Discussion
What does this research add?
This research replicates the results of a qualitative synthesis
of published research that was also carried out for the HTA
(Health Improvement Scotland, 2015). Accounts of the
physical and emotional impact, and the reliance on family
members, were corroborated. This study also adds to existing
knowledge by describing people’s experiences and perceptions
of AWDs.
Respondents were generally positive about AWDs. Even
for people who said they had not helped, they appreciated the
opportunity to try a treatment that might aid healing. Some
participants felt that they had the ‘right’ to try any treatment
that might help their wound. They were frustrated that AWDs
were not available to them in some settings, or were becoming
less available, and felt that decisions were being made purely
based on cost.
How does this fit with broader findings from the HTA?
The lack of clarity over when AWDs should be used has
resulted in an inconsistent approach across NHS Scotland. This
means that patients appear to be getting conflicting messages
from different health professionals—i.e. AWDs that they had
been treated with in one setting are not available to them in
another. This is an extra burden to people, who feel that their
preferred treatments are being withheld from them.
The main output of the HTA is a set of recommendations
for NHS Scotland. Taking all the evidence together, from each
of the four sections, recommendations were made that focused
on adopting a more consistent approach to AWD use in NHS
Scotland, with use limited to certain scenarios (agreed using
clinical consensus). It is hoped that this will help address the
issues around inconsistent access, which frustrated and worried
patients. It should also reduce use of AWDs until the evidence
becomes more compelling, either in support of or against
their use.
Study limitations
It is possible that the people who volunteered to take part in
the research might differ from people who did not. While a
variety of people (in terms of gender, age, wound types and
AWDs) were successfully included in the research, such astudy is not expected or able to represent the entire spectrum
of the potential patient population.
Both researchers who facilitated the focus group agreed
that the participants appeared to have suspicions about AWDs
becoming unavailable through NHS services. When asked
at the end of the discussion if they had heard rumours to
that effect, they said they had not. Given some participants’
experiences of inconsistent access to AWDs, and their
perception that it was due to costs, it was possible that they
have become concerned about their ongoing provision. This
may have influenced the discussions, making people feel that
they had to argue for AWDs’ continuing availability. BJN