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Palliative Wound Care

Background

Nursing aspects of palliative wound care are driven by patient and family goals,  integrated with three components of wound management: the management or palliation of the underlying cause of the wound, management of wound-related symptoms, and management of the wound and peri-wound skin, including lymphoedema. Wounds most commonly found include pressure ulcers, fungating malignant wounds, and fistulae. Patients with blistering skin conditions, inherited and acquired, have extensive longstanding wounds and palliative care needs. In addition, meticulous skin care for patients of all ages with debilitating long-term conditions is crucial to prevent unnecessary skin breakdown. The symptoms and psycho-social aspects and local problems associated with broken skin and wounds include odour, exudate, excoriation, maceration, bleeding, pain, and pruritus. Key clinical interventions include the application of wound dressings and skin care products. Unless these wounds and related problems and symptoms are managed effectively and consistently, body image and feelings of self-worth are affected together with the ability to socialise and maintain employment with associated loss of dignity and distance from social contacts.

Skin problems are prevalent in patients with advanced disease who are receiving palliative care. Nursing aspects include the management of skin breakdown and wounds together with related symptoms, and promoting patient comfort and dignity, thereby enhancing the quality of life of patients and families. Palliative wound care encompasses the care of patients, of all ages, with a weakened skin barrier together with the management of wounds caused by advanced and intractable diseases and conditions.

Palliative wound care acknowledges the psychosocial impact of wounds on the individual concerned, their family and friends, and also their clinicians. It is driven by patient and family goals, which are integrated with three wound management components to reduce the impact of wounds on all concerned:

  • management of palliation of the underlying cause of the wound
  • management of wound-related symptoms including physical, psycho-social and existential aspects
  • management of the wound and peri-wound skin.

The difference between curative and palliative wound care, in our view, has more to do with patients quality of life, goal setting and outcome measures than radically different clinical interventions. For example, palliative wound care goals include the management of odour, exudate, bleeding, pain, and the maintenance of an intact dressing system, which are interim goals towards wound healing by secondary intention. Wound healing may also be achievable, demonstrated by a study from Canada where the potential for complete healing of pressure ulcers of grade II and above, skin tears, and diabetic and venous ulcers increased the longer the patients lived.

The following are examples of skin damage and wounds in palliative care:

  • pressure ulcers
  • moisture associated skin damage (such as incontinence- associated dermatitis, per- wound skin damage, and intertriginous dermatitis)
  • skin tears
  • dry irritated skin
  • malignant fungating wounds
  • fistulae
  • blistering skin conditions, for example, epidermolysis bullosa, bullous pemphigoid.
Aims and Objectives
  • To conceptualise palliative wound care in terms of its definition, core elements, and any differences with general wound care management.
  • To develop, through consensus, an agreed set of core outcomes for reporting intervention studies in palliative wound care.
  • To agree the core elements of an undergraduate and post-graduate curriculum on palliative wound care.
  • To provide recommendations for optimal advanced wound care management in this population, for policy initiatives, to promote palliative wound care and areas that need research.
Milestones

September 2020: Agree membership of group, leads for each work package (WP), timelines and communication strategy

WP1: To conceptualise palliative wound care in terms of its definition, elements, and any differences with general wound care management.

  • September 2020 commence literature search.
  • January On-line survey of definitions and terminology
  • April 2021 Presentation and publication of findings

WP2: To develop through consensus an agreed set of core outcomes for reporting of studies in palliative wound care.

  • December 2020 commence literature search and define the scope of the core outcome set (e.g. may be confined to malignant fungating wounds only).
  • June 2021 commence on-line Dephi study
  • December 2021 Presentation and publication of findings

WP3: To agree the core elements of an undergraduate and  post-graduate module on palliative wound care.

  • March 2021 commence review of modules/programmes in palliative wound care.
  • December 2021 Consult with education providers and palliative care partners
  • May 2022 Agree core elements of U/G and P/G modules in palliative wound care.

WP4: To provide recommendations for optimal advanced wound care management in this population, for policy initiatives, to promote palliative wound care and areas that need research.

References
  • GROCOTT, P., GETHIN, G. & PROBST, S. 2013b. Malignant wound management in advanced illness: new insights. Curr Opin Support Palliat Care, 7, 101-5.
  • MAIDA, V., ENNIS, M. & CORBAN, J. 2012. Wound outcomes in patients with advanced illness. Int Wound J, 9, 683-92.
  • PROBST, S., ARBER, A. & FAITHFUL, S. 2013a. Malignant fungating wounds—the meaning of living in an unbounded body. European Journal of Oncology Nursing, 17, 38–45.
  • GETHIN, G. 2011. Management of malodour in palliative wound care. British Journal of Community Nursing, 16, S28–36.
  • GETHIN, G., GROCOTT, P., PROBST, S. & CLARKE, E. 2014. Current practice in the management of wound odour: an international survey. Int J Nurs Stud, 51, 865-74

Chair

Dr. Georgina Gethin

Senior Lecturer, School of Nursing and Midwifery, NUI Galway, Galway, Ireland

Click here to contact by email


Steering Group

Prof Sebastian Probst, Switzerland

Prof Patricia Grocott, UK

Prof Dimitri Beeckman, Belgium

Dr. Joy Odilic,UK 

Dr. Karin Blomberg, Sweden

Sharon Dobbs, UK

Karen Charnley, Ireland 

Additional members from Specialist Palliative Care Community tbc

 

- EAPC Board link


Partner Institutions

All Ireland Institute of Hospice & Palliative Care (AIIHPC)

European Wound Management Association (EWMA)

European Pressure Ulcer Advisory Panel (EPUAP)

 


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