional lymphoedema clinics

“…, Morgan et al . ). The Welsh Government has had devolved responsibility for health care and policy since 1999.…”

Redefining essential care in lymphoedema

“…Another component of essential care is dietary advice, weight management and wellness. Lymphoedema is a chronic condition with associated chronic illness challenges (Hardy, 2006;Morgan et al, 2012), and patients require form a tourniquet around the toes due to movement of bandages causing skin damage, and is often omitted due to the need for daily reapplication, which in turn results in fluid being pushed into the toes (Todd, 2011). The introduction of toe gloves has reduced the risk of tissue damage caused through toe bandaging and has achieved greater concordance from patients as garments are more comfortable and less likely to cause trauma.…”

“…Furthermore, the application of compression to obese limbs with an altered shape obviously proves difficult. It has been reported that up to 75% of patients attending a specific specialist service were obese, demonstrating a need for specialist equipment and a need to increase pressure on budgets (Morgan et al, 2012;Moffatt, 2014).…”

Lower limb chronic edema management program: Perspectives of disengaged patients on challenges, enablers and barriers to program attendance and adherence

“…Chronic edema is a major clinical problem that impacts on an individual’s physical and psychosocial wellbeing [9, 11, 12]. Unmanaged CO predisposes the individuals to leg ulcers/wounds, recurrent cellulitis and possibly hospitalization [3, 11, 13].…”