Researchers from USC and Rancho Los Amigos National Rehabilitation Center recently published an article in Advances in Skin and Wound Care examining the management of life-threatening pressure ulcers in people with spinal cord injury and the serious ethical considerations of their treatment.
Pressure ulcers result in huge medical costs, with surgical treatment cost averaging $60,000 per ulcer. According to published studies, the cost of treating them nationwide is estimated at $1.2 billion annually.
Florence Clark, professor and chair of occupational science and occupational therapy, said that serious ethical issues related to the conduct of surgery include questions regarding the acceptable odds of failure and the appropriate candidates for surgery when the odds of success or failure are taken into account.
For a large number of persons with spinal cord injury, pressure ulcers repeatedly recur, yet it is unclear what accounts for a repeated incidence or unsuccessful repair, Clark said.
Further, there is a tendency among health care workers to blame patients with repeated pressure sores for failing to adhere to recommended routines or preventive measures. At worst, this speculative rationale may then be used to deny potentially lifesaving surgeries because the patient is perceived as irresponsible, Clark said.
In the article, the USC/Rancho team advocated systematically documenting the factors that affect the probability of pressure sore development.
In addition to patient noncompliance with preventive routines, such factors as inadequate nutrition, unemployment, living an overextended lifestyle, skin type, and achievement motivation may contribute to pressure sore risk, they reported.
Last year the team began a study funded by the U.S. National Institute for Disability and Rehabilitative Research to uncover the complexity of lifestyle factors that contribute to pressure sore development.
The three-year, $450,000 grant, involves the use of qualitative methodology to develop an in-depth perspective on how pressure sores emerge in everyday life settings.
The team hopes that once factors leading to pressure sores are better understood, more effective interventions can be implemented to avoid pressure sore occurrence. Interventions that focus on lifestyle are potentially more effective and humane than denying patients surgery based on the current probability of recurrence, Clark said.
The USC/Rancho research team includes Clark and USC researchers Jeanne Jackson, associate professor of occupational science and occupational therapy, along with Rancho Los Amigos researchers Salah Rubayi, chief of the pressure ulcer management program and USC associate clinical professor of surgery; Michael Scott, director of spinal cord rehabilitation; Michal Atkins, occupational therapist and project coordinator, and Kathy Gross, director of occupational therapy. Debra Uhles-Tanaka, a vocational rehabilitation counselor from the California Department of Rehabilitation, is also on the investigative team.