A multicentre qualitative study of patient perceptions and experiences with secondary intention wound healing and skin grafting (PERCEIVE) across the United Kingdom and the Republic of Ireland

Abstract

Background: For skin surgical sites that cannot be closed directly, alternative methods such as secondary intention healing (SIH) and full thickness skin grafting (FTSG) are utilised. Published literature on wound closure methods are primarily focused on objective outcomes such as healing time, cosmesis and postoperative complications. There is a paucity of literature exploring patient experiences with these wound reconstructive modalities.

Objectives: To explore patient experiences of skin surgery with SIH and FTSG.

Methods: This is a multi-centre interview based qualitative study involving 6 sites across the UK and the Republic of Ireland. One-to-one semi-structured interviews were conducted with patients who had an open surgical wound (for SIH) or a FTSG following excision of keratinocyte cancers. Patients were interviewed twice: one within a week post-surgery and another three months later. Audio recordings of interviews were transcribed verbatim and analysed using the six-step thematic analysis method by Braun and Clarke.

Results: 24 patients (19 males and 5 females; 12 SIH and 12 FTSG) with histologically confirmed keratinocyte cancers took part in the first interview. Age ranged 44 to 88 years. There were 22 completed second round interviews. Four key themes emerged: perception of overall quality of care (non-clinical), pre-operative experience, intra-operative experience, and post-operative experience. The first time patients visualised their surgical wound when changing dressing was a critical moment in their journey.

Conclusion: Patient experiences with skin surgery are highly individualised. Addressing their information needs, including those related to ancillary, and involving them in shared decision-making can enhance patient satisfaction.