Patient experiences of, and preferences for, surgical wound care education

Abstract

The aim of this study was to describe patients' experiences of, and preferences for, surgical wound care discharge education and how these experiences predicted their ability to self‐manage their surgical wounds. A telephone survey of 270 surgical patients was conducted across two hospitals two weeks after discharge. Patients preferred verbal (n = 255, 94.8%) and written surgical wound education (n = 178, 66.2%) from medical (n = 229, 85.4%) and nursing staff (n = 211, 78.7%) at discharge. The most frequent education content that patients received was information about follow‐up appointments (n = 242, 89.6%) and who to contact in the community with wound care concerns (n = 233, 86.6%). Using logistic regression, patients who perceived that they participated in surgical wound care decisions were 6.5 times more likely to state that they were able to manage their wounds at home. Also, patients who agreed that medical and/or nursing staff discussed wound pain management were 3.1 times more likely to report being able to manage their surgical wounds at home. Only 40% (107/270) of patients actively participated in wound‐related decision‐making during discharge education. These results uncovered patient preferences, which could be used to optimise discharge education practices. Embedding patient participation into clinical workflows may enhance patients' self‐management practices once home.

1. INTRODUCTION

Internationally, one‐in‐four surgical patients develop post‐operative complications within 14 days of hospital discharge, ¹ with surgical site infection (SSI) being the most common. ² , ³ In a recent systematic review and meta‐analysis, the cumulative incidence of SSI for general surgery was 11%. ⁴ Patients with post‐operative complications have negative psychosocial ⁵ and functional outcomes, prolonged hospitalisation, ⁶ and 6% experience unplanned readmissions. ² In 2007, direct costs associated with hospital re‐admission, as well as prolonged hospitalisation and reoperation, were estimated to cost the United States (US) Veteran Health Administration hospitals US$8338–$29 595 per patient, depending on severity. ⁷ Post‐operative complications like SSIs are preventable; advocates assert that enabling patient participation in self‐management wound care practices can help to prevent SSI; however rigorous studies are required to substantiate this claim. ⁸

Surgical wound care management varies in complexity. For some patients, surgical wounds are “clean” and heal by primary intention. This type of wound care can be straightforward such as patients removing dressing themselves and/or a General Practitioner removing staples at 7–10 days. ⁹ Other patients are discharged from the hospital with complex dressings such as negative wound pressure therapy, or wounds dehisce, with some intentionally left open to heal (e.g., breast abscess), all of which require more intensive treatment, multiple operations and frequent community care. ⁹ , ¹⁰ Regardless of wound complexity, patients face challenges managing their wounds in the community.

Timely hospital discharge education may equip surgical patients with the knowledge and skills to participate in wound care management once home. Patient education includes information provided to patients, and when delivered effectively can enable patient understanding. ¹¹ Researchers have found that patients who perceive they received more information than expected at hospital discharge had significantly fewer wound complications than those who received less information than expected. ¹² It has been estimated that half of the hospital readmissions might be prevented with better patient discharge education. ¹³ There is growing interest in the importance of patient‐centred discharge education, which entails delivering education in a way that (1) encourages partnerships and shared decision‐making between the patient and healthcare professional; and (2) is individualised and based on patient needs and preferences. ¹⁴ Delivering discharge education in this manner increases patient confidence, empowerment and ability to self‐care once home. ¹⁴ , ¹⁵

However, practice variability means some patients do not receive discharge education, while others receive piecemeal information during other hospital activities, and often patients do not understand the importance of the information being shared ad hoc. ¹⁶ Further, when discharge education does occur it is not truly patient‐centred, due to a lack of shared decision‐making. ¹⁶ Also, patients' preferences for, and experiences of, discharge education are not always in concordance, as some patients desire written information but do not receive it. ¹⁷ Notably, patients with SSI have reported receiving inadequate discharge instructions about surgical wound care, highlighting possible links between discharge education and SSI. ¹⁸ The aims of this study were to:

• describe patients' experiences of surgical wound care discharge education and participation in wound care decisions, and their preferences for discharge education delivery;

• determine the estimated cost and what demographic factors (age, sex, level of education) predict patients' ability to manage their surgical wounds after hospital discharge; and

• determine whether patient experiences with surgical wound care discharge education predict their ability to manage their surgical wound after hospital discharge.

Understanding predictors of patients' ability to manage their surgical wound care provides a better understanding of individual patient needs and can be used to tailor education.

2. MATERIALS AND METHODS

2.1. Design

A cross‐sectional survey.

2.2. Setting and sampling

This quantitative telephone survey took place at two metropolitan tertiary hospitals in Queensland, Australia. The two sites were chosen as they cater to a broad patient population and perform most types of surgeries. From 2020–2021, about 44 700 patient admissions were. ¹⁹ From April to September 2021, patients were recruited from a total of 21 wards (day surgery, short‐stay and long‐stay surgical wards) across the two sites. Ethics approval was granted by the participating health services (HREC/2020/QGC/64063) and university (2020/880).

We aimed to obtain a sample size of 330 surgical patients; 165 patients at each site. Based on the literature in this area, ¹⁴ , ¹⁵ , ¹⁹ , ²⁰ , ²¹ , ²² we identified 15 potential predictors of the patient's ability to manage their surgical wounds. Hair et al. ²³ suggest that 10–20 participants are needed for each predictor (i.e., ≈ n = 300 for this study). Based on our previous research using phone interviews, loss to follow‐up during post‐discharge phone calls can be high, thus we aimed to over‐recruit by 10%, resulting in the target sample of 330 surgical patients.

Inclusion criteria were patients:

• post‐elective or emergency surgery with a surgical wound;

• aged ≥18 years;

• scheduled for hospital discharge within approximately 48 h of study recruitment;

• competent to give consent for research participation; and

• able to complete a telephone interview.

Exclusion criteria were patients:

• who were unable to understand English, palliated, or being discharged to a nursing home or other care facility.

2.3. Data collection

A nurse researcher at each site was trained in study procedures and was provided with a Standard Operating Protocol. On the day of data collection, the nurse researcher approached eligible patients consecutively at their site and provided an ethics‐approved written and oral description of the project, giving patients time to consider their participation. All eligible patients approached were recorded in a screening log in the secure, web‐based Research Electronic Data Capture software (REDCap). ²⁴ , ²⁵

Patients willing to participate provided written consent, their contact details, and demographic and clinical data (age, sex, type of surgery, highest level of education, and wound location). To obtain a baseline understanding of participants' perceived ability to manage their wounds, they answered one question, “I will be able to take care of my surgical wound at home” which had a 5‐scale response (strongly disagree—strongly agree). A similar question was repeated when the survey was delivered to participants once home to allow comparison over time. The survey was administered to participants by telephone, approximately 14 days after surgery (if they were discharged home at that point) or 14 days after hospital discharge from the surgical admission, whichever came first. The rationale for this timeline was that research shows that 75% of post‐operative surgical complications occur within 14 days after hospital discharge to the home. ²⁶ Patient demographic data, clinical data and survey responses were recorded in a de‐identified manner using a study ID, so that their personal information (i.e., name and phone number) were unable to be linked.

2.4. Survey development

A study‐specific survey was co‐developed with patients, wound care experts and researchers. Through a process of face validity, content validity and pilot testing, 106 items were reduced to 18 items. The survey is named “Surgical Wounds and Patient Participation Questionnaire” and contains four themes listed below; three about patient experiences of surgical wound care discharge education and one regarding their preferences (Please see Appendix A for further details about items):

Experiences

1. Wound care discharge education (10 items)

2. Participation in wound care decisions (3 items)

3. Patients' ability to manage their surgical wound to prevent wound complications (1 item)

Preferences

• 4Preferences for discharge education delivery (4 items)

Response options varied across themes including items that allowed multiple response options, Likert scale response options (strongly disagree – strongly agree) and yes/no/not applicable.

Recruited participants were sent a preliminary text message to arrange the telephone call and/or provide a reminder. At the pre‐arranged date and time, the nurse researcher telephoned recruited participants. Two follow‐up phone calls were made if participants did not answer (three phone calls in total). The nurse researcher recorded all data in a REDCap database.

2.5. Data analysis

Data were exported from REDCap into SPSS (Version 27) ²⁷ and cleaned and checked for accuracy. Descriptive statistics were used to compute absolute (n) and relative (%) frequencies, and means and standard deviations or medians/interquartile ranges, depending on the level and distribution of data. Survey items with multi‐response options, which are largely related to patient preferences, were analysed descriptively.

Multiple logistic regression was used to determine the predictors of patients' ability to manage their surgical wounds at home. Missing data was 0.06%; thus, missing values were not imputed. The predictors selected were based on the literature and included: patient age, sex, level of education, experiences of ‘wound care discharge education’ (Theme 1) and ‘participation in wound care decisions’ (Theme 2). ¹⁴ , ¹⁵ , ¹⁹ , ²⁰ , ²¹ , ²² We also included the hospital site as a covariate to statistically control for this potential confounder. Independent predictor variables were binarised based on researchers' judgements that these response options were conceptually consistent to allow them to be combined:

• The 5‐item Likert scale became: 0 = strongly disagree, disagree and neutral; and 1 = agree and strongly agree.

• Yes/no/not applicable response options became: 0 = no and not applicable; and 1 = yes.

The dependent outcome measure was the patients' ability to manage their surgical wounds. This outcome had five Likert scale response options ranging from 1 = strongly disagree to 5 = strongly agree. The outcome was non‐normally distributed, therefore, prior to the analysis, this variable was dichotomised. Using the 50th percentile as a cut‐off point the data was recoded as 0 = strongly disagree, disagree and neutral responses, and 1 = agree and strongly agree responses.

A model‐building approach ²² was used to identify model predictors. Prior to the analysis, the following multiple logistic regression assumptions were checked. First, all predictors were checked for multicollinearity; there were no statistically significant correlations of .70 or above. Next, relationships between the predictors and outcome measures were checked using univariate analysis, and predictors that had a P‐value of ≤.20 were simultaneously entered into a logistic regression model. ²³ , ²⁸ For multiple logistic regression analysis statistical significance was set at P < .05.

2.6. Consumer and clinician engagement

The Guidance for Reporting Involvement of Patients and the Public checklist ²⁹ was used to plan and report consumer and clinician engagement (See Appendix B). One consumer and one clinician were team members from early survey development (reported elsewhere) through to manuscript preparation. A second consumer joined the team during data collection. The two consumers had experienced a surgical wound and the clinician was a wound care expert. They reviewed study findings and provided their interpretations, which were used to shape the discussion and recommendations for future research and practice.

3. RESULTS

Of the 729 patients screened, 637 were eligible, and 419 were approached for consent. Of the 330 who provided consent 270 patients completed the survey (See Figure 1).

FIGURE 1.

Recruitment flowchart adapted from the CONSORT flow diagram ⁴⁴

As shown in Table 1, the mean sample age was 55.1 years (SD 17.9) and more females participated. There were average differences between sites, with Site 2 participants reporting higher levels of education. Site 1 had more orthopaedic and neurology patients whereas Site 2 had predominantly general surgical patients.

TABLE 1.

Characteristics of the sample and sites

Characteristic	Hospital 1 n = 145	Hospital 2 n = 125	Total sample n = 270
Age (Mean; SD)	56.3 (19.1)	53.8 (16.2)	55.1 (17.9)
Sex a	n (%)	n (%)	n (%)
Female	72 (49.7)	67 (53.6)	139 (51.5)
Male	73 (50.3)	58 (46.4)	131 (48.5)
Highest level of education b
Primary education	6 (4.1)	0 (0.0)	6 (2.2)
Secondary education	93 (64.1)	61 (48.8)	154 (57.0)
Vocational education	15 (10.3)	13 (10.4)	28 (10.4)
University education	29 (20.0)	50 (40.0)	79 (29.3)
Type of surgery c
General	93 (34.4)	40 (27.6)	53 (42.4)
Orthopaedic	70 (25.9)	51 (35.2)	19 (15.2)
Urology	34 (12.6)	19 (13.1)	15 (12.0)
Cardiac	14 (5.2)	1 (0.7)	13 (10.4)
Plastics	14 (5.2)	9 (6.2)	5 (4.0)
Gynaecological	13 (4.8)	12 (8.3)	1 (0.8)
Maxillofacial	11 (4.1)	8 (5.5)	3 (2.4)
Neurological	7 (2.6)	0 (0.0)	7 (5.6)
Ear, Nose and Throat	6 (2.2)	4 (2.8)	2 (1.6)
Thoracic	6 (2.2)	0 (0.0)	6 (4.8)
Vascular	1 (0.4)	0 (0.0)	1 (0.8)
Wound location
Abdomen	54 (37.2)	57 (45.6)	111 (41.1)
Leg/hip/ankle/ft	36 (24.8)	4 (3.2)	40 (14.8)
Head/scalp/face/neck/ear	17 (11.7)	14 (11.2)	31 (11.5)
Arm/shoulder/wrist/hand	19 (13.1)	11 (8.8)	30 (11.1)
Chest	5 (3.4)	20 (16.0)	25 (9.3)
Groin area	11 (7.6)	1 (0.8)	12 (4.4)
Back	2 (1.4)	7 (5.6)	9 (3.3)
Chest and legs	0 (0.0)	5 (4.0)	5 (1.9)
Abdomen and chest	0 (0.0)	3 (2.4)	3 (1.1)
Face and leg	0 (0.0)	2 (1.6)	2 (0.7)
Arm and abdomen	1 (0.4)	0 (0.0)	1 (0.4)
Arm and leg	0 (0.0)	1 (0.8)	1 (0.4)

^a n = 2 did not respond.

^b n = 3 did not respond.

^c n = 1 did not respond.

3.1. Patient experiences and preferences

Descriptive data for each of the four themes appears in Table 2 and 3. Theme 1 data shows that frequently delivered content was arrangements for follow‐up appointments and who to contact if there were surgical wound concerns (See Table 1). These instructions were delivered verbally, often with opportunities for patients to ask questions.

TABLE 2.

Theme 1 survey responses (n = 270)

EXPERIENCES	Yes (n (%))
I was given instructions about…
arrangements made for follow‐up appointments	242 (89.6)
who to contact if I had concerns about my surgical wound or about caring for the wound a	233 (86.6)
what activities I should avoid during wound healing b	198 (74.2)
the signs of infection in the wound a	176 (65.4)
how the wound should be cleaned c	† 152 (56.7)
the wound dressing I would use at home c	† 128 (47.8)
when and how stitches (or “tape”/steri‐strips or staples) are removed d	† 117 (44.0)
	Agree (n (%))
Before I was discharged from the hospital, I had the opportunity to ask questions about how to care for my surgical wound	224 (83.0)
	n (%)
How did you receive information about caring for your surgical wound? a
Verbal instructions with questions and answers	228 (84.4)
Printed material such as a brochure, checklist, or information sheet	120 (44.4)
Verbal instructions with no discussion	30 (11.1)
Teaching by using visual materials such as pictures or models	8 (3.0)
I did not receive any information	6 (2.2)
Online reading material	1 (0.4)
Online audio/visual material	1 (0.4)

^a =1 did not respond.

^b n = 3 did not respond.

^c n = 2 did not respond.

^d n = 4 did not respond.

^† n = ≥50 (19%) responded not applicable.

TABLE 3.

Theme 4 survey responses (n = 270)

PREFERENCES	n (%)
How would you like to receive information about caring for your surgical wound? a
Verbal instructions with questions and answers	255 (94.8)
Printed material such as a brochure, checklist, or information sheet	178 (66.2)
Teaching by using visual materials such as pictures or models	20 (7.4)
Online reading material	14 (5.2)
Online audio/visual material	10 (3.7)
Verbal instructions with no discussion	2 (0.7)
I would not like to receive any information	1 (0.4)
Where do you prefer to get your information about caring for your wound? c
From your doctor or medical specialist includes a general practitioner (GP)	229 (85.4)
Nursing staff	211 (78.7)
Information leaflet	43 (16.0)
Family, friends	5 (1.9)
Online search	5 (1.9)
Pharmacist	3 (1.1)
Do not mind	3 (1.1)
Other, physiotherapist	2 (0.7)
Other patients	0 (0.0)
Carer	0 (0.0)
When would you have preferred to have received information about managing your wound? b
At discharge	228 (85.4)
24–36 h after surgery	60 (22.5)
During my last preoperative visit to the surgeon/specialist	58 (21.7)
Other, would prefer information at follow‐up appointment (including GP)	4 (1.5)
Other, do not mind	2 (0.7)
I would prefer to have my follow‐up appointment c
As a hospital outpatient visit	168 (62.7)
By visiting a medical specialist or wound care nurse	43 (16.0)
As a telephone consult	25 (9.3)
Other, GP	18 (6.7)
Other d	13 (4.9)

^a = 1 did not respond.

^b n = 3 did not respond.

^c n = 2 did not respond.

^d Examples of ‘other’ included: as a hospital outpatient visit or GP, as a hospital outpatient visit or as a telephone consult, do not mind, do not mind but would like earlier follow‐up, home care nurse, as a telephone consult or GP.

For Theme 2, most patients (n = 227; 84.4%) reported that medical and nursing staff discussed surgical wound‐related pain management options, 165 (61.3%) stated that medical and nursing staff discussed wound care treatment options, and 107 (40.1%) were invited to participate in wound care decision‐making.

Regarding Theme 3, while in hospital, slightly more than three‐quarters of patients (n = 208; 77.0%) stated they would be able to take care of their surgical wounds at home. Two weeks after discharge, most patients (n = 244; 90.4%) reported they undertook their surgical wound care at home.

Table 3 highlights Theme 4 responses, showing patients preferred wound information delivered both verbally and with printed materials, by medical and nursing staff, at discharge.

3.2. Factors influencing the patient's ability to self‐manage their wound at home

Fifteen predictors were tested at the univariate stage; 8 had P‐values of ≤.2 and were entered into the multiple logistic regression model (Table 4). The full model containing all 8 predictors was statistically significant (χ ² = 24.03; [8, N = 270], P = .002), indicating that the model was able to distinguish between patients who reported they were and were not able to manage their surgical wound at home. The model explained between 8.7% (Cox and Snell R squared) and 19.1% (Nagelkerke R squared) of the variance in patients' perceived ability to manage their surgical wound, and correctly classified 90.9% of cases.

TABLE 4.

Multiple logistic regression analysis for predictors of patients' ability to manage their surgical wound once home

Predictor	Coefficient β	S.E.	Odds Ratio	95% CI	Wald χ2	P‐value
Site	0.87	0.57	2.39	0.79–7.26	2.35	0.13
Age	−0.02	0.01	0.98	0.96–1.01	1.45	0.23
Gender	−0.65	0.48	0.52	0.21–1.33	1.87	0.17
Medical/nursing staff discussed pain management options for wound‐related pain	1.14	0.56	3.12	1.03–9.42	4.06	0.04
Invited to share in the wound care related decision‐making	‐1.88	0.77	6.57	1.45–29.79	5.96	0.02
Before hospital discharge, given the opportunity to ask questions about how to care for surgical wound	0.53	0.56	1.70	0.57–5.03	0.91	0.34
Given instructions about how the wound should be cleaned	0.16	0.54	1.17	0.41–3.39	0.09	0.77
Given instructions about the signs of infection in the wound	−0.32	0.54	0.72	0.25–2.08	0.36	0.55

Note: The bold value represent p < 0.05.

As shown in Table 3, only two predictors, both of which related to the theme ‘participation in wound care decisions’, made a statistically significant contribution to the model. The strongest predictor of patients' perceived ability to manage their surgical wound was being invited to share in wound care‐related decision‐making, recording an odds ratio of 6.57 (95% CI 1.45–29.79, P = .02). This indicates patients who were invited to take part in decisions about wound care were 6.5 times more likely to perceive they were able to manage their post‐discharge surgical wound care compared to those who were not involved in decision‐making. Patients who agreed that medical staff and/or nursing staff discussed wound‐related pain management options were 3.1 times more likely to report being able to manage their surgical wound at home (OR = 3.12, 95% CI = 1.03–9.42, P = .04) compared to those who did not receive this information.

4. DISCUSSION

We found that patients preferred a combination of verbal and written surgical wound care instructions delivered by medical and nursing staff. Study participants reported that this information largely focussed on follow‐up arrangements and who to contact in the community. We also found that discharge education that encouraged patient participation in shared decision‐making and pain management conversations, enhanced patients' ability to manage their surgical wounds at home. However, only 40% of patients surveyed experienced shared wound care decision‐making.

Using logistic regression, we found that patient participation was associated with participants' perceived ability to self‐manage their surgical wound once home. This is consistent with previous qualitative research where patients have linked both shared decision‐making during discharge planning ³⁰ and understanding wound pain management as enhancing their recovery. ¹⁰ Further, research interventions that increase patient participation in their surgical care have been shown to improve patient knowledge and self‐confidence in care management. ³¹ However, patients in our study reported that they participated in shared decision‐making infrequently, which could be due to physicians’ preferences for dyadic approaches when preparing patients to self‐manage. ³² While shared decision‐making has been well‐defined for people with chronic wounds in the community, enacting shared decision‐making in acute surgical wound care is largely unexplored, representing an area for future research. ³³ , ³⁴

We uncovered that specific wound care instructions were infrequently provided to patients. This may be problematic as wound care communication between hospital and community healthcare professionals is limited, causing delays in patient care and increased community staff dissatisfaction. ³⁵ In the UK, surgical wounds account for 730 000‐1 840 000 visits to GPs, practice nurses and community nurses annually, costing up to £52 million. ³⁶ Despite this burden, GPs and community nurses lack guidelines and report challenges related to managing surgical wounds in the community ⁹ such as feeling pressured to follow hospital orders (even if not best practice) and poor access to hospital wound care products. ³⁵ It has been suggested that patients and families could be a conduit between the hospital and the community by providing specific wound care instructions. ³⁵ In fact, in another study, surgical patients reported wanting more specific information such as the rationale for dressing product choices. ¹⁰ Overall, increasing specific wound care information provided to patients could be a priority area for future healthcare improvement to empower patients to engage in post‐operative recovery.

We found that most participants desired and experienced verbal information, and about two‐thirds wanted and received written information. A blended approach of both verbal and written information is patients' preference ³⁷ and may be optimal given that only 47% of patients recall receiving “verbal only” discharge instructions. ³⁸ Researchers have shown that adding written discharge instructions improved recall by 58% and 67% for video discharge instructions. ³⁸ Additionally, we found that some patients desired electronic information‐sharing options even though they had not experienced this. Electronic discharge education interventions are increasingly being designed and show promising outcomes. For example, videos can demonstrate to patients how to clean and remove their surgical dressing; patients find these videos useful. ³⁹ Additionally, mobile health (mHealth) applications (app) can provide patients with daily wound care education and opportunities to upload wound photos for healthcare professionals to monitor. ⁴⁰ This app significantly decreased patients' functional limitations and increased the quality of life in the intervention group. ⁴⁰ Overall, a blended approach of verbal and written is recommended as it improves recall and aligns with a patient preference; however, as patients become more exposed to electronic interventions it will be interesting to monitor their preferences.

Our findings indicate that patients preferred surgical wound care information from medical and nursing staff. Other studies provide reasoning for these preferences; patients value regular contact with medical staff who performed the surgery, inspect the wound and report on healing ¹⁰ and recognise the empathic nature of nurses and feel comfortable approaching them for discharge information. ³⁷ Yet, there are barriers to these healthcare professionals providing effective discharge education, such as the medical staff's rushed and impersonal manner ³⁰ and nurses' reliance on medical staff to clarify patient queries. ³⁰ Additionally, 35% of medical residents report they are unsure which member of the multi‐disciplinary team should be responsible for discharge education, ⁴¹ and often nurses report undertaking this responsibility in the absence of other healthcare professionals. ⁴² In one study, the introduction of a Nurse Practitioner to the surgical team enhanced responsibility for discharge education and reduced unnecessary emergency department visits. ⁴³ Considering our findings, a clearly defined multidisciplinary approach may ensure optimal and patient‐centred discharge education.

We acknowledge several limitations. First, our study was conducted across two public hospitals, which may limit the generalisability of findings. While we recruited from 21 different wards, we did not access all surgical wards, thus selection bias may have occurred. However, involving many wards, from tertiary service hospitals that serve large catchment areas, heightens generalisability. A consumer on our team suggested the administration of the survey to private hospital patients to identify what can be learnt and exchanged across the two hospital systems. Second, while we found relationships between patient participation and patient ability to self‐manage their wound, the correlational design only permits the measurement of associations, and there may be other variables that are potential confounders. Third, our logistic regression findings had large confidence intervals meaning there is uncertainty in these results. More research with larger samples is required to confirm the findings. Fourth, the findings are at risk of recall bias, as participants reported experiences occurring two weeks prior to their phone call. Finally, consumers and clinicians involved in interpreting study findings were disappointed that family participation was not measured in our survey, highlighting that some wound locations cannot be managed without assistance. We recommend future research that investigates the family's role.

5. CONCLUSIONS

In conclusion, our study provides insights into an approach to discharge education for surgical wound care that promotes patient partnership and is based on patient experience and preferences. In terms of preferences, patients prefer discharge information that is verbal and written, by medical and nursing staff, at discharge. To enhance partnerships, shared decision‐making, patient participation and pain discussions can increase patients' ability to manage their wound. These results provide a new avenue for enhancing discharge education; embedding shared decision‐making processes into discharge education is a critical area for improvement to enhance patient self‐management abilities. Additionally, an approach to discharge education based on patient preference has been confirmed, providing the basis for pathways for discharge education that meets patient needs.

FUNDING INFORMATION

This study was funded by a Griffith University New Researcher Grant. Georgia Tobiano and Sharon Latimer were employed with funding from a NHMRC Centre for Research Excellence—Grant No. APP1196436.

APPENDIX A. “SURGICAL WOUNDS AND PATIENT PARTICIPATION QUESTIONNAIRE”

1. I was able to take care of my surgical wound at home

   • Strongly disagree
   • Disagree
   • Neutral
   • Agree
   • Strongly Agree
2. In relation to your most recent surgical procedure, how was your surgical wound closed?

   • You may select more than one answer:

     • Stitches
     • Staples
     • Tape/steri‐strips?
     • Adhesive glue
     • Wound not closed
     • Unsure
     • Other, please specify ________________
3. Did the medical staff and/or nursing staff discuss with you your treatment options in relation to wound care?

   • Yes
   • No
   • Not applicable
4. Did the medical staff and/or nursing staff discuss with you your pain management options for wound‐related pain?

   • Yes
   • No
   • Not applicable
5. Were you invited to share in the decision‐making related to your wound care?

   • Yes
   • No
   • Not applicable
6. Before I was discharged from the hospital, I had the opportunity to ask questions about how to care for my surgical wound

   • Strongly disagree
   • Disagree
   • Neutral
   • Agree
   • Strongly Agree

We would like to know what you were told about caring for your surgical wound

I was given instructions about:		Yes	No	Not applicable
7.	How the wound should be cleaned
8.	The wound dressing I would use at home
9.	The signs of infection in the wound
10.	Who to contact if I had concerns about my surgical wound or about caring for the wound
11.	What activities I should avoid during wound healing
12.	When and how stitches (or ‘tape’/steri‐strips or staples) are removed?
13.	Arrangements made for follow‐up appointments

• 14
  Where do you prefer to get your information about caring for your wound?

  • You may select more than one answer:

    • From your doctor or medical specialist
    • Nursing staff
    • Online search
    • Information leaflet
    • Other patients
    • Family, friends
    • Carer
    • Pharmacist
    • Do not mind
    • Other ______________________
• 15
  How did you receive information about caring for your surgical wound?

  • You can select more than one answer:

    • Printed material such as a brochure, checklist, or information sheet
    • Verbal instructions with no discussion
    • Verbal instructions with questions and answers
    • Teaching by using visual materials such as pictures or models
    • Online reading material
    • Online audio/visual material
    • I did not receive any information
    • Other
    • If other, please specify
• 16
  How would you like to receive information about caring for your surgical wound?

  • You can select more than one answer:

    • Printed material such as a brochure, checklist, or information sheet
    • Verbal instructions with no discussion
    • Verbal instructions with questions and answers
    • Teaching by using visual materials such as pictures or models
    • Online reading material
    • Online audio/visual material
    • I did not receive any information
    • Other
• 17
  When would you have preferred to have received information about managing your wound?

  • You may select more than one answer:

    • During my last preoperative visit to the surgeon/specialist
    • 24–36 h after surgery
    • At discharge
    • Other _______________________
• 18
  I would prefer to have my follow‐up appointment:

  • As a hospital outpatient visit
  • As a telephone consult
  • By visiting a medical specialist or wound care nurse
  • Other _________________

APPENDIX B. THE GUIDANCE FOR REPORTING INVOLVEMENT OF PATIENTS AND THE PUBLIC CHECKLIST

Selection and topic	Item
1: Aim	The purpose of consumer and clinician engagement was to gain different viewpoints on the findings to add richness to the discussion, recommendations and implications Please see our other study which focuses on survey development for details of consumer and clinician engagement in earlier phases of this work (blinded for peer review)
2: Methods	The clinician and consumers were engaged once data were analysed. Two consumers and one clinician were provided with plain‐language summaries of the findings. One consumer had an academic background and was provided with a more scientific summary. The consumers and clinician were asked to read the results, and reflect on the following questions: Were there any results that were very interesting/striking? Why? Were there any results that are similar to your experiences? Were there any results that were a bit boring (things you already suspected)? After reading these results, what would you like to see a change in practice? Any other thoughts or ideas The consumers and clinicians were offered to return their feedback via email or could give feedback in a meeting with the lead researcher The lead researcher reflected on the feedback provided and then wrote the discussion and conclusion section of the manuscript. The complete draft manuscript was then returned to the consumers and clinicians to provide feedback on the manuscript and ensure their feedback was incorporated.
3: Study results	Some of the core feedback from the consumers and clinician is as follows: Surprised by how many patients received wound care education, consumer experience is that limited and superficial wound care instructions were provided Unsurprised that patients want information at discharge, but identified challenges with this time point Unsurprised by findings that nurses are the preferred source of information, consumers also view nurse information as a trusted source and want frequent interaction with this group Both surprised and unsurprised by information received about and preferences for follow‐up care, mixed experiences with follow‐up care and experienced barriers to attending hospital OPD appointments Recommended a blended model of verbal and written discharge education, as all had concerns about a ‘verbal only’ approach Disappointed that there were no survey questions about family member assistance, a wide range of surgical wounds were included in the study and some patients may not be able to reach their wounds, thus requiring family input
4: Discussion and conclusions	Consumer and clinician engagement positively influenced the study: Key discussion points were identified from consumer and clinician feedback allowing the team to shape the discussion. Some discussion points differed from the key discussion points researchers had identified, providing a new lens Future recommendations for clinical practice and research were identified Minor changes were made to the draft manuscript based on consumer and clinician feedback (such as changes to the title), and consumers and clinicians approved the final manuscript
5: Reflections/critical perspective	Consumer and clinician reflections: Overall consumers were satisfied with their input. Some specific feedback included that they felt they had the right level of interaction, felt included at each stage and felt that their comments were taken on board and were identifiable in the draft manuscript When reviewing the draft manuscript, a consumer found reviewing, particularly the statistics, challenging. However, the lead researcher's instructions to concentrate on the discussion were helpful Researcher reflections: Using plain language summaries of results seemed to work well, allowing the consumer and clinician to understand the research findings and provide high‐quality feedback Providing the consumers and clinician with questions to guide their interpretation of findings worked well, and provided targeted feedback Utilising three people for feedback resulted in some variations in opinions, the researchers wondered how many people the ideal number is when interpreting findings

Tobiano G, Walker RM, Chaboyer W, et al. Patient experiences of, and preferences for, surgical wound care education. Int Wound J. 2023;20(5):1687‐1699. doi: 10.1111/iwj.14030

DATA AVAILABILITY STATEMENT

Data may be available on request. We will need to consult ethics/governance for approval to share the results.