Patient experience of scar assessment and the use of scar assessment tools during burns rehabilitation:a qualitative study

Background:Scar assessment plays a key role during burns aftercare,to monitor scar remodelling and patients’psychosocial well-being.To aid assessment,subjective scar assessment scales are available that use health-care professionals’and patients’opinions to score scar characteristics.The subjective scales are more widely used in clinical practice over objective scar measures.To date,there is no research that considers patients’views on scar assessment and the role of subjective and objective assessment tools.Therefore,the aim of this qualitative study was to explore patients’perspectives on scar assessment and the utility of scar assessment tools during burns rehabilitation.Methods:Semi-structured interviews were conducted with 10 adult burn patients who were being reviewed in clinic for scarring.Participants were recruited via their clinical care team and research nurses at the Queen Elizabeth Hospital,Birmingham,UK.Topics covered during interview included patient experience of scar assessment,the use of scar assessment tools and discussion surrounding important factors to be addressed when assessing scars.A thematic analysis using the Framework Method was conducted.Results:Participants identified key subthemes that contribute towards the overarching theme of patient-centred scar assessment.These are:patient-led care;continuity in care;learning how to self-manage scarring;and psychological assessment.Links were demonstrated between these subthemes and the remaining themes that describe scar assessment strategies,indicating their potential patient-centred contributions.The subjective opinions of clinicians were found to be valued above the use of subjective or objective scar assessment tools.Scar assessment scales were perceived to be a beneficial method for self-reflection in relation to psychosocial function-ing.However,minimal feedback and review of completed assessment scales led to uncertainty regarding their purpose.Patients perceived objective tools to be of primary use for health-care professionals,though the measures may aid patients’understanding of scar properties.Conclusions:Scar assessment tools should be used to support,rather than replace,health-care professionals’subjective judgements of scarring.Adapting the way in which clinicians introduce and use scar assessment tools,according to patient needs,can support a patient-centred approach to scar assessment.

Ensuring that the outcome domains proposed for use in burns research are relevant to adult burn patients:a systematic review of qualitative research evidence

Background:There have been several attempts to define core outcome domains for use in research focused on adult burns.Some have been based in expert opinion,whilst others have used primary qualitative research to understand patients’perspectives on outcomes.To date there has not been a systematic review of qualitative research in burns to identify a comprehensive list of patientcentred outcome domains.We therefore conducted a systematic review of qualitative research studies in adult burns.Methods:We searched multiple databases for English-language,peer-reviewed,qualitative research papers.We used search strategies devised using the SPIDER tool for qualitative synthesis.Our review utilized an iterative three-step approach:(1)outcome-focused coding;(2)development of descriptive accounts of outcome-relevant issues;and(3)revisiting studies and the broader theoretical literature in order to frame the review findings.Results:Forty-one articles were included.We categorized papers according to their primary focus.The category with the most papers was adaptation to life following burn injury(n=13).We defined 19 outcome domains across the 41 articles:(1)sense of self;(2)emotional and psychological morbidity;(3)sensory;(4)scarring and scar characteristics;(5)impact on relationships;(6)mobility and range of joint motion;(7)work;(8)activities of daily living and self-care;(9)treatment burden;(10)engagement in activities;(11)wound healing and infection;(12)other physical manifestations;(13)financial impact;(14)impact on spouses and family members;(15)analgesia and side effects;(16)cognitive skills;(17)length of hospital stay;(18)access to healthcare;and(19)speech and communication.We suggest that sense of self is a core concern for patients that,to date,has not been clearly conceptualized in the burns outcome domain literature.Conclusions:This outcome domain framework identifies domains that are not covered in previous attempts to outline core outcome domains for adult burn research.It does so with reference to existing theoretical perspectives from the sociology and psychology of medicine.We propose that this framework can be used as a basis to ensure that outcome assessment is patient-centred.Sense of self requires further consideration as a core outcome domain.