Elliott Daisy
Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS.
BMJ Open. 2017 Nov 26;7(11):e016155. doi: 10.1136/bmjopen-2017-016155.
To develop outcome measures to assess practical management of primary surgical wounds and patient experience.
Mixed methods, including qualitative interviews and data extraction from published randomised controlled trials (RCTs).
Two university-teaching NHS hospitals and three district NHS hospitals in the South West and Midlands regions of England.
Sixty-four patients and 15 healthcare professionals from abdominal general surgical specialities and obstetrics (caesarean section).
Measures were developed according to standard guidelines to identify issues relevant to patients' experiences of surgical wounds and dressings, including analysis of existing RCT outcomes and semi-structured interviews. These were written into provisional questionnaire items for a single outcome measure. Cognitive interviews with patients and healthcare professionals assessed face validity, acceptability and relevance. Findings from interviews were regularly shared with the study team who suggested amendments to modify and reword items to improve understanding before further iterative testing with patients and healthcare professionals.
Analyses of existing RCT outcomes and interviews produced a total of 69 issues. Pretesting and iterative revision established the need for two separate measures. One measure addresses healthcare professionals' experience of wound management in two key areas: exudate and its impact, and allergic reactions to the dressing. The other measure addresses patients' experience of wounds in seven key areas: wound comfort, dressing removal, dressings to protect the wound, impact on daily activities, ease of movement, anxiety about the wound and satisfaction with dressing. Each measure took less than five min to complete and both were understood and acceptable to patients and healthcare professionals.
This in-depth study has developed two measures to assess practical management of primary surgical wounds and patient experience. Further work to test their validity, reliability and application to other settings is now required.
HTA - 12/200/04; Pre-results.
制定结果指标以评估原发性手术伤口的实际管理情况及患者体验。
混合方法，包括定性访谈以及从已发表的随机对照试验（RCT）中提取数据。
英格兰西南部和中部地区的两家大学教学NHS医院及三家地区NHS医院。
64名患者以及15名来自腹部普通外科专业和产科（剖宫产）的医护人员。
根据标准指南制定指标，以确定与患者手术伤口及敷料体验相关的问题，包括对现有RCT结果的分析和半结构化访谈。这些被编写成单一结果指标的临时问卷项目。对患者和医护人员进行认知访谈，以评估表面效度、可接受性和相关性。访谈结果定期与研究团队分享，研究团队建议进行修改，对项目进行修改和重新措辞，以提高理解度，然后再与患者和医护人员进行进一步的迭代测试。
对现有RCT结果的分析和访谈共产生了69个问题。预测试和迭代修订确定需要两个单独的指标。一个指标涉及医护人员在两个关键领域的伤口管理体验：渗出液及其影响，以及对敷料的过敏反应。另一个指标涉及患者在七个关键领域的伤口体验：伤口舒适度、敷料拆除、保护伤口的敷料、对日常活动的影响、活动便利性、对伤口的焦虑以及对敷料的满意度。每个指标完成时间不到五分钟，患者和医护人员都能理解并接受。
这项深入研究制定了两个指标来评估原发性手术伤口的实际管理情况及患者体验。现在需要进一步开展工作来测试它们在其他环境中的效度、信度和适用性。
HTA - 12/200/04；预结果。
