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

Abstract

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 functioning. 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.

Becoming Experts in Their Own Treatment: Child and Caregiver Engagement With Burn Scar Treatments

“…These findings have particular relevance for clinicians, suggesting that education may need to focus on ensuring families understand the importance of continuing to use scar treatments even if ongoing improvements in scar appearance, or the way their scars feel, are difficult to identify. Discussions with clinicians should be encouraged as this may influence decisions to cease scar treatments or aid in determining an alternative treatment option (if children are experiencing adverse events), as the viewpoint of a trusted clinician has been identified as highly valued by patients with burns and chronic diseases (Ljungholm et al, 2022; Price et al, 2021).…”

Effects of low‐dose dexamethasone on inflammatory factors in drainage fluid and wound healing after thyroid surgery during perioperative period

“…The MSS is a multi-item categorical scale, which made global scar assessment with a visual analog scale. 15 The POSAS, developed with the support of the Dutch Burn Foundation, 16 including patients' views on scar assessment, can support patient-centred care 17 and is broadly used in clinical practice. 18 It seems that Colour items of SBSES at 1 month (dexamethasone vs placebo: 0.69 ± 0.47 vs 0.41 ± 0.50, E & F) by a blinded staff 1 week and 1 month after the operation in the outpatient department.…”

“…The MSS is a multi-item categorical scale, which made global scar assessment with a visual analog scale. 15 The POSAS, developed with the support of the Dutch Burn Foundation, 16 including patients' views on scar assessment, can support patient-centred care 17 and is broadly used in clinical practice. 18 It seems that Colour items of SBSES at 1 month (dexamethasone vs placebo: 0.69 ± 0.47 vs 0.41 ± 0.50, R e t r a c t e d P = .024) were better in the dexamethasone group, which may be explained by the intergroup difference of vascularity item in POSAS (dexamethasone vs placebo: 1.97 ± 1.03 vs 2.63 ± 1.31, P = .030 at 1 week; 2.34 ± 1.12 vs 3.06 ± 1.29, P = .021 at 1 month) (Tables 3-5).…”

Towards the Holistic Assessment of Scar Management Interventions

“…Finally, there should be further reflection on the patient-centred use of scar assessment tools in routine clinical practice. Patient-centred scar assessment has been explored via qualitative research in the UK [27]. Whilst this work may not be generalisable to all settings, it provides a framework to understand patient-centred scar assessment during routine follow-up and some simple recommendations for patient-centred practice, such as a clarity of purpose for scar assessment and clear feedback loops to patients.…”