Empowerment in chronic wound care—exploring the scope for patient contribution†

In this study, we investigated the concept of empowerment in chronic wound care and propose to facilitate patient control by making use of degrees of freedom (DOF): that is, shaping of everyday wound care tasks initiated by patients and based on their wishes, mostly in terms of patients executing treatment steps, requesting or directing health care professionals to undertake changes, or modifications of internal states. As a first step, we conducted a systematic literature search, followed by an inductive form of qualitative content analysis, which resulted in the identification of 5 dimensions as main elements of empowerment: education and shared decision making, adherence to self-care behaviors, responsibility and control, general call for empowerment, and DOF. However, the latter are noticeably absent in the literature. To investigate patients’ freedom in shaping the wound care process, we conducted a second literature search. A number of possibilities for patients to influence the wound care process could be identified, but experimental or clinical evidence about their effects is missing, their variety is limited, and they are only inadequately described. However, DOF should be an indispensable aspect of genuine empowerment, since they allow patients to occupy the role of the agent in the treatment process and give rise to the subjective experience of feeling empowered. Thus, in the third part, we develop a research proposal on how to investigate and include DOF in the clinical practice of wound care. Finally, limitations about implementations are discussed (e.g., patients being reluctant to overcome their passive role, resulting in frustration for health care professionals).