Collaboration and Partnership in a 5-Level Engagement Framework for Diabetic Foot Ulcer Management: A Patient-oriented Scoping Review

The management of diabetic foot ulcers (DFUs) is complex, and patient engagement is essential for DFU healing, but it often comes down to the patient's consultation. Therefore, we sought to document patients’ engagement in terms of collaboration and partnership for DFUs in 5 levels (direct care, organizational, policy level, research, and education), as well as strategies for patient engagement using an adapted engagement framework. We conducted a scoping review of the literature from inception to April 2022 using the Joanna Briggs Institute method and a patient-oriented approach. We also consulted DFU stakeholders to obtain feedback on the findings. The data were extracted using PROGRESS+ factors for an equity lens. The effects of engagement were described using Bodenheimer’s quadruple aims for value-based care. Of 4,211 potentially eligible records, 15 studies met our eligibility criteria, including 214 patients involved in engagement initiatives. Most studies were recent (9 of 15 since 2020) and involved patient engagement at the level of direct medical care level (8 of 15). Self-management (7 of 15) was the principal way to clinically engage the patients. None of the studies sought to define the direct influence of patient engagement on health outcomes. Very few studies described patients’ characteristics. Engaged patients were typically men from high-income countries, in their 50s, with poorly controlled type 2 diabetes. We found little rigourous research of patient engagement at all levels for DFUs. There is an urgent need to improve the reporting of research in this area and to engage a diversity of patients. La prise en charge des ulcères du pied diabétique (UPD) est complexe, et la participation des patients est essentielle à la cicatrisation de l’UPD, mais elle se limite souvent à la consultation du patient. Par conséquent, nous avons cherché à décrire la participation des patients atteints d’UPD en matière de collaboration et de partenariat à cinq niveaux (soins directs, organisationnel, de l’élaboration des politiques, de la recherche et de l’éducation), et les stratégies de participation des patients à l’aide d’un cadre adapté de participation. Nous avons mené une revue exploratoire de la littérature de sa création à avril 2022 en utilisant la méthode proposée par l’Institut Joanna Briggs et une approche axée sur le patient. Nous avons aussi consulté les intervenants en UPD pour obtenir des commentaires sur les résultats. Les données ont été e