Diabetic foot ulcer is a devastating complication of diabetes mellitus and can significantly impact a person’s quality of life. The lifetime risk of developing a diabetic foot ulcer is between 19% and 34% (Mcdermott et al., 2023).
Patient autonomy is a vital principle in health care, emphasising the right of patients to make informed decisions about their own medical treatment. There are several factors that may hinder a patient’s ability to make informed decisions about their care.
Diabetic foot ulcer research has shown that patients may have a lack of knowledge of the role diabetes plays in the aetiology of a diabetic foot ulcer and patients are either unaware of, or unconcerned about, their risk of diabetes-related foot problems (Zhu et al., 2023). Many patients also felt that they had a lack of control over the risk of developing a diabetic foot ulcer
The impact diabetes has on mental health also needs to be considered. Up to 40% of patients with diabetes can experience psychological problems which can impact their ability to participate in self-management of their diabetes (Garrett and Doherty, 2014).
When we consider patient care, it is often easy to have a traditional health care provider style. This style is often highly directive and demanding on patients to adhere to a list of behaviours. Patients tend to have little input to this “traditional style of care”.
Research has shown that the collaborative approach of shared decision making between clinicians and their patients improves patient autonomy by giving patients more information and greater involvement in their medical care (NICE, 2024).
Research that the author conducted in 2018 (Wilde, 2018) looked at the effectiveness of a behaviour change model to enable a change in behaviour around wound care. The model called COM-B describes the three key factors capable of changing behaviour are capability, motivation and opportunity (Michie et al., 2011).
This model was utilised to develop a new wound care pathway which enabled patients to be actively involved in their wound care. The key themes around shared decision making to improve autonomy were linked to each factor.
Capability needs to be considered, in terms of whether the patient has the physical skills and equipment to be actively involved in their wound care. To enable capability, the patient needs to be given education to increase their knowledge around the wound and the disease process that caused it.
Opportunity is a situation in which it is possible for you to do something that you want to do. In relation to wound care this may be having support from family and/or friends or the use of a leaflet/video which explains how to effectively clean and change a wound dressing. Health Care professionals play a crucial role in promoting patient opportunities and empowering them to take an active role in their own healthcare.
There are several factors that could impact a patient’s motivation. Motivational interviewing is a skill that clinicians can use to enhance patient engagement and facilitate positive behaviour change.
The key elements of motivational interviewing are building rapport, using open-ended questions and affirmations, reflective listening and summarising. The use of motivational interviewing enables healthcare staff to create a supportive environment that empowers patients to take charge of their health (Pennock, 2023).
By implementing the strategies described healthcare providers can foster a sense of autonomy in patients, leading to better management of diabetic foot ulcers and improved overall outcomes.
References
Bu, F., Fancourt, D. How is patient activation related to healthcare service utilisation? Evidence from electronic patient records in England. BMC Health Serv Res 21, 1196 (2021). https://doi.org/10.1186/s12913-021-07115-7
McDermott K, Fang M, Boulton AJM, Selvin E, Hicks CW. Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers. Diabetes Care. 2023 Jan 1;46(1):209-221. doi: 10.2337/dci22-0043. PMID: 36548709; PMCID: PMC9797649.
Michie, S., Van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6(1)
National Institute for Health and Care Excellence, Shared Decision Making, 2024
Pennock S., Revolutionize Nurse-Patient Relationships: Motivational Interviewing for Nurses, 27th December 2023
Wilde, K, Self-management shared care wound care pathway, Wounds UK, June 2018, Vol: 14 | Issue: 03
Wilde K, "Patients' perceptions of self-management of chronic wounds." Wounds UK 16.3 (2020).
Zhu X, Lee ES, Lim PXH, Chen YC, Chan FHF, Griva K. Exploring barriers and enablers of self-management behaviours in patients with diabetic foot ulcers: A qualitative study from the perceptions of patients, caregivers, and healthcare professionals in primary care. Int Wound J. 2023; 20(7): 2764-2779.