Abstract

Critical examination of  skin care self‑management  in lymphoedema

Aimee Jones, Mary Woods, Katharine Malhotra. Chronic Oedema  October 2019

Lymphoedema is a long‑term chronic condition that results from lymphatic insufficiency and may cause skin changes, which can cause discomfort and impact patients’ quality of life. The four cornerstones of lymphoedema management are exercise, lymphatic massage, compression and skin care. This article critically examines self‑management in lymphoedema focusing on skin care. Patients may initially demonstrate enthusiasm to undertake the required skin care independently. However, psychosocial factors, such as financial burden and physical restraints, can affect motivation and behaviours over time. A patient’s knowledge of the importance of skin care self‑management should not be limited to the initial assessment, but should be continually assessed throughout their lymphoedema journey. The ongoing provision of patient‑centred care may have psychological and behavioural benefits and help optimise skin care self‑management.

Main findings

• Without sustained lymphoedema management, lymphatic insufficiency can result in skin changes, such as thickening, hyperkeratosis, papilomatosis and deepening of the skin folds; these changes potentially cause the patient discomfort and impact on their quality of life, interests and lose motivation to engage in it (Bullock, 2016).
• Patients are often expected to become experts in their condition following a single teaching session.
• Information provision alone is not sufficient to motivate behaviour change and support self-management.
• The ongoing assessment of a patient’s preferred method/style of learning (throughout the patient journey) would allow for the provision of targeted educational interventions, for example, written information sheets/leaflets, online resources and groups.
• Ongoing holistic lymphoedema assessment is required to deliver truly patient-centred care. Ongoing assessment throughout the patient journey will allow understanding of the psychosocial factors that may affect patients’ motivation and enthusiasm to undertake successful skin care self-management in lymphoedema.
• Patients should be encouraged to be active participants in their lymphoedema journey, being given the time and opportunity to share their concerns and experiences of skin care self-management.
• Further, the ongoing assessment of a patient’s method/style of learning would allow for patient-centred educational interventions that are tailored to patient need. Working in partnership with patients during the assessment process not only has the potential to enhance the quality of life for the patient living with lymphoedema, but also reduce potentially costly dependence on primary and secondary health providers in the future.