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Key messages

• Patients and families living with chronic, complex wounds experience substantial functional and emotional burden, making person-centred care that prioritises continuity and clear communication essential to improve outcomes and care experience.
• The aim was to explore the lived experience of patients and/or family members during treatment and follow-up in specialist wound units, identifying perceived needs, barriers and expectations to inform improvements in continuity and quality of care.
• A qualitative, phenomenological study describing patient and family experience of complex wound care, highlighting that coordination, communication and sustained support are as influential as technical treatment in shaping perceived safety and overall care experience.

Introduction

Chronic wounds are defined as lesions that fail to progress through an orderly and timely sequence of healing phases and show no significant progress towards healing within a period of 4 to 12 weeks despite appropriate treatment.¹ These wounds are characterised by prolonged or persistent inflammation that disrupts the normal tissue repair process, resulting in stalled or non-healing lesions.² The care of chronic, complex, or hard-to-heal wounds represents a growing challenge for health systems due to their substantial clinical burden and their social and economic consequences.³

These wounds significantly impair quality of life, affecting function, autonomy, and emotional wellbeing in those who experience them.⁴ Although advances have been made in diagnosis and treatment, incidence and prevalence continue to rise, driven by population ageing, the increasing burden of chronic disease and socioeconomic determinants.^4,5

In Spain, the overall prevalence of chronic wounds managed in the general population has been estimated at between 0.2% and 1.6%, increasing to around 3% among people aged over 65 years.^5,6 Venous leg ulcers are the most common, followed by pressure injuries, arterial ulcers, and wounds associated with diabetic foot disease.^5-7 In home care and long-term care settings, prevalence may range between 3.5% and 6.5%, with a mean age of approximately 72–77 years and a predominance of women; moreover, over 70% of individuals have relevant comorbidities that influence wound trajectory and resource use.^6,7

This complexity calls for an interdisciplinary, holistic approach that incorporates the patient’s subjective experience. Person-centred care and attention to patient experience are associated with better outcomes and care quality and can help identify barriers and needs that may not be captured by quantitative studies.⁸ In Osakidetza, the Basque Health Service, in Basque Country, Spain, people living with these wounds move between primary care and specialised units for the management of complex wounds, often along prolonged and potentially fragmented care pathways. Understanding their experience is essential to humanise care, promote participation and strengthen continuity of care.⁹ The aim of this study was to explore in depth the lived experience of patients and/or family members during treatment and follow-up in specialised wound units within Osakidetza, identifying perceptions, needs, barriers and expectations to inform improvements in quality and continuity of care.

Materials and methods

This study adopted a qualitative design grounded in interpretative phenomenology, an approach suited to exploring and understanding how individuals construct meaning from their lived experiences within their lifeworld context. Drawing on the hermeneutic tradition of Heidegger and Gadamer, this methodology emphasises the interpretive nature of human experience and recognises that understanding phenomena necessarily involves the researcher’s engagement in a dialogical process of interpretation.

The research team comprised five members experienced in health research. Two of the authors have extensive expertise in qualitative methodology and research design. The remaining team members received formal training in research methodology to ensure consistent and rigorous data collection and analysis. The principal investigator oversaw the study design and analysis, while a designated team member conducted all interviews, ensuring a consistent, sensitive and methodologically sound approach to data collection across all participants.

The study was conducted between May and October 2025 in specialist wound units within Osakidetza. Data were collected through in-depth, semi-structured interviews with patients aged ≥18 years and/or family members or primary informal caregivers with direct experience of the treatment process and active follow-up of chronic wounds. To ensure maximum heterogeneity, a purposeful sampling strategy was employed, considering variables such as wound type, age, sex (maintaining proportionality in line with wound prevalence), geographical area, and the reference care setting (primary care or specialist unit). Participants were recruited during routine consultations, and the interview appointment was agreed upon at that time.

Written informed consent was obtained from all participants prior to each interview and audio/video recording, following a process whereby the investigator reviewed the informed consent document with potential participants, addressed all questions and concerns, and ensured documented understanding before proceeding.

Interviews were conducted face-to-face, in settings of the participant’s choice (either at home or in a healthcare facility), to maximise comfort and authenticity of expression. Interviews lasted between 19 and 55 minutes. All interviews were audio-recorded and, where consent was provided, video-recorded to capture non-verbal dimensions relevant to phenomenological interpretation. Immediately following each interview, the principal investigator completed structured field notes documenting the date, time, location, observable features of the setting, and reflective observations regarding the participant’s demeanour, emotional tone and contextual factors that might inform interpretation. These field notes served to situate the interview within its phenomenological lifeworld context.

Interviews were conducted either individually (with the patient alone) or jointly (with patient and informal caregiver/family member present). The interview topic guide (Table 1) was developed following a literature review and consensus agreement among the research team, covering dimensions related to the care pathway, expectations, perceived barriers, support received and unmet needs.

 

Table 1. Overall thematic framework of the interviews

 

For joint interviews (13 of 36 total interviews), both the patient and caregiver were invited to speak freely about their experiences. During data analysis, particular attention was paid to distinguishing individual perspectives, points of convergence and divergence between patient and caregiver accounts, and the co-constructed nature of some narratives. Where carers’ contributions were substantively distinct or added new dimensions to understanding the care experience, these were analysed as integral to the lived experience of the family unit navigating chronic wound care. The analysis explicitly considered how informal caregiving responsibilities shaped the patient’s experience and, reciprocally, how the patient’s condition affected the caregiver’s wellbeing and participation in the care journey.

Data analysis followed a systematic approach consistent with interpretative phenomenological methodology. All interviews were transcribed verbatim. Analysis proceeded through stages of: (1) repeated, immersive reading of each transcript to develop familiarity with the participant’s account; (2) initial noting of descriptive, linguistic, and conceptual comments to identify preliminary meaning units; (3) independent coding by two researchers to ensure rigour and reflexivity; (4) identification of emergent themes and clustering of meaning units into thematic categories; and (5) iterative refinement of themes through consensus discussion to resolve discrepancies. Throughout analysis, particular attention was directed towards understanding the temporal, relational and embodied dimensions of participants’ lived experience, aspects central to hermeneutic phenomenology. Atlas.ti software was employed to support systematic data management and traceability.

Study quality and credibility were supported through investigator triangulation, theoretical saturation and returning partial findings to some participants (member checking). Reflexivity on the part of the research team (acknowledging the interpretative stance inherent in phenomenological inquiry) was maintained throughout the analytical process to minimise unexamined researcher bias.

The Euskadi Research Ethics Committee approved the project (internal code: PI2025004). The study protocol conformed to the ethical principles of the Declaration of Helsinki (2024).

Results

Data saturation was achieved with 36 interviews (23 individual, 13 joint interviews with patient and informal caregiver). The sample comprised 28 participants (Table 2) ranging from 34 to 84 years (mean age 68 years), with 20 men (71%) and 8 women (29%). The majority (64%) had multimorbidity, predominantly diabetes (39%) and vascular disease (36%). Participants represented diverse wound aetiologies, including venous ulcers (43%), diabetic foot wounds (29%), pressure injuries (18%) and arterial ulcers (10%).

 

Table 2. Characteristics of interviewed participants

 

Analysis of the interviews revealed a coherent set of themes organised into four overarching categories or thematic units, enabling an integrated understanding of the experience of those affected: from their care pathway through to coping strategies and appraisal of the system.

Care pathway

The first dimension to emerge from the analysis relates to the pathway people affected follow within the healthcare system, from the onset of the problem through to wound treatment. This pathway is neither linear nor uniform, and is shaped by multiple clinical, organisational and experiential factors. Across accounts, three broad categories were identified that structure this stage (Table 3).

 

Table 3. Selected verbatim quotes for each category and subcategory of macro-category 1: Care pathway

 

Taken together, these categories help to explain how the care trajectory is configured from the patient’s subjective perspective, revealing critical points, barriers and protective factors within the health system.

Onset of the problem and initial care

Accounts of the start of the care process reflect a varied experience from the first contact with the health system, shaped by how the problem emerged, the initial diagnosis and the response received. Regarding onset, the complex wounds described by participants were linked both to acute events and to processes associated with an already known clinical course:

“The wound started because I got a chafe. It was Easter and it was raining. I took my shoes off, put them on the radiator and went away… on holiday. Then, the next morning I put on some espadrilles and they were damp. And I looked and I had a blister from the shoes” (M27).

Many narratives identified delays in recognising and assessing severity, with initial “benign” or reassuring interpretations that did not match the situation, increasing uncertainty and distress. First contact (usually in primary care) was sometimes described as lacking resolution, due to the absence of clear explanations or attitudes perceived as downplaying symptoms. However, experiences of early attention and support from the outset also emerged, generating reassurance and trust. Overall, timely care, diagnostic clarity and a proactive professional approach were associated with a safer and better-lived start to the process.

“At no point have I seen that they have much experience with varicose ulcers. No, they need to study it more” (F7).

“It itched ... on the side of my foot and I scratched it. I scratched until I could see a little wound forming ... So, I went to my health centre; they dressed it there, but it wouldn’t close” (M18).

Referral and transitions between levels of care

Referral to specialist units and transitions between levels of care were experienced as a critical point in the pathway. Participants described heterogeneous experiences, but with a recurrent pattern of delays, uncertainty and a sense of a “fragmented pathway”, particularly when referral was not early or when the reasons and steps in the process were not clearly explained.

“I understand it’s not their speciality and that this all ends up being referred to specialist units ... But from the doctor and so on, I don’t know whether they’re not trained for this, or ... I don’t know, I can’t say” (F1).

“as soon as she saw the wound was getting a bit out of hand or she couldn’t control it directly, she referred me to the complex wound unit” (F5).

Several accounts identified difficulties in coordination between primary and specialist care, including episodes of insufficient or inconsistent information and lack of continuity in follow-up. These discontinuities generated insecurity and the perception of being left waiting without a clear plan. In contrast, when referral was rapid and the pathway was well defined (with professionals who informed, anticipated timeframes and maintained contact), the experience was described as safer and more reassuring.

“I think that’s where the process fails. Because by the time you end up coming here ... the department is extremely overstretched, and the wound problem is much bigger than it was at the beginning” (M2).

In summary, findings indicate that perceived quality in this segment depends less on referral itself and more on how it is managed: reasonable timelines, understandable communication, pathway traceability and effective coordination between levels.

Clinical treatment and procedures

Upon accessing specialist care, participants described treatment as a demanding process in which their overall perception oscillated between clinical effectiveness and the difficulty of sustaining it over time. Frequent wound care and dressing changes (often prolonged and painful) were experienced as one of the harshest elements of the pathway, both due to physical impact and due to uncertainty and anxiety linked to procedures and wound progression.

“They had to inject the anaesthetic into the wound. I had an awful time, truly awful. It’s a kind of pain that’s inherent to the wound” (M28).

Beyond pain, procedures were perceived as a constant intrusion into daily routine, generating emotional wear and a sense of life being “conditioned” by the care schedule. Clinical complications (such as infections or setbacks) were also reported, intensifying frustration and exhaustion. Even so, several people expressed recognition when they perceived improvement and, especially, when the approach was experienced as personalised and committed.

“There have been times when they’ve closed for a month. Two months. But of course, they’ve closed on one side and opened up on the other” (M19).

Relationship with professionals and the system

The experience of the care process depends not only on clinical procedures, but also on the quality of human relationships and the organisation of the system. This thematic unit, centred on interactions between patients, professionals and healthcare structures, is key to understanding the overall care experience and is organised into three interrelated categories (Table 4). Overall, the relational dimension (interpersonal and institutional) was identified as a central component of perceived quality, influencing understanding of treatment and emotional wellbeing.

 

Table 4. Selected verbatim quotes for each category and subcategory of macro-category 2: Relationship with professionals and the system.

 

Treatment by professionals

How participants were treated was identified as one of the most influential components of the care experience. Participants stressed that kindness, respect and empathy were not “secondary” aspects, but elements that directly shaped how they experienced pain, uncertainty and the overall burden of the process. When they perceived closeness and dignified treatment, trust in the team increased, the sense of safety was reinforced and the course became more bearable, even during difficult phases.

Moreover, the way professionals related to the person (making eye contact, using their name, asking about their situation beyond the wound, validating their distress) was interpreted as a form of recognition that reduced the sense of being “alone” with a prolonged problem. By contrast, attitudes perceived as cold or minimising generated frustration and, in some cases, distrust or a sense of abandonment.

“They looked after me with such care; they treated me perfectly. I mean, they were concerned” (M3).

“She [the nurse] takes it almost into the personal realm, in the way she looks after us all” (M18).

Continuity of the professional was highlighted as key to building a therapeutic relationship. In primary care, frequent staff turnover was associated with having to repeat one’s story, perceived changes in clinical criteria and a sense of weaker follow-up, which fuelled insecurity. Conversely, in specialist units greater team stability was described, facilitating familiarity, trust and a more containing emotional climate.

“I understand it isn’t their speciality and that all this then ... But from the doctor and so on, I don’t know whether they’re not prepared for this” (F1).

Overall, findings suggest that humane treatment and team stability not only improve satisfaction but also support adherence and engagement with treatment by strengthening the therapeutic alliance and the perception of being accompanied.

Information and communication

The quality of information and the way it was communicated throughout the care process represented a key axis in patients’ experience. This category captures views regarding informational clarity and understanding of treatment and progression.

A first aspect emphasised by several people was the need for clear, understandable information, especially at the outset or when treatment changed.

In addition, the manner of communication (beyond content) and the willingness to communicate were perceived as important factors. Patients valued professionals who explained calmly, with empathy and kindness, and who were available to answer questions.

“At all times [in the wound unit] they kept us informed about what ... what they were going to do, and when, and how we were going to see that progress” (M26).

“[In the wound unit] they are the ones who ask me what I want to do; I’m the one who decides what we do” (M17).

Coordination between professionals

Coordination between professionals and care services was identified as another critical factor in the pathway. In early phases, especially in primary care, organisational and internal communication failures (appointments, referrals, information transfer) were described and experienced as sources of insecurity and loss of trust. In some cases, this lack of coordination was perceived as an additional burden, as it forced the person themselves to “act as the link” between professionals.

“There isn’t full connection. But I have seen there are connections when ... when someone is interested, when it is in the patient’s favour” (M17).

“Every day I have a different nurse [at the health centre]” (F8).

After referral to specialist units, experiences of better coordination emerged, with teams sharing information and acting in a more integrated manner. Even so, isolated episodes of discontinuity during transitions (discharge, changes of care level) were reported, generating a sense of abandonment. Overall, findings suggest that pathway traceability and effective communication between levels are decisive for perceived safety and continuity of care.

Impact on the patients’ lives

Beyond clinical dimensions, living with a complex wound entails profound consequences for the daily, emotional and identity-related life of those who go through it. This thematic unit, organised into three categories (Table 5), captures the transformations people experience in their bodies, routines and relationship with themselves, highlighting the biopsychosocial scope of the problem. Overall, it becomes visible that the wound marks the body but also reorganises how people live, feel and narrate themselves, generating needs that extend well beyond the clinical.

 

Table 5. Selected verbatim quotes for each category and subcategory of macro-category 3: Impact on the patient’s life

 

Functional and everyday impact

Living with a complex wound was associated with a marked disruption of daily life. This category brings together experiences related to loss of autonomy, changes in routines and usual activities, and in some cases work-related limitations derived from the process.

For many, the wound significantly reduced mobility, directly affecting day-to-day organisation. Previous routines had to be adapted to the timing of wound care and to physical limitations, generating a sense of confinement and frustration.

“I need help both from my son and from people outside, because I can’t even move a plate” (F8).

“Go to the beach? No! With ulcers you can’t even go to the swimming pool” (M6).

Overall, daily life was reorganised around the wound: timetables, spaces, social relationships and leisure activities became conditioned by clinical progression, with limited capacity to anticipate or plan. Although this impact is not always visible within healthcare settings, it constitutes a structural burden for those living with chronic or prolonged wounds.

Emotional dimension

The experience of a chronic or hard-to-heal wound involved a sustained emotional impact. In interviews, people clearly described frustration, helplessness, fear and exhaustion, especially during phases of stagnation or worsening, alongside processes of gradual adaptation, acceptance and resilience.

Frustration at the absence of visible progress was one of the most recurrent feelings, associated with psychological fatigue when daily effort did not translate into improvement. Sadness and anxiety were also present, linked to the prolonged nature of the problem, functional dependence, pain and uncertainty regarding prognosis.

“I feel unwell ... I get very angry. And, well, I’m now dealing with a bit of depression” (F8).

Despite this impact, several accounts showed progressive acceptance and the capacity to reframe the experience, developing internal coping strategies. Patience and efforts to maintain a positive focus appeared as resources to sustain the process and navigate difficulties.

“I also try to be as independent as possible ... because psychologically I feel better if I do it myself” (F5).

Impact on identity

Beyond functional limitation and emotional impact, living with a complex wound affected sense of identity and how people saw themselves (and were perceived by others). This category captures changes in character, disruption of biographical continuity and a transformation in the relationship with one’s own body, indicating an impact on deep subjective dimensions.

Some people described changes in temperament and in how they related to others, attributed to accumulated discomfort, frustration or isolation. Narratives of irritability emerged, alongside the feeling of “no longer being” who they were before the problem began.

In addition, experiences of biographical rupture were expressed: a break in life continuity in which the wound marks a turning point, establishing a “before” and “after” that reconfigures how people live and think about themselves.

“From never having been in an operating theatre in my life, to, in the last four or five years, not getting out of here” (M7).

Support and coping

Faced with the physical, emotional and social burden of living with a complex wound, people develop different ways of sustaining themselves and managing the situation. This thematic unit, structured into two categories (Table 6), captures sources of support and subjective strategies that come into play in coping with the illness and its impact, making visible both the bonds that provide containment and, above all, personal ways of making sense of and managing the experience. This axis shows that coping is not solely an individual matter, but is configured at the intersection of relational networks, cultural context and personal agency.

 

Table 6. Selected verbatim quotes for each category and subcategory of macro-category 4: Support and coping

 

Support networks

During the illness and treatment process, people described the central importance of support networks in sustaining emotional balance and the logistics of care. This category reflects that coping with a complex wound is constructed in relation to others, and not only through individual experience.

The most frequent and decisive support was from family (especially partners and cohabiting relatives or children) who assumed direct care tasks, accompanied them to appointments and provided emotional containment.

“[I’ve had help] from my parents, at all times” (M26).

In addition, the support of the healthcare team (particularly nursing staff) emerged strongly as a relevant source of emotional support. For many, care in the wound unit functioned as effective affective support: listening, continuity, the manner of care and closeness had a stabilising effect that helped them through moments of vulnerability.

“It’s not a patient–professional relationship, no. She’s my friend now” (M28).

Coping strategies

In addition to external support, interviewees described personal strategies to sustain themselves emotionally during a prolonged and uncertain process. This category captures subjective resources used to make sense of the experience and adapt to its demands.

One of the most reiterated attitudes was patience, understood as a way of moving through a course without immediate solutions and based on care maintained over time. Normalising suffering also appeared frequently, minimising complaints or avoiding constant focus on the wound in order not to feel overwhelmed.

“We’ll take it day-by-day, trust a bit that it will improve and, above all, be patient. Because these are lesions where you don’t see progress daily or straight away. So, well, you must look at it with a bit of perspective and draw on patience, above all” (M26).

“I keep myself going. So, adding the care from the wound unit really helps me; it strengthens me a great deal” (M17).

These strategies do not imply denying pain; rather, they channel it to prevent emotional distress from overwhelming everyday life, and they reflect agency and adaptive capacity in the face of a situation experienced as a limit.

Discussion

This qualitative study has enabled exploration, through the perspectives of patients and/or family members, of the most salient dimensions of their care experience in the context of complex wounds. The thematic analysis identified four main axes (clinical pathway, relationship with professionals and the system, impact on life, and coping strategies), showing that the process is not limited to the technical management of a lesion.

The lived experience of care is also shaped by listening, information-giving, accompaniment and continuity-factors that clearly modulated trust in the system and the emotional wellbeing of those navigating prolonged and uncertain trajectories.

Fragmentation of the care pathway and the need for continuity

One of the most relevant findings is the perceived fragmentation in transitions between primary care and specialist units, with accounts of diagnostic delays, late referrals and failures in inter-level communication. These experiences generated insecurity, confusion and, at times, distrust in the system. This finding aligns with international qualitative evidence: Squitieri et al¹⁰ identified care coordination as a key domain of experience in chronic wounds, alongside the organisation of access and establishment of care, consistent with the emergent categories in our analysis.

Diagnostic delays carry clinical consequences beyond patient experience. Cohort evidence shows median diagnostic delay of 57 days in chronic wounds; wounds diagnosed within 4 weeks show significantly better healing (54.5% at 12 weeks) versus those diagnosed at 4–12 weeks (17.0%) or beyond.^11,12 This emphasises that timely diagnosis is a clinical imperative. Delayed recognition of diabetic foot ulcers and arterial insufficiency increases amputation risk. These findings reinforce the urgency of enhanced wound assessment in primary care, particularly given our participants’ accounts of inadequate initial evaluations.

In this context, continuity of care emerged as an essential organisational and relational element. The presence of specialist units, when they function as a coordinating and reference hub, can reduce clinical variability and improve perceived continuity-particularly when supported by clear referral protocols, streamlined pathways, shared information and named professionals who ensure traceability. Our results support strengthening these structures to reduce the feeling of “going from one place to another” and to lessen the wear associated with a care odyssey.

Alignment with transitional care frameworks

Our findings align with established transitional care frameworks. The Transitional Care Model (TCM) identifies core components for safe transitions: care coordination, provider continuity, timely information transfer and patient education. Our participants reported deficits across these dimensions: coordination failures between primary and specialist care, lack of provider continuity, inadequate information transfer during referrals and insufficient patient education. The TCM emphasises a transitional care coordinator bridging care levels; specialist wound units appear to function as de facto transitional hubs when optimally configured. However, referral often occurs late, after prolonged primary care episodes marked by fragmentation. Integrating TCM principles earlier (through designated wound coordinators and structured communication protocols) could mitigate fragmentation and improve outcomes.^13,14

The relational dimension as a cornerstone of perceived quality

The relationship with professionals (treatment, communication and coordination) was central to the experience. Empathy, respect and team continuity (especially in specialist units) strengthened trust, provided a sense of safety and supported adherence to treatment. These findings converge with the literature linking person-centred care to better outcomes and experiences in chronic wounds.^8,9

A systematic review by Gethin et al⁹ highlighted that person-centred interventions improve satisfaction, knowledge, self-care and quality of life by integrating patients’ perspectives, beliefs and autonomy. In parallel, shared decision-making is associated with lower decisional conflict, improved adherence  and greater empowerment.^15-17

Empathy functions as a clinical mechanism influencing adherence and engagement. Participants explicitly linked empathy to sustained adherence. The evidence shows empathy improves treatment adherence and strengthens therapeutic alliance.^18,19 In chronic wound care, empathy fosters trust, enables disclosure of barriers and sustains engagement.

In our study, informational clarity and willingness to explain calmly (and to answer questions) were particularly valued. On the contrary, the absence of understandable explanations or contradictory information increased frustration and a sense of abandonment. This reinforces the need to systematically incorporate effective communication strategies, health education and patient participation in care plans, with coherent messages across levels.^10,20

Biopsychosocial impact of complex wounds

Accounts confirm that the impact of complex wounds extends beyond the physical, affecting functional, emotional, social and identity-related dimensions: loss of autonomy, reorganisation of routines, psychological fatigue, low mood and changes in self-perception. This multidimensionality has been widely described in the literature, which documents deterioration in quality of life due to pain, limitation, sleep disturbance, anxiety/depression, isolation and loss of roles, as well as economic consequences.^21-23 In the Spanish context, Samaniego-Ruiz et al²⁴ also describe poor associated quality of life, largely related to knowledge deficits and psychological factors, consistent with our findings.²⁴

In addition, the bidirectional relationship between psychosocial status and healing is particularly relevant: depression and anxiety may act as negative predictors of wound progression and, at the same time, be consequences of chronicity, creating a reinforcing feedback loop. Recent evidence supports that psychological factors influence healing directly and indirectly and that depression may precede or result from the lesion.^25-28 Practically, these findings support integrating psychosocial assessment and support into the management of complex wounds, particularly in prolonged trajectories or where pain is intense and complications recur.

Social support and coping strategies

Family support was described as indispensable, both for practical care and emotional containment, and some professionals were experienced as affective support beyond their technical role. The literature supports that isolation and lack of support are associated with poorer quality of life and a greater risk of complications or delayed healing.^23,29 Regarding coping, subjective resources emerged, such as patience, gradual adaptation and normalisation of suffering. These strategies reflect agency and adjustment capacity but also highlight heterogeneity in resilience and the need for professional support to strengthen coping skills when wear exceeds personal resources.²⁷

Professional education

The results underline the relevance of specific training in complex wounds, with perceived differences between the technical expertise available in primary care and in specialist units. The literature suggests that competence deficits at the first level may be associated with suboptimal approaches, delays and patient frustration.^30,31 Nevertheless, our findings also suggest that engagement of primary care professionals, when accompanied by effective coordination with specialist units, improves the overall perception of the service, even in the presence of structural limitations. This reinforces the need to strengthen training and clinical coordination, particularly at the system entry point.

Limitations

This qualitative phenomenological study prioritises depth of understanding over statistical representativeness. Findings are transferable to settings with comparable organisational structures and health systems. The study was conducted exclusively in specialist wound units, providing rich contextualisation of patient experience within this setting; however, findings may not fully represent lower-complexity wounds managed entirely in primary care. The sex distribution (71% male) reflects epidemiological prevalence but may limit gender-specific insights. Finally, transferability to substantially different health systems require careful consideration. Readers in analogous settings with integrated specialist services are well-positioned to assess applicability to their own contexts.

Conclusion

This study supports progress towards a comprehensive model of care that combines clinical competence with continuity, effective communication and sustained support. Incorporating the voices of patients and families not only deepens understanding of the phenomenon but also provides a robust foundation for redesigning practices and care pathways towards a genuinely person-centred approach.

Implications for clinical practice and future research

• Taking patients’ and families’ perspectives into account provides a robust basis for redesigning practices and care pathways towards a person-centred approach.
• Exploring the experiences of patients and their families helps to identify barriers within healthcare delivery.
• It would be valuable to explore experiences in primary care (including fewer complex wounds), examine gender differences in greater depth, and evaluate psychosocial interventions integrated into complex wound management.
• Further development and validation of wound-specific patient-reported experience measures (PREMs), tools capturing patient perspectives on care quality, would enable systematic measurement of patient experience and support continuous improvements.

Acknowledgements

We would like to thank Hospital Santa Marina (Osakidetza) and the complex wound units of the Integrated Healthcare Organisations of Bilbao-Basurto, Ezkerraldea-Enkarterri-Cruces, and Barrualde-Galdakao, and most especially the patients and family members who agreed to share their experiences with us.

Author contributions

SBP conceived, designed and led the study. EMB coordinated the interviews. SBP and EMB conducted the qualitative analysis and drafted the first version of the manuscript. NBG, PIH and MFR contributed to data collection (interviews), produced the interview transcripts, participated in triangulation and critically revised the manuscript. All authors reviewed and approved the final manuscript.

ORCID ID

Sendoa Ballesteros-Peña 0000-0001-5344-6880

Conflict of interest

None declared.

Funding

This work forms part of the ExPacHer research project and was fully funded by the Fenin Foundation.

Author(s)

Sendoa Ballesteros-Peña*^1,2,3, Eztizen Miranda-Bernabé¹, Nerea Bugallo-García⁴, Paula Ibáñez-de Haro⁴, Marta Fernández-Ruiz^4
1Biobizkaia Health Research Institute, Barakaldo, Spain
²Osakidetza Hospital Santa Marina, Bilbao, Spain
³University of the Basque Country, Leioa, Spain
⁴Multiprofessional Teaching Unit for Family and Community Care of Bizkaia, Osakidetza, Bilbao, Spain

*Corresponding author email sendoa.ballesteros@ehu.eus

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