Patients with hard-to-heal wounds: a review and synthesis of their experiences and perceptions of maggot debridement

Abstract

Objective: There is little use of maggot debridement therapy (MDT) worldwide, albeit there is much literature supporting its benefits and effectiveness for hard-to-heal (chronic) wounds. Hard-to-heal wounds are becoming ever more prevalent and MDT can play a pivotal role in wound care management. This underuse can be associated with patients' perceptions and experiences of MDT. The aim of this study was to synthesise available evidence exploring the perceptions and experiences of patients with hard-to-heal wounds regarding MDT.

Method: This was a systematic review of qualitative evidence using thematic synthesis. Published papers and grey literature from inception until December 2021 were identified from PubMed, Embase, Cochrane, CINAHL, PsycINFO, ProQuest Social Science Premium Collection, Academic Search Complete, Web of Science, WorldWideScience.org, MedNar and Scopus. The screening process, assessment of methodological quality, and data extraction were conducted by two independent reviewers. Papers included had qualitative designs, such as phenomenology and descriptive-exploratory. Mixed methods papers and case reports were included for their qualitative components. Eligible papers were appraised using checklists from the Joanna Briggs Institute for qualitative research and case reports. Data were extracted using a standardised form. Findings were synthesised using Thomas and Harden's thematic synthesis approach.

Results: A total of six papers exploring patients' (n=67) perceptions and experiences regarding MDT were included. Some 52 findings were grouped into 11 categories, generating three synthesised findings: the complexity of living with a hard-to-heal wound and seeking help; the effects of interpersonal relationships; and the relationship between the individual and the larvae.

Conclusion: Findings of the review showed that health professionals are key drivers in encouraging patients' acceptance of MDT and enhancing their treatment experiences. Together with a patient-centric approach, patients' concerns can be effectively addressed. Public and patient education can be beneficial to address misconceptions regarding the therapy.

Keywords: biosurgery; chronic wounds; experiences; hard-to-heal; larval therapy; maggot debridement therapy; maggot therapy; patients; perceptions; qualitative; systematic review; wound; wound care; wound dressing; wound healing.