Page 68 - APPENDIX B: Trials Investigating the Management of Acute Radiation-Induced Skin Reactions Reading Qualitative Research

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WOUND CARE

This participant highlighted the presumption of a bolus effect regardless of the type or condition

of dressing that leads to removal prior to radiotherapy and also described a policy change about

leaving dressings on during radiotherapy that is underway at their centre (discussed in more

detail later).

In summary, this section of the survey results showed that there is inconsistency in

practice regarding radiating through wound dressings across Canada with 50% of centres who

always remove and 50% who sometimes remove dressings prior to radiotherapy. The findings

revealed that dressings are not left in place at all times at any of the centres. An analysis of the

explanations provided disclosed that dressings are generally removed for the dosimetric reasons

such as to prevent a bolus effect, however if dressings are thin, they may be radiated through.

Physical factors for dressing removal comprised being too bulky or lifting, whereas other factors

might include “organization policy” or standard practice, prognostic factors or patient preference

(A. Hughes, personal communication, August 29, 2013). Current practices are referred to as

“institutional and traditional practices” (A. Bolderston, personal communication, August 22,

2013).

Clinical decision-making. This section of the survey aimed to find out the nature of

clinical decision-making and to identify wound care guidelines that might be used in practice for

when to remove or radiate through dressings. It was requested that, if possible, the respondents

share an electronic copy of such record for reference. An open text response box was available

to explain any other response.