Towards a Reduction in the Burden of Chronic Wounds on Patients and the Health Service

Lead Research Organisation: MRC Health Services Resrch Collaboration

Abstract

Chronic wounds (e.g. leg and foot ulcers) are a common feature of many illnesses. They are a source of considerable discomfort and distress to patients and result in substantial costs to the health service. For example, diabetic foot ulcers are estimated to cost the health service ~~220 million per year. However, to date, little consideration has been given to the role of patient factors (in particular an individuals emotional well-being and/or their behaviours) in influencing an individuals risk of developing an ulcer or how quickly such wounds heal.||Through a series of inter-connected observational studies, the programme is exploring: ||The patient characteristics that influence the risk of ulceration in diabetes.||The role of patient characteristics in the healing of lower extremity wounds (i.e., diabetic foot ulcers and venous leg ulcers).||How communication between patients and health care professionals influences patients behavioural and emotional responses to their condition and their clinical outcomes. ||The data from these studies is intended to inform the development of behavioural interventions to reduce the risk of ulceration and/or improve healing rates in chronic wounds.||

Technical Summary

Chronic wounds (e.g. leg and foot ulcers) are a common feature of many illnesses. They are a source of considerable discomfort and distress to patients and result in substantial costs to the health service. For example, diabetic foot ulcers are estimated to cost the health service ~~220 million per year. ||Through a series of inter-connected observational studies, the programme is exploring:||The psychological and behavioural factors that influence the risk of ulceration in diabetes: The pathophysiological factors that give rise to ulceration are well understood. However, the role of patient factors in influencing ulcer risk has been neglected. Through a series of in-depth interviews with diabetic patients without ulcers (n=18), we have explored patients understanding of the causes of ulceration and the preventative behaviours they engage in. This work has shown that, in general, patient understanding is poor and unrelated to current clinical models of ulcer risk. ||We now propose to undertake a systematic review of the ulcer risk literature to identify gaps in existing knowledge and potential areas for intervention.||The role of psychological and behavioural factors in the healing of lower extremity wounds (i.e., diabetic foot ulcers and venous leg ulcers): Experimental research has suggested that the healing of acute wounds can be significantly delayed by psychological distress. Chronic distress is evident in up to 1/3 of patients with lower extremity wounds. ||In two parallel observational studies we are exploring the role of distress in the healing of venous leg ulcers (n=100) and diabetic foot ulcers (n=100) over a 24 week period; and examining the phsyiological and behavioural mechanisms underlying any relationship between distress and healing.||How communication in the clinical encounter influences patients behavioural and emotional responses to their wounds and their clinical outcomes: Previous research has suggested that communication in the clinical encounter can be important in determining a patients behavioural and emotional responses to their condition, and this may in turn affect their clinical outcome. The management of diabetic foot ulcers, as with other aspects of diabetes care, requires the active engagement of the patient. Thus, in a sub-group of patients in the main observational study (n=30) we are examining the content of the clinical encounter between health care professional and patients on 3 occasions (first visit, 6 and 12 weeks later) and exploring how communciation influences the patients behavioural and emotional responses and their healing rates over 12 weeks.||The data from these studies are intended to inform the development of behavioural interventions to reduce the risk of ulceration and/or improve healing rates in chronic wounds.||

Publications

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Gale L (2008) Patients' perspectives on foot complications in type 2 diabetes: a qualitative study. in The British journal of general practice : the journal of the Royal College of General Practitioners

 
Description Contribution to 2016 NICE guidance on Prevention and management of foot problems in people with diabetes
Geographic Reach National 
Policy Influence Type Participation in a national consultation
URL https://www.nice.org.uk/guidance/NG19
 
Description NIHR Research for Patient Benefit
Amount £250,000 (GBP)
Organisation National Institute for Health Research 
Department Research for Patient Benefit
Sector Public
Country United Kingdom
Start 03/2009 
End 02/2011
 
Description Social Genomics of Wound Healing in Diabetic Foot Ulcers 
Organisation University of California, Los Angeles (UCLA)
Department School of Medicine UCLA
Country United States 
Sector Academic/University 
PI Contribution I have co-authored an RO1 application with colleagues from the above institutions. Outcome will be known in September 2018. I am the health psychology lead on this work bringing expertise on psychological and behavioural influences in chronic wounds. In september 2018 we were invited to revise and resubmit the application. We are awaiting a funding decision.
Collaborator Contribution UCLA: bring expertise in wound healing assessment and social genomics; USC: bring expertise in diabetic foot ulcers
Impact None so far
Start Year 2017
 
Description Social Genomics of Wound Healing in Diabetic Foot Ulcers 
Organisation University of Southern California
Department Keck School of Medicine
Country Unknown 
Sector Academic/University 
PI Contribution I have co-authored an RO1 application with colleagues from the above institutions. Outcome will be known in September 2018. I am the health psychology lead on this work bringing expertise on psychological and behavioural influences in chronic wounds. In september 2018 we were invited to revise and resubmit the application. We are awaiting a funding decision.
Collaborator Contribution UCLA: bring expertise in wound healing assessment and social genomics; USC: bring expertise in diabetic foot ulcers
Impact None so far
Start Year 2017
 
Description All in the Mind (radio 4) 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact I was interviewed for All in the Mind to discuss a recent publication regarding the effects of expressive writing on wound healing
Year(s) Of Engagement Activity 2017
 
Description Invited talk at Diabetes UK and invited paper in Diabetic Medicine 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact I have been invited to contribute to an invited review on the diabetic foot for Diabetic Medicine (to bve published in 2017) and to participate in an invited symposium on the Diabetic Foot at the Diabetes UK meeting in March 2017. My presentation and contribution to the article cover 'Psychological and Behavioural influences on the Diabetic Foot'
Year(s) Of Engagement Activity 2017
 
Description Psychology of Healing 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Type Of Presentation Keynote/Invited Speaker
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact The talk was sold out and resulted in an engaging debate in a Q&A session with members of the public following the presentation.

NONE
Year(s) Of Engagement Activity 2010
 
Description Stress: a question of life or death. Or is it? 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact Keynote at 2017 Psychobiology Conference
Year(s) Of Engagement Activity 2017