Page 67 - APPENDIX B: Trials Investigating the Management of Acute Radiation-Induced Skin Reactions Reading Qualitative Research

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WOUND CARE

provided for always removing dressings prior to radiation treatment are, “except when dressing is

used as a bolus”; “bolus effect however if dressing quite small they treat through it”; “done on

treatment unit - sometimes left on with palliative patients” and “we need to assess the stage of

the wound”. Therefore, the reasons for removal of dressings prior to radiotherapy were the

purpose of the treatment and or clinical assessment of both the wound and dressing condition.

This is an important and expected result, based on the literature review and practice at the local

Radiation Oncology Centre, where I am working.

The conditions when wound dressings are left in place are explained in the open text

responses as “depends on radiation therapists preference and if dressing will interfere with

treatment”; “depends upon the treatment plan and the oncologist”; “ removed when bolus is

possible”; “if dressing too bulky that it may interfere with treatment”; “tangential beams; if the

dressing is lifting; thickness or concerns related to bolus dosing” and “depending on the type of

energy used for radiation---some dressings can be maintained”. One of the interview

participants informed:

It would be the physician who decides about removing the dressing but honestly I have
been here 16 years, I can’t even think of maybe five times that we haven’t removed the
dressings, we always remove the dressing. (P#1)

Based on patient preference or prognostic factors, it was reported that dressings are sometimes

left on with palliative patients. One of the telephone interview participants shared:

I think like a lot of people under the misconception if you need to remove dressings
because you don’t want a bolus effect or you don’t want to change or cause a problem.
So we’re willing to learn all about the radiation patients and we are working with our
physicist and a bio physicist to learn a little more about really thicknesses and really
what will make an impact, a difference and a change. So we’re going to probably right
at this recent times start to make the changeover for some of our dressings that will stay
on and that are the lighter type dressings that don’t have a lot of absorbency, that don’t
have a lot of wet or increase in thickness to what’s on against the skin area and then we
will make more of a change and put out more education for the staff and everything.
(P#4)