Inclusive Dialogue


What good is a treatment if your patient won’t adhere to it?

Some patients may perceive compression therapy or offloading as a MAJOR INCONVENIENCE, as it involves engaging with treatment for a LONG PERIOD OF TIME.1

Low adherence with therapy may results in DELAYED HEALING and poor healing outcomes2.

Healthcare professionnals have an IMPORTANT ROLE to play in explaining :

  • The aetiology,
  • Why the treatment is important
  • Why they should wear compression or offloading continuously
  • Etc

The objective is to enable them to play an ACTIVE ROLE IN THEIR CARE as much as possible.

It’s about moving patients from compliance to CONCORDANCE and, where possible, to promote EMPOWERMENT4

How to improve concordance, and therefore the healing outcome ?

The aim is to treat the person, not just the disease.

The quality of dialogue between the healthcare professional & the patient is key to ensuring that effective treatment is implemented.

The dialogue should also involve the patient’s caregivers, who may play a central role in their care.

It’s about engage in Inclusive Dialogue with the patient, 
their relatives & other clinicians to ensure
full consideration of patient needs and continuity of care

How to implement inclusive dialogue with a patient presenting with a wound?

1/ Ensure that your patient feels part of the choices made through ACTIVE LISTENING

30% of our communication is verbal and 70% is non-verbal.  The goal is, to listen to the person and provide them with empathetic understanding.

There are also five steps that can help to implement active listening, the S.O.L.E.R method4:

Squarely face the person.

Open posture.

Lean towards the person.

Eye contact.


But the key is to adapt to the patient AND to their disease.It is important look at the patient and take into consideration:

  • Physicial abilities
  • Cognitive abilities
  • Psychosocial environment

The key question is what is my patient capable of accepting and doing ?

Example of questions to ask for a leg ulcer patient6:

  • What is the worst thing/most painful about your leg ulcer?
  • Do you have any worries about your treatment plan?
  • Explain to me how is it affecting your life.

2/ Always explain the rationale for the decisions that are made and the role they can play, through PATIENT EDUCATION TOOLS

Have a look at our LEGS GO! and SAVEFEETSAVELIVES programs which aim to promote inclusive dialogue


1- Van Hecke A, Grypdonck M, Defloor T. A review of why patients with leg ulcers do not adhere to treatment. J Clin Nurs. 2009; 18(3):337–49.
2- Nelson EA, Bell-Syer SE. Compression for preventing recurrence of venous ulcers. Cochrane Database Syst Rev 2014; 9: CD002303.
3- Brooks J, Ersser SJ, Lloyd A, Ryan TJ. Nurse-led education sets out to improve patient concordance and prevent recurrence of leg ulcers. J Wound Care. 2004; 13(3),111-116
4- Bianchi J, Flanagan M, King B. 3D: a framework to improve care for patients with leg ulcers. Implementing person-centred diagnosis, evidence-based treatment decisions and inclusive dialogue with the 3D framework. J Wound Care 2020; 29 (11 Suppl a):S1–S66
5- Egan, 1986
6- The principles of holistic wound assessment, November 2015 Nursing Times 111(46):14-16