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WOUND CARE

Clinical Practice Guideline or Best Practice Guideline for when to remove a dressing during

radiotherapy. A question posed to experts was, “How can the practice of removing or radiating

through dressings be effectively evaluated? What evidence is needed to develop a practice

guideline?”

Expert A. Hughes emphasized the impact of evidence on practice as she responded, “I

believe that we are a long way from having sufficient evidence to develop an evidence based

practice guideline. However, further research in this area could support (or not) some of the

existing perceptions of best practice” (personal communication, August 30, 2013). A Radiation

Oncologist posited, “One has to define the types of wound (radiation dermatitis versus

malignant wound), type of thickness of dressing, and intent of therapy (radical/curative versus

palliative)” (personal communication, August 25, 2013). Expert M. McQuestion explained in

relation to evaluating the practice and evidence needed in developing a Clinical Practice

Guideline:

It is challenging but consideration should be given to level I evidence and availability of
methodologically sound RCT studies, but other methods can be considered. Should it be
a “Clinical Practice Guideline” where level I evidence is preferred, or would it be best to
develop a Clinical Guide that encompasses other levels of evidence, consensus building
and decision-making to develop a standard of practice in light of existing evidence…
Build provincial or national consensus for what criteria will be used for evaluating the
evidence. (personal communication, August 30, 2013)

The suggestion to develop a clinical guide is a valid point for consideration. The current

evidence from this thesis would suggest that further research is required, in addition to gathering

expert consensus. Evidence must be stronger than what the current state of knowledge has

revealed. Nonetheless, until a sufficient body of evidence is developed through replicated

empirical studies, expert consensus in this regard is invaluable. It is noteworthy that three