Grants We Funded

Abstract

Project Summary: Plastic surgery improves quality of life (QoL) through surgery. Burn patients are particularly in need given the significant decrease in QoL that occurs after injury. Physical and psychological changes from scarring limit activities of daily life and alter how burn survivors perceive themselves in society. Plastic surgery attempts to ameliorate the effects of scar through releasing contractures and rearranging/resurfacing scar to improve function and appearance. Ironically, current evidence shows that scar surgery may not improve QoL for burn survivors, and in some cases QoL may be worse after surgery. We aim to create a surgical decision aid that will improve the shared decision-making process around burn reconstruction to decrease decisional regret, improve patient satisfaction, and improve QoL. Shared decision making increases patient satisfaction and value agreement as well as decreases decisional conflict and regret. Decision aids are targeted tools that assist with patient education, value assessment, and informed decision making. Developing and piloting a decision aid will require assessment of the needs of burn survivors related to scarring and the impact on QoL and self-perception. The specific aims of this project are to: 1) determine attitudes and perceptions towards scar surgery amongst multiple stakeholders in burn care and, using these learnings, 2) develop a decision aid for use in burn scar surgical consultation, and 3) assess the efficacy of this decision aid focusing on decisional regret, patient satisfaction with surgery, and QoL. To achieve aim (1) we will survey burn survivors, burn survivor families, and burn providers (surgeons, nurses, therapists, psychologists) regarding opinions towards reconstructive scar care. Delphi processing will distill these data which will in turn aid in the pursuit of aim (2) whereby we develop an electronic decision aid. This tool will be informed by the framework created by the Ottawa Hospital Research Institute. Finally, for aim (3) we will evaluate our decision aid's efficacy. This will consist of conducting pre and post-operation surveys to measure 1) decisional regret, 2) satisfaction with surgery (Likert scale), and 3) patient health related quality of life using the PROMIS-29.

Impact Statement: Creating a high-fidelity decision aid for reconstructive burn surgery will have a significant impact on burn survivors and contribute to the broader field of plastic surgery. Management of the functional and psychosocial sequelae of burn scarring is one of the greatest unmet needs within plastic surgery. While we await pharmacological therapies, surgery and laser remain mainstay treatments for scar. Therefore, improving shared decision making is imperative given current evidence shows mixed results in improving QoL from burn reconstructive surgery. A more standardized and thorough shared decision-making process that is informed by burn survivors themselves is imperative. The PSF has an opportunity to advance surgical care for burn survivors through funding this research.

Biography
I am a plastic surgeon and surgical intensivist dedicated to the prevention, treatment, and rehabilitation of burn injuries. My interest in burn started as a medical student rotating through the burn unit at LA County/USC; I quickly recognized my calling. Nowhere in all of surgery did one single team treat every problem for a patient. One day in less than 12 hours we placed central lines, managed ARDS, performed escharotomies, and reconstructed an axillary contracture with a parascapular flap. The surgeons were both saving lives and improving quality of life, and their patients had profound gratitude for their care. I was fortunate to match into plastic surgery and continue my pursuit of becoming a plastic surgeon dedicated to burn patients. I completed a postdoc in health systems design as a resident which ignited my career in health services research. As I finished my training in residency, I was disturbed by a few patients for whom we performed scar operations and made significant improvements to mobility and appearance, yet the patients were dissatisfied. This led me to investigate changes in quality of life after scar operations using the largest prospective, longitudinal dataset in burn survivors. My work has demonstrated mixed results in changes in quality of life after scar operations, necessitating investigation and action. I believe a decision aid has the potential to significantly benefit burn survivors in making better decisions around reconstructive surgery.