Building the knowledge base for patient-centred care: improving the use of qualitative study findings through meta-analysis and systematic reviews

Chronic venous leg ulcer care: Putting the patient at the heart of leg ulcer care Part 2: Development and evaluation of the consultation template

Part 2 in this article series summarises the final two phases of a study which explored the experiences of patients with leg ulcers and the impact of this condition on their quality of life. Early phases of the study revealed a mismatch between issues that affected a patient's quality of life and what they discussed during subsequent health care consultations. In light of this, a nominal group technique was employed to facilitate the development of a new leg ulcer consultation template with patient partners. The aim of this was to include many of the issues raised in phases 1. The new template was evaluated in terms of its utility, significance and clinical potential. The application of this template during routine consultations appears to encourage the patient to disclose issues that are important to them and may have otherwise been overlooked.

Nurse-patient consultations in primary care: do patients disclose their concerns?

OBJECTIVE

To quantify the extent to which patients disclose their concerns to community nurses during wound care consultations.

METHOD

Using an 'observation checklist' based on themes and subthemes that were identified in a previous study of the same patients, 20 wound care consultations were observed. The non-participant observer completed the checklist and made field notes regarding the context and nature of interactions.

RESULTS

Patient participants had 160 opportunities to raise concerns regarding previously-identified pain, exudate and odour, yet they did not do so on 64 (40%) occasions. They had 28, 32 and 84 opportunities to raise emotional, wound care and daily living issues, respectively, and they did not on 16 (56%), 3 (9%) and 32 (38%) occasions. Overall, patients did not raise 38% of their concerns. Of the concerns that were raised, 8% were either not acknowledged or were disregarded by their community nurse.

CONCLUSION

If these data are representative, this has profound implications for person-centred care and shared decision-making models of care, which are predicated on patients articulating their needs. They also have implications for the development of practitioners' communication and consulting skills.

A new quality of life consultation template for patients with venous leg ulceration

OBJECTIVE

Chronic venous leg ulcers (CVLUs) are common and recurrent, however, care for patients predominantly has a focus which overlooks the impact of the condition on quality of life. The aim of this study was to develop a simple, evidence-based consultation template, with patients and practitioners, which focuses consultations on quality of life themes.

METHOD

A nominal group was undertaken to develop a new consultation template for patients with CVLUs based on the findings of earlier qualitative study phases.

RESULTS

A user-friendly two-sided A4 template was designed to focus nurse-patient consultations on the quality of life challenges posed by CVLUs.

CONCLUSION

CVLUs impact negatively on the quality of life of the patient but this receives inadequate attention during current consultations. This new template will help to ensure that key concerns are effectively raised, explored and addressed during each consultation.

DECLARATION OF INTEREST

The NHS West Midlands Strategic Health Authority funded this study. The authors have no conflicts of interest to declare.

A meta-synthesis of women's symptoms experience and breast cancer

The aim of this paper is to examine the symptom experience of women with breast cancer using meta-synthesis. Women with breast cancer may experience many symptoms resulting from the primary disease and/or treatment of the disease. It is very important the overall symptom experience from the patients' perspective is captured and understood by health professionals. The question developed was 'What is the symptom experience of women with breast cancer from time of diagnosis to completion of treatment'. The meta-synthesis process as developed by Sandelowski and Barroso was used to collect and analyse the data. The overarching idea emerging from this meta-synthesis is that the symptoms experience for women with breast cancer has effects on the very 'self' of the individual. Emerging is women's need to consider the existential issues that they face while simultaneously dealing with a multitude of physical and psychological symptoms. This meta-synthesis develops a new, integrated, and more complete interpretation of findings on the symptom experience of women with breast cancer. The results offer the clinician a greater understanding in depth and breadth than the findings from individual studies on symptom experiences.