The importance of relationships in patient experiences of leg ulcer treatment

Abstract

Background: Leg ulcers are a chronic wound of the lower leg, known to have a profound effect on patient quality of life. Whilst the comparative effectiveness of treatment modalities is often investigated, no previous research has explored the patient experience of different treatments for chronic leg ulceration. This study aimed to investigate patient experiences of both conservative and surgical treatment for leg ulcers. Methods: Semi-structured interviews were conducted with thirty-two participants who had undergone conservative or surgical treatment for chronic leg ulceration. Interviews were transcribed verbatim and analysed using Thematic Analysis. Findings: Four primary themes were identified: ‘uncertainty’, ‘chronology’, ‘agency’ and ‘adjustment’, transcended by an overarching theme of ‘relationships’. Participants discussed significant uncertainty regarding their condition, their treatment expectations and their experiences. They demonstrated varying perceptions of chronicity, and this often appeared to change through the course of treatment. Many undergoing conservative treatment described feelings of powerlessness and resignation, whilst the process of surgical treatment appeared to trigger a sense of empowerment. Overarching all of these findings was the importance of patient-clinician relationships in treatment, and the potential for these to fundamentally change the patient experience. Discussion: These results demonstrate how relationships are an integral part of the treatment process, having the power to damage or redeem patient’s experiences. This key role of relationships is discussed in the context of patient-centred care and related disciplines, including therapeutic alliance and learner-centred education. The findings have implications for clinical guidelines and integrated care.