Self-management in burns aftercare: exploratory research

Background
Some 250,000 individuals sustain burns in the UK every year with the potential of lasting impact on appearance, and psychological, social, and physical functioning. For severe burns, patient care presents a considerable challenge, necessitating an integrated multi-disciplinary approach and utilising a range of treatments. Typically it consists of two distinct phases; the first acute phase is when the patient is hospitalised where once stabilised the key requisite is closing the wound. The second phase consisting of rehabilitation and post-discharge management is termed “aftercare” [1] and addresses aesthetic, functional and psychological requirements. For some patients this can last for a number of years and can involve a combination of treatments that include scar management modalities (e.g. massage, creaming, pressure garment therapy); occupational and physiotherapies; psychological counselling, and further surgery.

The aftercare period is critical in terms of the overall success of treatments, rehabilitation and the degree to which a functioning patient can rejoin society. For example, a lack of adherence to recommended treatment regimens may have implications for the degree of scarring, functionality and psychosocial issues, as well as cost implications for health care services. However despite its importance, patients and their carers are expected to negotiate much of the lengthy and complex care regimen independently with only intermittent contact with care providers.

Severe burns are technically defined as a chronic condition due to their effects lasting longer than three months [2]. However, this chronicity is not always recognised [3] despite the lasting impact on physical appearance and capability, and the psychological implications of long-term treatment, being similar in nature to those suffering from more widely recognised chronic disease or illness [4].

The obstacles burns patients face in maintaining their aftercare in the years following the injury, such as depression, fatigue, and dependence on family support are comparable to those experienced by patients with other chronic conditions. Our recent work on the PEGASUS study [5] a feasibility study for a trial of scar management regimens demonstrated that patients appeared to be using many of the same self-management techniques as employed by patients with more widely recognised chronic diseases [6]. However patients with, for example Type II Diabetes or Hypertension, receive explicit support i.e. training and education that encourages problem solving, decision making, and appropriate use of resources [7]. In turn this support has led to improved patient engagement, adherence, and efficiency of healthcare utilisation [8]. This PhD will explore the scope for self-management in burns aftercare within a UK context.

Aims
(1) to explore the current availability and use of self-management strategies in UK burns aftercare and
(2) to identify potential targets areas for the development of new self-management interventions and gauge the feasibility and acceptability of these

Objectives
Whilst the successful candidate will need to develop a full PhD protocol it is likely that these aims will be met via a number of inter-related PhD work packages;

1) Evidence review of existing self-management modalities used for patients in other chronic conditions.
2) Examination of the current availability and use of (explicit and implicit) self-management resources and strategies in UK burns aftercare using survey and qualitative research approaches.
3) In-depth examination of the use of self-management processes by burns patients using qualitative research approaches.
4) Scoping the potential for a cross-sectional study examining the association between self-management processes and burns aftercare outcomes.
5) Examining attitudes towards the implementation of self-management interventions amongst patients, healthcare professionals and other relevant stakeholders.