Ensuring that the outcome domains proposed for use in burns research are relevant to adult burn patients: a systematic review of qualitative research evidence.

Background
There have been several attempts to define core outcome domains for use in research focused on adult burns. Some have been based in expert opinion, whilst others have used primary qualitative research to understand patients’ perspectives on outcomes. To date there has not been a systematic review of qualitative research in burns to identify a comprehensive list of patient-centred outcome domains. We therefore conducted a systematic review of qualitative research studies in adult burns.
Methods
We searched multiple databases for English language peer-reviewed qualitative research papers. We used search strategies devised using the SPIDER tool for qualitative synthesis. Our review utilised an iterative three-step approach: (1) outcome-focused coding (2) development of descriptive accounts of outcome-relevant issues (3) revisiting studies and the broader theoretical literature in order to frame the review findings.
Results
Forty one articles were included. We categorised papers according to their primary focus. The category with the most papers was adaptation to life following burn injury (n=13). We defined 19 outcome domains across the 41 articles: (a) sense of self (b) emotional and psychological morbidity (c) sensory (d) scarring and scar characteristics (e) impact on relationships (f) mobility and range of joint motion (g) work (h) activities of daily living and self-care (i) treatment burden (j) engagement in activities (k) wound healing and infection (l) other physical manifestations (m) financial impact (n) impact on spouses and family members (o) analgesia and side effects (p) cognitive skills (q) length of hospital stay (r) access to healthcare and (s) speech and communication. We suggest that sense of self is a core concern for patients that, to date, has not been clearly conceptualised in the burns outcome domain literature.
Conclusions
This outcome domain framework identifies domains that are not covered in previous attempts to outline core outcome domains for adult burn research. It does so with reference to existing theoretical perspectives from the sociology and psychology of medicine. We propose that this framework can be used as a basis to ensure that outcome assessment is patient-centred. Sense of self requires further consideration as a core outcome domain.

Keywords: outcome domains; adult burns; qualitative research; systematic review.