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To what extent do patients with diabetic foot complications recall diabetic foot self-management education?

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Background
Foot complications in patients with diabetes are a severe burden. Studies show that approximately 25% of all patients with diabetes will develop a foot ulcer during their lifespan and approximately 80% of all major lower limb amputations are preceded by a foot ulcer, typically because of loss of protective sensation and/or peripheral artery disease.
Research has shown that patients who follow the recommended foot care education are less likely to develop foot ulcers than those who do not follow the recommendations. Structured education in preventive foot care is therefore essential for patients with diabetes to be able to self-manage foot care and constitutes an important part of the daily work load of podiatrists. It is therefore crucial for the prevention of foot ulcers that the key messages in the education are heard, understood and remembered by the patients.
Previous studies have shown a low degree of consistency between the instructions podiatrists intend to communicate and the instructions patients remember immediately after the consultation. In one study 58% of patients did not recall the same key message just after the consultation as did their podiatrist (1).
Psychosocial issues can be a barrier to effective communication e.g. if the patient is worried about complications and/or exhausted due to several other consultations on the same day. The communicative skills of the podiatrist also influence the education.
Two conditions challenge the development of the education provided by podiatrists: podiatrists work alone with the patient in the consultation and the outcome of diabetic foot education can be influenced by several diabetes issues, e.g. the amount of severe complications among the patients.
Aims
The aim of this study is to analyse the association between the instructions that podiatrists in the Foot clinic at Steno Diabetes Center Copenhagen (SDCC) communicate in the consultation to patients with or at risk of foot ulcer and the instructions remembered by the patients immediately after the consultations.
Furthermore, the aim is to identify the impact of psychosocial aspects as well as elements in the organization of the consultations on the above associations between podiatrists’ and patients’ recall of key messages.
The study is expected to form a starting point of development of the structured education in the Foot clinic through e.g. training and psychological supervision sessions for the podiatrists.

Methods
Participants
The participants in the study are
• 40 patients with diabetes (type 1 or 2) meeting the inclusion criteria: attending a consultation in the Foot clinic at SDCC from February to April 2019, at risk of having/already having foot ulcers (risk classification (1-3), International Working Group on the Diabetic Foot) and Danish speaking, and
• four podiatrists treating patients and providing specific foot health care education in the Foot clinic.
Design
The data collection includes podiatrists’ notes from consultations in the EPR (electronic patient record), data from 40 audio recorded consultations and data from patient interviews. Immediately after the consultation a psychologist collects written consent from the patient and conducts a semi-structured interview (max 15 minutes) with the patient. The interview will include background data (gender, diabetes type, number of same-day consultations, education, occupation, number of consultations in the foot clinic during the last two years). The main question is: “What information did you get from the podiatrist today regarding the care of your feet? and a PAID-5 questionnaire (Problem Areas in Diabetes Scale - Five-item Short Form).

Planned Analysis
The podiatrist’s written notes, the audio recordings and the interview data will be categorised and coded in ‘key messages about foot care’. The coded responses from podiatrist and patient will be classified as either ‘Full agreement’, ‘Partial agreement’ or ‘No agreement’.
We will also explore the association between the patient’s background data and the consistency between recalled key messages of patient and notes by podiatrist.
Expected outcomes
The study is expected to provide:
a. Insight into the communication in specific foot care education in the Foot clinic, SDCC
b. Knowledge of possible barriers for patients (e.g. SES, PAID, organization of consultations) to obtain effective education for specific foot self-care
c. Data material to develop research based appropriate training for the podiatrists to deliver effective diabetes specific foot health education according to patients’ psychosocial conditions.
Questions
• How do we identify cut points for agreement or non-agreement between key messages provided by podiatrists and the key messages recalled by patients?
• How can the study findings and the audio recordings be used to improve the psychological counselling process of the education in the Foot clinic?
• What will the biggest challenge be in regards to use the results from this study in preparation of a training course in the Foot clinic?
OriginalsprogEngelsk
Publikationsdato25 apr. 2019
Antal sider3
StatusUdgivet - 25 apr. 2019
BegivenhedPSAD Scientific Spring Meeting, Malaga, Spain - Casa Diocesana, Malaga, Spanien
Varighed: 25 apr. 201926 apr. 2019
Konferencens nummer: 24

Konference

KonferencePSAD Scientific Spring Meeting, Malaga, Spain
Nummer24
LokationCasa Diocesana
LandSpanien
ByMalaga
Periode25/04/201926/04/2019

Begivenhed

PSAD Scientific Spring Meeting, Malaga, Spain

25/04/201926/04/2019

Malaga, Spanien

Begivenhed: Konference

ID: 58465527