Patients’ experiences of treatment and the scar management pathway during the Early Laser for Burn Scars (ELABS) trial: An embedded qualitative study.

Abstract

Background Due to improvements in acute burn management, burn injuries are a leading cause of morbidity globally. Alongside physical sequelae of burns, there are significant psychological implications. Limited qualitative research exists exploring quality of life (QoL) and delayed reintegration into society; the latter is argued as the greatest unmet challenge in burn rehabilitation. Furthermore, there is a lack of research into non-scar outcomes after pulse dye laser (PDL) treatment of burn scars. This qualitative study examines the patient’s experience of early PDL treatment and its impact upon QoL and social reintegration. Methods This qualitative study is nested within a national, multicentre, parallel-arm randomised controlled trial (RCT) across seven National Health Service hospitals in the United Kingdom (Early Laser for Burn Scars (ELABS), Trial registration ISRCTN14392301). The Consolidated Criteria for Reporting Qualitative Studies were used. Of the 153 participants in the trial, 34 were approached across a range of demographic, burn and site criteria including: gender, age, burn location, depth, total body surface area (TBSA), skin type, site location, and treatment arm. Data was collected using semi-structured telephone interviews. reflexive thematic analysis was used to analyse the transcribed data. Results 20 participants were interviewed. Six themes were constructed: frustration with initial burns treatment, feeling disconnected, human costs (with three sub themes: having to adapt, it’s changed how I feel about myself, and it doesn’t just affect me), money worries, reflections on pulse dye laser treatment, and moving forwards. Conclusion The scar management journey is long and complex due to significant physical, psychological, financial, and psychosocial impacts. These can negatively affect QoL and reintegration into society. Use of early PDL treatment can ameliorate these challenges by positively impacting upon QoL and supporting individuals whilst they create their ‘new normal’ and adjust to reintegration into society.