Page 113 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Introduction 87

interventions; indeed their inclusion as an outcome measure
in randomised control trials (RCT) has become standard
practice (Fayers and Machin 2007 ). This is in part a response
to the recognition that whilst advances in medical science
have enabled us to increase longevity, this is often at a cost.
For example, many chronic wounds result from other long
term conditions such as diabetes, vascular disease, obesity or
spinal cord injury, as well as being a corollary of an aging
population (Sen et al. 2009 ). Treatments may be aggressive,
causing as much pain and distress as the illness itself.
Furthermore, despite medical advancement it is not always
possible to cure. Thus in palliative care, QoL is not just an
outcome, but also an endpoint measure. In both cases,
patient choice becomes a vital part of the clinical decision
making process (Shukla et al. 2008 ). Wounds have variable,
and often protracted healing rates, which can lead to a
wound becoming chronic even when optimum care is being
provided. Clinicians may therefore need to acknowledge
early on in the care process that for some patients, whilst
healing may be the main intended outcome in the longer
term, it may not be the priority of care. Incorporating a mea-
sure of QoL and well-being within a care pathway, shifts the
focus from the wound and physical outcomes such as heal-
ing, to the whole person, with the aim of making living with
a wound the best it can be.
Despite the ubiquitous nature of QoL assessment in
recent years, and the assimilation of terms such as well-being
into common parlance, a lack of consensus remains in both
academic and clinical settings, regarding the definitions of
QoL and well-being. This has led in turn to the development
of a range of models and approaches to assessing QoL and
well-being. Consequently, negotiating this field can be bewil-
dering to the uninitiated. The aim of this chapter is therefore
to provide a clear summary of the dominant theories and
measurement approaches in the field, before providing guid-
ance to the application of this theory and measurement in
practice, and the possible value for both clinicians and
patients with wounds (See Box 4.1).