t has been my pleasure to act as a guest editor for this special edition of WOUNDS: A Compendium of Clinical Research and Practice. Those who know me personally will be aware that outcomes research, and quality of life (QoL) in particular, has been an interest of mine for a number of years. When I first started my own research in this field, health-related QoL was a relatively new concept still treated with scepticism by many. Occasionally, this is still the case, but increasingly clinicians (who, traditionally, have informally been involved in QoL outcomes for centuries) and researchers are aware of the enormous potential for changing practice that comes with a full assessment of the impact of a condition or intervention on an individual’s life.
|  | | Professor Patricia Price
|
In compiling this edition, we have tried to focus on areas other than leg ulceration. This area has seen the greatest interest in recent years, and good reviews already exist1 for those interested in this topic. We have tried to look at other areas that may be of interest to readers, including QoL in patients with pressure ulceration, which is an area fraught with methodological difficulties. This is an area where the distinction between those with spinal-cord injury and the frail elderly with pressure-related damage may need to be made very clear. For the frail elderly, problems related to self-reporting their QoL become increasingly important—particularly as some countries still find it difficult to grant ethical permission for research to include those who have cognitive difficulties, leaving a section of health provision without a clear framework for when and who should be involved in proxy ratings.
The second article tackles a different group of patients where issues related to palliative care must also be part of QoL decision making, namely those with fungating wounds. This article investigates the translational aspects of research in this area, where the interface between clinical care and maximizing QoL outcomes can make a significant difference in the day-to-day lives of patients. The staff members involved in this research have invested heavily in developing the appropriate methods to measure progress toward achieving negotiated goals of care. The sensitive nature in which the method allows patients to be an integral part of negotiated care encapsulates the caring side of QoL work, while the measurement of progress fits the outcomes research agenda.
We have also tried to include qualitative work in this issue to reflect the personal aspects of QoL an individual may wish to express when experiencing a chronic wound. The study on patients with diabetic foot disease has included an additional interesting angle on QoL by asking podiatrists for their views. In the United Kingdom, podiatrists are increasingly the lead profession in dealing with foot complications, and it is encouraging that researchers are including this perspective within their work. Whenever I have taught courses on QoL for healthcare professionals, they have often commented that researchers are less interested in the impact that this patient group has on their own work-related QoL: perhaps this research will add to our limited knowledge in this area.
We hope this section will encourage individuals to think about QoL from different perspectives. This remains an exciting area for future research; not only does it allow for a range of research designs to be used, it encourages clinicians to think about the assessment of outcomes in its broadest terms while maintaining scientific objectivity. Both the process a patient goes through during an intervention and the resulting health state at the end of treatment can affect a patient’s QoL. Accurately assessing such an impact will allow clinicians to keep patients at the center of clinical decision making in order to demonstrate that care of the highest quality can be provided.
|
