Exploring Patient and Podiatrist Perspectives of the 'In-Remission' Status in Diabetes-Related Foot Disease

The term 'in-remission' has been historically associated with the disease status in cancer. In diabetes foot care, the term was introduced into risk stratification systems in order to support patient communication and healthcare prevention strategies post-ulceration. However, despite the inclusion of an 'in-remission' category into risk stratification systems, the adoption and perception of the terminology in clinical practice remains unknown. The aim of this study is to explore patient and clinician perceptions of the term 'in-remission' in the context of diabetes foot disease management.

Semi-structured focus groups or interviews were conducted to identify the perceptions and impact of the term 'in-remission' on end users. Participants included patients classified as 'in-remission' as well as podiatrists who routinely work with people who have diabetes. Recruitment occurred via social media adverts, posters and snowball sampling. All focus groups and interviews were recorded and transcribed verbatim. Data were analysed for themes.

The study included n = 9 people with diabetes classified as in-remission and n = 12 podiatrists. One online focus group was held with n = 5 podiatrists, whereas individual telephone interviews were conducted with the remaining n = 7 podiatrists and all n = 9 participants with diabetes. Three overarching themes were identified with several sub-themes in each group. Perceptions and implementation of the term 'in-remission' were highly variable whereby podiatrists tend to avoid using the term directly with patients and instead focus on patient education and held mixed views of the impact on patients. People with diabetes were largely unaware of their 'in-remission' status and had varied opinions on what 'in-remission' means and how it may impact on foot care.

Awareness and implementation of the term 'in-remission' into podiatry practice are inconsistent. Despite the intention of the term to increase patient awareness and access to services, themes were identified regarding applicability and suitability resulting in avoidance by clinicians and confusion and fear from people with diabetes. These findings suggest that the term is not having the intended effect and further work is required to more fully explore the adoption of this terminology.