DS06 A multicentre qualitative study of patient perceptions and experiences with secondary intention wound healing and skin grafting
Authors: Chris Puo Nen Lim, Jenny Caesar, Garret O’Connell, William Hunt, Aldiwani Mohanad, Dushyanth Gnanappiragasam, Mun-Wai Lam, Gregory Parkins, Martin Porter, Rachel Abbott, Michael O’Connell, Thomas Oliphant, Simon Tso, Aaron Wernham
Journal: British Journal of Dermatology (2024)

Abstract Despite the prevalence of skin cancer surgeries, there is a paucity of literature exploring patient experiences in wound healing modalities when primary closure is not viable. Understanding the nuances of patient experiences in skin surgeries with secondary intention healing and skin graft repair is essential to optimize patient care, decision making and safety. A qualitative, multicentre study was conducted across six sites, encompassing all four nations of the UK. Participants were invited to take part in two one-to-one semistructured interviews within 1 week and 3 months post-surgery. The study was registered as a quality improvement project at all participating trusts, and funding was obtained from the British Society for Dermatological Surgery. Two authors independently coded the qualitative data using the inductive process and subsequently compared and identified the main themes. In total 24 participants took part in the first interview, and 22 participants completed the second interview. They comprised 19 male and five female respondents, aged 44–88 years, with various skin cancers: 9 basal cell carcinomas, 13 squamous cell carcinomas, 1 basosquamous carcinoma, and 1 atypical fibroxanthoma. Surgical interventions included 12 skin grafts and 12 cases of secondary intention healing. The study revealed three primary themes: (i) perception of quality of care, (ii) intraoperative experience and (iii) postoperative experience. Patients’ perceptions of care quality were influenced by organizational aspects of the surgery service, including staff communication and environmental factors. Provision of high-quality information about skin surgery, clear expectations and staff introductions was associated with increased preparedness for skin surgery. Participants reported that graphic illustrations of skin surgery wound healing outcomes would facilitate their decision making about the modality for skin surgery site repair. Challenges included long waiting times, parking issues and inadequate Wi-Fi facilities causing anxiety. Subthemes from intraoperative experience included physical environment, staffing, skin surgery and local anaesthetic. There were no notable differences between the intraoperative experiences of participants who underwent skin surgery with secondary intention healing and skin graft repair. Subthemes from postoperative experience included wound dressing, quality of postoperative advice and waiting time for wound healing. Patients valued continuity of care, information about waiting time, provision of high-quality information during consultation, and information reinforced by written materials in skin surgery. Our findings indicate that both secondary intention healing and skin graft repair are acceptable to patients, with specific preferences and concerns identified in each phase of the surgical journey. This study underscores the importance of holistic patient care, emphasizing effective communication, environment optimization and patient education in skin cancer surgery. The findings have implications for clinical decision making and planning of future clinical trials involving skin surgery.