Do systematic reviews address community healthcare professionals’ wound care uncertainties? Results from evidence mapping in wound care

Abstract

BackgroundComplex wounds such as leg and foot ulcers are common, resource intensive and have negative impacts on patients’ wellbeing. Evidence-based decision-making, substantiated by high quality evidence such as from systematic reviews, is widely advocated for improving patient care and healthcare efficiency. Consequently, we set out to classify and map the extent to which up-to-date systematic reviews containing robust evidence exist for wound care uncertainties prioritised by community-based healthcare professionals.MethodsWe asked healthcare professionals to prioritise uncertainties based on complex wound care decisions, and then classified 28 uncertainties according to the type and level of decision. For each uncertainty, we searched for relevant systematic reviews. Two independent reviewers screened abstracts and full texts of reviews against the following criteria: meeting an a priori definition of a systematic review, sufficiently addressing the uncertainty, published during or after 2012, and identifying high quality research evidence.ResultsThe most common uncertainty type was ‘interventions’ 24/28 (85%); the majority concerned wound level decisions 15/28 (53%) however, service delivery level decisions (10/28) were given highest priority. Overall, we found 162 potentially relevant reviews of which 57 (35%) were not systematic reviews. Of 106 systematic reviews, only 28 were relevant to an uncertainty and 18 of these were published within the preceding five years; none identified high quality research evidence.ConclusionsDespite the growing volume of published primary research, healthcare professionals delivering wound care have important clinical uncertainties which are not addressed by up-to-date systematic reviews containing high certainty evidence. These are high priority topics requiring new research and systematic reviews which are regularly updated. To reduce clinical and research waste, we recommend systematic reviewers and researchers make greater efforts to ensure that research addresses important clinical uncertainties and is of sufficient rigour to inform practice.

Factors associated with complex surgical wounds in breast and abdomen: a case-control observational study

“…Thus, the nursing team should assume responsibility for patients safety, so that its clinical decisions be in line with the best scientific evidence available. However, there are records in the literature of failures in the nursing care process, as evidenced in previous research 10 , 16 - 17 . It is possible to mention the dissatisfaction of patients with complex surgical wounds with the lack of continuity and quality of nursing care in the management of the complex wound, particularly the lack of information about the care to be provided to the wound in post-discharge moments, conflicting pieces of information provided by different healthcare professionals and failure to comply with the frequency of exchange of dressings at home 10 .…”

“…In this context, the management of the treatment of surgical wounds should include the identification of possible critical factors for healing so as to provide individualized care. Nursing performance has an important role in monitoring the evolution of the wound healing process in general, however, previous studies 10 , 16 - 17 have shown flaws and lack of knowledge in clinical practice, impacting the quality of care.…”

Assessment of pain in chronic wounds: A survey of Australian health care practitioners

“…Although pain is considered the fifth vital sign, the literature suggests that there is poor compliance with local pain assessment protocols . There is much uncertainty in wound care, which means decision making can be difficult, contributing to ineffective treatment and patient harm . Uncertainty can affect any health care decision, such as assessment, diagnosis, and management.…”

“…35 There is much uncertainty in wound care, which means decision making can be difficult, contributing to ineffective treatment and patient harm. 36 Uncertainty can affect any health care decision, such as assessment, diagnosis, and management. Results of numerous studies 37 over the past decades provide evidence that many nurses caring for patients in pain lack adequate information about pain management, which can also be applied to other health professionals involved in wound care.…”

Evaluation of the Cochrane Consumers and Communication Group’s systematic review priority-setting project

“…Our priority-setting process, with considerable stakeholder engagement, in particular consumers, and using comprehensive and explicit methods compares favourably against these. With regards to outcome evaluations, Buckley [2] and Christie [7] both assessed the research activity (including systematic reviews) that had arisen subsequent to their stakeholder-derived research priorities. Compared to our evaluation, these would answer just one of the elements (Shifted priorities and/or reallocation of resources) that we report against.…”