NEW YORK (Reuters Health) – Patients and physicians often disagree about the final outcomes of surgical scars, a systematic review confirms.
“It happens in more than one out of four cases,” Dr. Joseph F. Sobanko of the University of Pennsylvania in Philadelphia, who led the study, told Reuters Health in a telephone interview. “I think that patients and surgeons are evaluating scars under different lenses.”
Agreement between patients and physicians on the definition of a good final surgical scar outcome is needed so that physicians can counsel patients on what to expect, he added. “This is something that should be discussed in the informed consent process.”
For decades, Dr. Sobanko noted, surgical scarring outcomes have been based on ratings by physicians and “blinded” experts, with validated patient-reported outcomes incorporated only recently. And while an increasing number of instruments are being developed to rate surgical scars specifically, he added, some of those now in use were developed to evaluate burn scars.
In the new study, published online February 1 in JAMA Facial Plastic Surgery, Dr. Sobanko and his colleagues found 29 studies that incorporated at least one physician- and patient-reported scar measure, including a total of 4,485 patients. Twenty studies were randomized clinical trials, five were prospective but nonrandomized, and four were descriptive.
Eleven trials, assessing procedures such as cesarean delivery or mammoplasty, enrolled 962 women. In the remaining trials, involving a variety of other surgeries, close to three-quarters of the patients were women. Only 10% of studies focused on facial procedures.
Eight of the 29 studies showed disagreement between patient and physician ratings of surgical scar outcomes. Patients and expert raters also had different views on which aspects of a scar were important, with scar depth being a stronger consideration for patients and scar pigmentation and relief more important for physicians.
In his own Mohs and reconstructive-surgery practice, Dr. Sobanko said, he routinely shows his patients photographs of cases similar to their own, and provides a detailed description of what to expect as the scar heals.
“We believe that it’s helpful to explain and actually see what to expect,” he said. “The chasm between patient and physician perspectives is really important to minimize in order to improve patient outcomes, and we think that these findings can help in the perioperative period.”
SOURCE: http://bit.ly/2BJaijx
JAMA Facial Plast Surg 2018.
Tidak ada komentar:
Posting Komentar