Editorial Message: Compliance Revisited

I think there are few things more frustrating in wound care than patients with whom we have spent time determining the cause of their ulcer, carefully explaining what the best evidence-based treatment for that problem would be, answering any questions that might be asked, and applying the treatment only to find out at the follow-up visit that the patient took off the bandage before it had a chance to do any good. I wonder why patients ask for our help and opinions if they are not going to give our treatments a chance. Does that bother you? When I’ve asked patients about this, I’ve received many different feeble excuses: “The bandage just didn’t feel right on my leg”; “The bandage was too hot”; “The bandage was too tight”; “The bandage did not look good with my dress clothes”; “I couldn’t wear my high-heel shoes with the bandage on my foot”; “The bandage got wet when I took a shower”; “The bandage smelled bad”; and the list goes on and on. 

The unfortunate truth of the matter is that patients do not like to wear bandages. As I sit here at my keyboard with my index finger bandaged after being attacked by something in my briefcase this afternoon, I can understand the problem. Typing is a challenge with a bandaged finger, but I tolerate it because I know it will help heal my wound. In one study of patients and compression bandages,¹ Miller et al found that only 51.6% of the study patients admitted they did not use their compression bandages. On closer questioning, it was determined that 80% of the patients did not wear their bandages. This large number does not surprise me. At our wound care center, we have often looked out the front window and seen a patient sitting in their car trying to put a compression bandage back on his/her leg before coming in for his/her appointment! When confronted about this, the patient will assure the nurse that the bandage is exactly the way it was put on at the previous visit. The nurse usually responds that it’s interesting because it appears the leg was wrapped by someone left handed, and neither she nor any of the other nurses in our center is left handed!

The previously mentioned study¹ found 4 main reasons associated with patients not wearing their bandages. The first was age; I guess the older one gets, the less one tolerates inconveniences even though it is for their benefit. The second reason was pain associated with the bandage. I certainly would not argue with removing a painful bandage, but when these patients are questioned closely, their definition of “pain” had nothing to do with hurting. I guess the bandages were just a “pain” to wear. The last 2 reasons patients removed bandages had to do with wound size and wound depth. The larger and deeper the ulcer, the more likely the patient was not to wear the bandage. One would think patients with worse ulcers would be more likely to wear their bandages.  

No matter the reasons behind patients not wearing their bandages, it should be obvious that they will not get the benefit of the treatment, and their ulcers will be less likely to improve. In this day when the practitioner is being held responsible for ulcer healing, it can be especially troubling. How can you and I be held responsible for our treatments if the patients do not utilize them? How can someone say, as in this case, that compression therapy is not effective in treating venous ulcers when 80% of the patients don’t wear the compression bandages? There are many other examples we could add here. Something has to be done so that the patient shares in the responsibility of his/her healing.  The least they can do is wear their bandages!