Department of Surgery, University of California Davis Health, Sacramento, CA, USA.
Center for Health Policy, University of California Davis Health, Sacramento, CA, USA.
Vasc Med. 2021 Apr;26(2):200-206. doi: 10.1177/1358863X20987896. Epub 2021 Feb 19.
Patients with chronic limb-threatening ischemia (CLTI) face numerous barriers to caring for lower extremity wounds. We explored the perceptions of CLTI patients to their wound/management and sought to determine attitudes towards their vascular provider as well as willingness for management through telemedicine. Patients admitted to hospital for treatment of Rutherford Grade 5 and 6 CLTI were asked complete a wound evaluation survey and took part in a semi-structured interview. Semi-structured interviews were recorded, transcribed, and analyzed using an inductive coding strategy. Codes were grouped for thematic analysis and aggregated into assertions. Eleven patients with a mean age of 60 years (35-79 years) were interviewed. All patients had peripheral artery disease (PAD) and eight patients had diabetes as well. Three overarching themes were identified. First, patients appear to have limited coping mechanisms and are overwhelmed by the care of their wounds. Second, in this cohort of patients, many had become passive observers of their care as demonstrated by a limited understanding of their disease processes and detachment from wound management. The third theme was how strong the desire to do everything to prevent limb loss was, but patients acknowledged this is hard to translate into real life with limited resources. Patients with CLTI have concerns that vascular providers must recognize and address to build strong patient-provider relationships and increase activation for management of their wounds and other medical conditions. Patients who have access to technology and with guidance may be able to understand getting care through remote medicine.
患有慢性肢体威胁性缺血 (CLTI) 的患者在护理下肢伤口方面面临诸多障碍。我们探讨了 CLTI 患者对其伤口/管理的看法，并试图确定他们对血管提供者的态度以及通过远程医疗进行管理的意愿。因 Rutherford 分级 5 级和 6 级 CLTI 住院治疗的患者被要求完成伤口评估调查，并参加半结构化访谈。使用归纳编码策略对半结构化访谈进行记录、转录和分析。对代码进行分组进行主题分析，并将其汇总为断言。对 11 名平均年龄为 60 岁（35-79 岁）的患者进行了访谈。所有患者均患有外周动脉疾病 (PAD)，8 名患者还患有糖尿病。确定了三个总体主题。首先，患者似乎应对机制有限，对伤口的护理感到不知所措。其次，在这组患者中，许多人对自己的疾病过程缺乏了解，对伤口管理漠不关心，表现出对自己护理的被动观察。第三个主题是多么强烈地希望尽一切努力防止肢体丧失，但患者承认，由于资源有限，这很难转化为现实生活。CLTI 患者有一些担忧，这些担忧是血管提供者必须认识到并加以解决的，以建立强大的医患关系，并增加对其伤口和其他医疗状况的管理积极性。有机会获得技术并获得指导的患者可能能够理解通过远程医疗获得护理。
