Advertisement

Health Related Quality of Life (HRQOL) Implications for People with Pressure Ulcers

  • Trudie YoungEmail author
  • Katia Furtado
  • Paulo Alves
Chapter

Abstract

Improved health related quality of life (HRQOL) and symptom management are important objectives for the management of pressure ulcers given the high morbidity associated with these wounds. Previous pressure ulcer studies have frequently associated increased pain, high levels of wound exudate and odour as factors reducing the HRQOL of people with pressure ulcers. Such impact extends beyond the person with the pressure ulcer affecting family members and carers. It is generally recognised that healthcare professionals may underestimate the impact of pressure ulcers upon HRQOL.

Pressure ulcers place increased financial pressures upon healthcare systems, individual healthcare facilities and upon individuals with pressure ulcers. Recent recognition that pressure ulcers are one indicator of the quality of healthcare delivery has had significant impact upon increasing healthcare professional and patient information and education to deliver improved coproduction of effective pressure ulcer prevention and management.

Formal measurement of HRQOL among people with pressure ulcers presents significant challenges where self-reporting of HRQOL is restricted by the clinical condition of the people with pressure ulcers. Regardless generic quality of life tools have been used to show reductions in both physical and mental components of HRQOL when people with and without pressure ulcers are compared adjusting for age, gender and co-morbidities.

Keywords

Health related quality of life Quality indicator Pain Odour Exudate Pressure ulcer Symptom management Patient reported outcome measures Social isolation Education Body image 

References

  1. 1.
    Agency for Healthcare Research and Quality (AHRQ). Are we ready for this change? Preventing pressure ulcers in hospitals: a toolkit for improving quality of care. Rockville, MD. April 2011. http://www.ahrq.gov/professionals/ systems/long-term-care/resources/pressure-ulcers/pressureulcertoolkit/putool1.html.
  2. 2.
    Russo CA, Elixhauser A. Hospitalizations related to pressure sores. In Statistical Brief #3. AHRQ Healthcare cost and utilization project. April 2006. www.hcupus.ahrq.gov/reports/statbriefs/sb3.pdf. Accessed 14 June 2013.
  3. 3.
    Vangilder C, Macfarlane GD, Meyer S. Results of nine international pressure ulcer surveys: 1989 to 2005. Ostomy Wound Manage. 2008;54:40–54.PubMedGoogle Scholar
  4. 4.
    Pancorbo-Hidalgo PL, et al. Risk assessment scales 4 pressure ulcer prevention: a systematic review. J Adv Nurs. 2006;54:94–110.CrossRefPubMedGoogle Scholar
  5. 5.
    Elliott J. Strategies to improve the prevention of pressure ulcers. Nurs Older People. 2010;22(9):31–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Price P, Harding K. Cardiff. Wound Impact Schedule: the development of a condition specific questionnaire to assess health-related quality of life in patients with chronic wounds of the lower limb. Int Wound J. 2004;1:10–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Bowling A. Research methods in health. 2nd ed. Buckingham: Open University Press; 2002.Google Scholar
  8. 8.
    Gorecki C, et al. What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors. J Tissue Viability. 2012;21:3–12.CrossRefPubMedGoogle Scholar
  9. 9.
    Price P, Harding K. Measuring health-related quality of life in patients with chronic ulcers. J Wound Care. 1996;8:91–4.Google Scholar
  10. 10.
    Fallowfield L. The quality of life: missing dimension in healthcare. London: Souvenir Books; 1990.Google Scholar
  11. 11.
    Price P. Psychological impact of skin breakdown. In: Flanagan M, editor. Wound healing and skin integrity. Chichester: Wiley-Blackwell; 2013. p. 102–16.Google Scholar
  12. 12.
    Clark M. Pressure ulcers and quality of life. Nurs Stand. 2002;16:74–78, 80.CrossRefGoogle Scholar
  13. 13.
    Franks PJ, Winterberg H, Moffatt CJ. Health-related quality of life and pressure ulceration assessment in patients treated in the community. Wound Repair Regen. 2002;10:133–40.CrossRefPubMedGoogle Scholar
  14. 14.
    Gorecki C, et al. Patient-reported outcome measures for chronic wounds with particular reference to pressure ulcer research: a systematic review. Int J Nurs Stud. 2014;51:157–65.CrossRefPubMedGoogle Scholar
  15. 15.
    Gorecki C, Brown JM, Lamping DL, Nixon J. Development of a patient-reported outcome measure of quality of life for use with patients with pressure ulcers. Pressure ulcers: not just a disease of the elderly-are your patients at risk 2009a. In: TWELFTH annual European Pressure Ulcer Advisory Panel Open Meeting, 2011.Google Scholar
  16. 16.
    Hopkins A, Dealey C, Bale S, Defloor T, Worboys F. Patient stories of living with a pressure ulcer. J Adv Nurs. 2006;56:345–53.CrossRefPubMedGoogle Scholar
  17. 17.
    Whittington K, Patrick M, Roberts JL. A national study of pressure ulcer prevalence and incidence in acute care hospitals. J Wound Ostomy Continence Nurs. 2000;27:209–15.PubMedGoogle Scholar
  18. 18.
    Gorecki C, Brown JM, Nelson EA, Briggs M, Schoonhoven L, Dealey C, Defloor T, Nixon J, European Quality of Life Pressure Ulcer Project group. Impact of pressure ulcers on quality of life in older patients: a systematic review. J Am Geriatr Soc. 2009b;57:1175–83.CrossRefPubMedGoogle Scholar
  19. 19.
    Franks PJ. Quality of life as an outcome indicator. In:A colour guide to the nursing management of chronic wounds. London: Mosby; 1997.Google Scholar
  20. 20.
    Spilsbury K, Nelson A, Cullum N, Iglesias C, Nixon J, Mason S. Pressure ulcers and their treatment and effects on quality of life: hospital inpatient perspectives. J Adv Nurs. 2007;57:494–504.  https://doi.org/10.1111/j.1365-2648.2006.04140.x.CrossRefPubMedGoogle Scholar
  21. 21.
    Fox C. Living with a pressure ulcer: a descriptive study of patients’ experiences. Br J Community Nurs. 2002;7:10, 12, 14, 16.CrossRefPubMedGoogle Scholar
  22. 22.
    Essex HN, Clark M, Sims J, Warriner A, Cullum N. Health-related quality of life in hospital in patients with pressure ulceration: assessment using generic health-related quality of life measures. Wound Repair Regen. 2009;6:797–805.CrossRefGoogle Scholar
  23. 23.
    Douglas V. Living with a chronic leg ulcer: an insight into patients’ experiences and feelings. J Wound Care. 2001;10:355–60.CrossRefPubMedGoogle Scholar
  24. 24.
    National Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. In: Haesler E, editor. Prevention and treatment of pressure ulcers: clinical practice guideline. Osborne Park, WA: Cambridge Media; 2014.Google Scholar
  25. 25.
    Langemo D, Emily H, Wayne N, Aletha T, Young T. Evidence-based guidelines for pressure ulcer management at the end of life. Int J Palliat Nurs. 2015;21:225–32.CrossRefPubMedGoogle Scholar
  26. 26.
    Price P, Butterworth RJ, Bale S, Harding K. Measuring quality of in patients with granulating wounds. J Wound Care. 1994;3(1):49–50.CrossRefPubMedGoogle Scholar
  27. 27.
    Franks P. Quality of life as an outcome indicator. In:A colour guide to the nursing management of chronic wounds. London: Mosby; 1998.Google Scholar
  28. 28.
    Mudge E. Meeting report. Tell me if it hurts: the patient’s perspective of wound pain. Wounds UK. 2007;3:6–7.Google Scholar
  29. 29.
    Gorecki C, Lamping DL, Brown JM, Madill A, Firth J, Nixon J. Development of a conceptual framework of HRQL in pressure ulcers: a patient focused approach. Int J Nurs Stud. 2010;47:1525–34.CrossRefPubMedGoogle Scholar
  30. 30.
    Blanes L, Carmagnani MI, Ferreira LM. Quality of life and self-esteem of persons with paraplegia living in São Paulo, Brazil. Qual Life Res. 2009;18:15–21.CrossRefPubMedGoogle Scholar
  31. 31.
    Bahaarestani M. The lived experience of wives caring for their frail, homebound elderly husbands with pressure ulcers. Adv Wound Care. 1994;7:40–52.Google Scholar
  32. 32.
    Albrecht GL, Devlieger PJ. The disability paradox: high quality of life against all odds. Soc Sci Med. 1999;48(8):977.  https://doi.org/10.1016/S0277-9536(98)00411-0.CrossRefPubMedGoogle Scholar
  33. 33.
    Phillips D. Quality of life: concept, policy and practice. London: Routledge; 2006.CrossRefGoogle Scholar
  34. 34.
    Hammell W. Exploring quality of life following high spinal cord injury: a review and critique. Spinal Cord. 2004;42:491–502.CrossRefPubMedGoogle Scholar
  35. 35.
    Bury M, Newbould J, Taylor D. A rapid review of the current state of knowledge regarding lay led self-management of chronic illness: evidence review. National Institute for Health and Clinical Excellence; 2005.Google Scholar
  36. 36.
    Hammer C, Cullum NA, Roe BH. Patients’ perception of chronic leg ulcers. J Wound Care. 1994;3(2):99–101.CrossRefGoogle Scholar
  37. 37.
    Lucas LS, Martins JT, Robazzi ML. Quality of life of wound patients in the lower limbs. leg ulcer. Cienc Enferm. 2008;14(1):43–52.Google Scholar
  38. 38.
    Naylor WA. A guide to wound management in palliative care. Int J Palliat Nurs. 2005;11:572–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Alves P, Filomena M, Paulo R, Lúcia S. Epidemiology of pressure ulcers: interpreting Epidemiologic data as quality indicator. Lisboa: Servir; 2013.Google Scholar
  40. 40.
    Edwards IM, Moffatt C, Franks P. An exploration of patients understanding of leg ulceration. J Wound Care. 2002;11(1):35–9.CrossRefPubMedGoogle Scholar
  41. 41.
    International Society of Lymphology. The diagnosis and treatment of Peripheral lymphedema: 2013 consensus document. Lymphology. 2013;46:1–11.Google Scholar
  42. 42.
    Gorecki C, Lamping DL, Nixon J, Brown JM, Cano S. Applying mixed methods to pretest the Pressure Ulcer Quality of Life (PU QOL) instrument. Qual Life Res. 2012;21:441–51.CrossRefPubMedGoogle Scholar
  43. 43.
    Gorecki C, Brown JM, Cano S, Lamping DL, et al. Development and validation of a new patient reported outcome measure for patients with pressure ulcers: the PU QOL instrument. Health Qual Life Outcomes. 2013.  https://doi.org/10.1186/1477-7525-11-95.
  44. 44.
    Luna P, Paulo A. Prevalence risk and pressure ulcer prevention in long-term care units. Dissertation in Evidence and Decision Health. Faculty of Medicine, University of Porto; 2012.Google Scholar
  45. 45.
    Franks PJ, Collier ME. Quality of life: the cost to the individual. In: Morisson M, editor. The prevention and treatment of pressure ulcers. London: Harcourt Publishers Limited; 2001. p. 37–45.Google Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Welsh Wound Innovation CentreWalesUK
  2. 2.Multidisciplinary Wound Care Team in Alentejo Unidade Local de Saúde do Norte AlentejanoHospital de PortalegrePortalegrePortugal
  3. 3.Centre for Interdisciplinary Research in Health (CIIS), Wound Research LabUniversidade Católica PortuguesaPortoPortugal

Personalised recommendations