{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T10:45:38Z","timestamp":1785149138187,"version":"3.55.0"},"reference-count":34,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T00:00:00Z","timestamp":1770508800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T00:00:00Z","timestamp":1770508800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Fonden","doi-asserted-by":"publisher","award":["NNF18OC0051995 in the call \u2018Postdoc Fellowships in Nursing Research\u2019"],"award-info":[{"award-number":["NNF18OC0051995 in the call \u2018Postdoc Fellowships in Nursing Research\u2019"]}],"id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Scandinavian Caring Sciences"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To explore how nurses communicate with patients at risk of amputation due to chronic leg wounds, with a specific focus on discussions regarding amputation and death and to explore the perceived barriers that nurses face when engaging in conversations about prognosis, treatment options and end\u2010of\u2010life care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An exploratory qualitative design was employed, utilising non\u2010participant observations and focus group interviews conducted in specialist wound clinics across four hospitals in Denmark. The observations included 85 consultations involving 84 patients with chronic leg wounds, and four focus group interviews were conducted with 13 registered nurses. Data analysis followed a qualitative content analysis procedure and is reported according to the COREQ guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>The study revealed that the primary goal of nurses is to achieve wound healing, which often overshadows the need for discussions about amputation and death. Five key themes emerged: \u2018Professional responsibility shaped by emotional involvement\u2019; \u2018Meeting patients with honesty rather than compassion\u2019; \u2018Avoiding conversations about amputation and death\u2019; \u2018Timing dilemmas in conversations about amputation and death\u2019; and \u2018Biomedical confidence and psychosocial uncertainty\u2019. Nurses expressed a desire for deeper conversations but felt constrained by institutional practices and personal beliefs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study highlights the critical need for a systematic approach to communication about amputation and end\u2010of\u2010life care in chronic wound management. By identifying barriers and emphasising the importance of holistic, patient\u2010centred care, the findings contribute to the ongoing discourse on improving palliative care practices for patients with chronic wounds. The insights gained can inform training and guidelines to enhance nurses' competencies and foster more open discussions about difficult topics, ultimately improving patient outcomes and quality of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Recommendations for Clinical Practice<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Several barriers hinder nurses from discussing amputation and death with patients, including perceived incompetence, time constraints, lack of systematic approaches, unclear roles among healthcare professionals, and personal beliefs.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>The strong emphasis on achieving wound healing can overshadow the need for compassionate discussions about potential amputation, the broader implications of living with chronic wounds, and the risk of dying.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Nurses often prioritise the practical tasks around wound healing over holistic patient care, which can lead to neglecting important conversations about prognosis and end\u2010of\u2010life care.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/scs.70198","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T07:46:53Z","timestamp":1770623213000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["How Nurses Communicate About Amputation and Death in Specialised Outpatient Wound Clinics\u2014A Qualitative Study"],"prefix":"10.1111","volume":"40","author":[{"given":"Emma Sandberg","family":"Nautrup","sequence":"first","affiliation":[{"name":"University of Southern Denmark  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristoffer","family":"Marsaa","sequence":"additional","affiliation":[{"name":"Steno Diabetes Centre Copenhagen  Herlev Graested Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi","family":"Bergenholtz","sequence":"additional","affiliation":[{"name":"Zealand University Hospital, Research Support Unit &amp; REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and Department of Clinical Research University of Southern Denmark  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9436-6887","authenticated-orcid":false,"given":"Ulla Riis","family":"Madsen","sequence":"additional","affiliation":[{"name":"Vascular Surgery Department, Zealand University Hospital, Roskilde; Orthopaedic Department, Holbaek Hospital &amp; REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital &amp; Department of Clinical Research University of Southern Denmark  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,8]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1056-8727(00)00133-1"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1471-6712.2001.00018.x"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.115.002938"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.13607"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.70128"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19063195"},{"key":"e_1_2_15_8_1","unstructured":"WHO \u201cDefinition of Palliative Care \u201d(2023) https:\/\/www.who.int\/europe\/news\u2010room\/fact\u2010sheets\/item\/palliative\u2010care."},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.21037\/apm-24-57"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/NJH.0000000000000821"},{"key":"e_1_2_15_11_1","doi-asserted-by":"publisher","DOI":"10.21037\/apm-23-138"},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2013.22.10.534"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/17482631.2021.2009202"},{"issue":"1","key":"e_1_2_15_14_1","first-page":"85","article-title":"Wound Healing\u2010a Practical Algorithm","volume":"28","author":"Jeffcoate W. 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