Basics of Palliative Wound Care for Professionals
While wound care professionals should always aim to provide curative care to their patients, this isn’t always possible. Some patients will have terminal health conditions that are non-responsive to curative therapies. The treatment objective in this group of individuals is not to achieve complete wound resolution, rather it is to make the patients as comfortable as possible at the endpoint of their lives.
What Is Palliative Wound Care?
Palliative wound care refers to strategies involved in relieving the symptoms experienced by patients with terminal illnesses or diseases that prevent complete wound resolution due to their negative effects on normal body physiology. Palliative care aims to improve the quality of life experienced by patients with chronic debilitating illnesses, as well as those in their last stages of terminal medical conditions by offering symptomatic control for distressing events. Basically, palliative care is all about providing the maximum comfort, decency, and dignity for terminal patients while explaining outcomes, and handling the expectations of their loved ones in an empathic but realistic manner.
Palliative Wound Care vs. Curative Wound Care
All wound care specialists owe their patients the obligation of clarifying treatment goals as early in the management period as possible. In most patients with acute wounds and no underlying medical conditions, the goal of therapy is curative. However, for a significant number of patients with acute to chronic wounds or comorbid conditions like hypertension, diabetes mellitus, and peripheral arterial disease, a palliative approach to wound care should be advocated.
Wound care professionals should be able to combine relevant patient history, the presence of clinical features, laboratory analysis, and radio diagnostics to predict treatment outcomes. A wound with potential for full resolution will show signs of improvement while a wound selected for palliative care will fail to improve even with aggressive therapies.
Benefits of Palliative Wound Care
The benefits of opting for a palliative wound care program are numerous. To begin with, palliative wound care presents a unique opportunity to improve a patient's quality of life. Minimizing distressing symptoms associated with terminal diseases will allow affected patients to live as comfortably as possible. Also, palliative wound care allows wound care professionals to avoid exposing their patients to unnecessary, and often physically or mentally traumatizing therapies which promise little if any improvement.
In these instances, careful symptom control is of more benefit to the patients involved. Finally, opting for conservative wound management as their disease state progresses, allows patients, and their relatives to come to terms with the outcomes of therapy. Clearly defining palliative wound care goals allows them to process and overcome negative feelings about their health states.
Components of Palliative Care
There are various aspects of palliative care all wound care professionals must employ if they are to effectively manage patients who can no longer benefit from curative treatments. The key components every palliative wound care plan must contain include:
- Pain management
- Infection control
- Managing wound exudate
- Wound odor control
- Diet/nutritional support
- Psychological support
The control of pain associated with terminal illnesses and uncurable wounds is a critical factor in palliative care. Patients must be given adequate and appropriate analgesia to control this symptom at all stages of endpoint care. Opioid analgesia, non-steroidal anti-inflammatory drugs, and anticonvulsants can be used to treat pain after careful consideration of symptom severity and drug side effect profile.
Due to the non-healing nature of wounds associated with patients selected for palliative care, there is an ever-present risk of colonization by pathogenic microorganisms with subsequent infection. Consequently, the use of appropriate antibiotic/antifungal therapies in wound palliation is critical to attaining set treatment goals. Further, careful, continuous local wound care helps wound care professionals limit microbial contamination of wound sites. Gentle cleansing and debridement play a key role in this regard.
Managing Wound Exudate
Wound exudate typically occurs as a consequence of wound healing attempts by injured tissues. In patients with non-healing chronic wounds, excessive production of exudate can worsen tissue damage. The enzymatic breakdown from proteinases contained within the wound fluid can be controlled by the use of absorptive dressings which keeps the wound site as dry as possible.
Wound Odor Control
The wounds in patients with terminal conditions are typically malodorous. This can negatively impact the relationship they have with their loved ones, and damage their self-esteem. Social isolation resulting from offensive wound odors must be handled as a top priority in palliative wound care. The use of odor-reducing dressings containing carbon/charcoal, as well as regular wound cleansing, and debridement are effective methods to tackle offensive wound odors.
Patients requiring palliative wound care often develop a loss of appetite as their disease state progresses. These patients experience increasing difficulties in maintaining adequate oral intake of required nutrients. The focus in palliative wound care would be to encourage affected patients to eat and drink smaller meals as often as possible to offset any nutritional deficits. In patients who are completely unable to tolerate orally, wound care experts may consider enteral nutrition.
Palliative wound care must integrate psychological therapy to help patients cope with the mental health implications of their treatment. Group therapy involving family members can be initiated to help patients cope with their anxiety, fears, grief, and also clarify treatment expectations.