A qualitative study of the experience of lower extremity wounds and amputations among people with diabetes in Philadelphia
A qualitative study of the experience of lower extremity wounds and amputations among people with diabetes in Philadelphia
复制标题
DOI：
10.1111/wrr.12593
复制
发表时间：
2017-09-01
影响因子：
2.9
通讯作者：
Margolis, David J.
中科院分区：
文献类型：
--
作者：
Barg, Frances K.;Cronholm, Peter F.;Margolis, David J.
本研究的目的是探讨2型糖尿病患者对足部溃疡和下肢截肢的看法。这是一项定性观察性研究，采用开放式半结构化访谈，有目的地选择39名糖尿病患者，因为他们患有足部溃疡（n=19）或下肢截肢（n=20）。对访谈进行录音、去识别，并输入NVivo 10.0进行编码和分析。我们的综合分析方法结合了应用于所有成绩单的归纳和演绎衍生代码。总结编码数据并检查模式。参与者对糖尿病与足部溃疡或截肢之间关系的描述揭示了对疾病过程的有限理解。无论该人是否患有足部溃疡或截肢，都表示中断和丧失独立性。大多数人认为足部溃疡的治疗建议非常困难。截肢是一个可怕的结果，但有些人学会了适应，有时觉得截肢提高了他们的生活质量。临床医生认为，重点保肢优于大截肢。然而，由于护理的复杂性，需要频繁的医疗保健提供者访问，护理失败的频率，复发的频率，以及与足部溃疡相关的死亡率，临床医生优先考虑生活质量挽救可能更合适。足部溃疡治疗失败可能是由于提供者缺乏对治疗对患者生活影响的理解。
The purpose of this study was to explore perceptions among people with type 2 diabetes about foot ulcers and lower extremity amputations. This was a qualitative observational study utilizing open-ended, semistructured interviews of 39 people with diabetes who were purposively selected because they had either a foot ulcer (n=19) or a lower extremity amputation (n=20). Interviews were audio-recorded, deidentified, and entered into NVivo 10.0 for coding and analysis. Our integrated analytic approach combined inductively and deductively derived codes that were applied to all transcripts. Coded data were summarized and examined for patterns. Participants' description of the relationship between diabetes and their foot ulcer or amputation revealed a limited understanding of the disease process. Disruption and loss of independence was expressed whether the person had a foot ulcer or an amputation. Treatment recommendations for foot ulcers were viewed by most as extremely difficult. Amputation was a feared outcome, but some learned to adapt and, at times felt that the amputation enhanced their quality of life. Clinicians have assumed that a focus on limb salvage is preferred over a major amputation. However, because of the complexity of care requiring frequent healthcare provider visits, the frequency of care failure, the frequency of recurrence, and mortality associated with having had a foot ulcer, it may be more appropriate for clinicians to prioritize quality-of-life salvage. Foot ulcer treatment failure may be due to a lack of providers' understanding of the impact of treatment on a patient's life.