Page 93 - APPENDIX B: Trials Investigating the Management of Acute Radiation-Induced Skin Reactions Reading Qualitative Research

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WOUND CARE

power of studies, important flaws in the design of conduct, gaps in the chain of evidence or lack

of information on important health outcomes” (Pearson, Field, & Jordan, 2007, p. 108).

Appendices A and B reveal that only two clinical trials were retrieved. Adamietz et al. (1995)

had Mepitel® dressings left in place on patients with cancer (n=21) during radiotherapy. Even

though Diggelmann et al. (2010) discuss that the bolus effect is low and that Mepilex® Lite may

be left in place, in the actual study some patients had their dressings positioned on top of

reference marks and therefore for the sake of consistency, all dressings were removed prior to

treatment (p. 977). No relevant Randomized Controlled Trials (RCTs) that are considered the

‘gold standard’ in evidence of effectiveness were retrieved. Important health outcomes for

patient care that include quality of life indicators such as pain, itching, comfort, sleep patterns,

activities of daily living and wound healing are not addressed in the retrieved relevant studies.

In situations when empirical evidence is missing or inconsistent, expert opinion is another

type of best available evidence on a topic such as radiating through dressings (Pearson, Field, &

Jordan, 2007). Accordingly, a question posed to experts was, “Can you comment on the

assumption that removing wound dressings prior to daily radiation treatment is best practice?”

The general opinion was removing dressings is not best practice in relation to wound

management. Expert M. McQuestion explained further:

I would suggest that automatic removal of dressings prior to treatment is not best
practice, particularly in situations where the dressing in thin (what constitutes “thin”,
i.e., < 5 mm., < 3 mm.) adheres well to the skin / wound without gaps or the dressing is
not fluid filled (in that case changing the dressing but keeping one in place would be
preferred), patient factors (malignant wounds, pain associated with removal, cost of
supplies to the patient, etc.) and treatment factors. (personal communication, August 30,
2013).

Existing evidence regarding radiating through dressings suggests that thin dressings (up to 2

mm.) may be left in place during radiotherapy without significant bolus effect. While this may