Are Caregivers Able to Estimate How Patients Judge Their Scars?

Eskes, Anne M.

Tuesday, 31 July 2012: 3:30 PM

Anne M. Eskes, MSc, RN
Department of Quality Assurance & Process Innovation, Academic Medical Center, University of Amsterdam and Amsterdam School of Health Professions, Amsterdam, Netherlands
Fleur E. Brölmann, MD
Department of Quality Assurance & Process Innovation, Academic Medical Center at the University of Amsterdam, Amsterdam, Netherlands
Dirk T. Ubbink, MD, PhD
Departments of Quality Assurance & Process Innovation and Surgery, Academic Medical Center at the University of Amsterdam, Amsterdam, Netherlands
Hester Vermeulen, RN, PhD
Department of Quality Assurance & Process Innovation, Academic Medical Center, and Amsterdam School of Health Professions, University of Amsterdam, Amsterdam, Netherlands

Learning Objective 1: The learner will be able to explain that their caregivers' view is not necessarily in line with the patients’ view.

Learning Objective 2: The learner will be able to get insight in the need of incorporating the patient’s values and opinions in the clinical decision-making process.

Background

Nowadays, incorporating patient values and opinions in the decision-making process has become a standard in delivering high-quality care. However, caregivers tend to use their own opinion regarding the pros and cons of a treatment as a proxy for the patient’s opinion. We investigated the agreement in judgment between caregivers and patients regarding donor site scars (DSS) after split-skin grafting. Furthermore, we investigated which scar characteristics best predict the patients’ overall satisfaction.

Methods

Patients with a DSS after split-skin grafting for any indication were included. Twelve weeks after complete wound healing, patients and their caregivers rated the DSS in vivo during outpatient visits using the validated Patient and Observer Scar Assessment Scale (POSAS), comprising seven wound characteristics. The caregivers’ assessment was not revealed before the patients completed their scores. Inter-observer agreement (IOA) was expressed as intra-class correlation coefficients (ICC). POSAS items that best predicted the patients’ overall satisfaction were calculated using multivariable regression analysis.

Results

A total of 106 patients with a DSS were included. Most of the DSSs were located on the thigh (n=102; 96%). Ten caregivers from four different medical centers judged the DSSs. IOA regarding the overall opinion of the DSS was ‘moderate’ at best (ICC 0.44; 95% confidence interval 0.27 to 0.58). IOAs regarding the other POSAS-items were ‘poor’. Itching and color best predicted the patients’ overall satisfaction. For caregivers, vascularity, pigmentation, relief, and pliability were most predictive for their overall judgment.

Conclusion

Patients and caregivers show poor agreement in their appreciation of the donor site scar using the POSAS. This hampers shared decision-making, in which the patient's opinion is incorporated in treatment choice. Caregivers should realize their view may differ from their patients’ view, because treatment decisions should match the needs and preferences of the patient.

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