Quality of life and experiences of treatment in chronic leg ulcers.

摘要

Leg ulcers are a chronic wound of the lower leg, prone to high levels of recurrence and associated with poor quality of life (QOL). Whilst a substantial body of literature has investigated the comparative efficacy of various treatments, little research has explored patient’s qualitative experiences of these treatments or their impact on psychological outcomes. This thesis aimed to address this gap in the literature through a systematic review and four empirical studies. Firstly, a systematic review found evidence for a relationship between wound status and QOL in leg ulceration, and revealed that surgical management may be associated with greater improvements in QOL than compression therapy alone. Next, study 1 used a cross-sectional design (n = 159) to explore predictors and mediators of quality of life in individuals with leg ulcers and reinforced this relationship between clinical severity and quality of life, suggesting that negative mood may mediate the relationship between these two elements. Study 2 then employed a longitudinal design (n = 6) to investigate the QOL of individuals undergoing minimally invasive surgical management, observing a significant improvement in emotional elements of disease specific QOL at 6-months post-surgery, but no significant improvements in other aspects of QOL. Study 3 used a qualitative design (n = 11) to explore the experiences of individuals undergoing minimally-invasive surgery,. The results highlighted the importance of finding a sense of hope and empowerment not associated with other treatment approaches, and the importance of beliefs surrounding chronicity. Finally, Study 4 also used a qualitative design (n = 21) to explore patients experiences of non-surgical treatment, finding overwhelming feelings of powerlessness and frustration, whilst stressing the redemptive power of good relationships. Overall, the findings of these studies suggest that patient’s experiences of treatment for leg ulcers can be conceptualised in terms of three key themes: ‘notions of chronicity’, ‘impact of relationships’, and ‘hope and agency’. Transcending these themes is the proposal that leg ulcers and their treatment, whether surgical or not, exist in a dynamic system and that that their treatment should therefore be approached holistically.