By Aletha Tippett MD

Palliative wound care is a relatively new field targeting wound treatment for patients at the end of life, or patients with terminal disease or inability to tolerate standard care. The traditional goal of wound care is to heal or prepare for surgical closure, but techniques and procedures used to “heal” a wound can be painful or uncomfortable and very costly, plus patients who qualify for palliative care may not live long enough to heal a wound.

Even with limitations on wound healing, it is inappropriate to ignore wounds or declare them untreatable in patients at the end of life (1). Palliative wound care requires a different mindset than traditional wound care, yet is based on the same fundamental scientific principles. An all-embracing approach to palliation in wound care involves:

• Being able to properly assess the patient and wound to determine if palliation is appropriate;
• Developing a comprehensive strategy for palliation of various types of wounds—pressure, arterial, malignant, neuropathic and stasis;
• Considering alternative treatment modalities, including biotherapy;
• Choosing proper support surfaces to enhance care of the patients and their wounds;
• Considering interdisciplinary approach with nutrition, surgery and vascular surgery as indicated; and
• Managing symptoms of chronic wounds, especially pain and odor.

An effective palliative wound program has many benefits, including improved quality of life and achieving the goal of healing the whole person. It continues to be a challenge to successfully incorporate palliative care concepts into our existing health care system that focuses so heavily on disease eradication. It is equally challenging to integrate palliative concepts throughout the continuum of wound care when the primary goal has always been curative. Palliative wound care is the merging of symptom management into advanced wound care. Palliative care goals work in tandem with those aimed at complete wound closure, addressing objectives focused on quality of life issues for both patient and family. Palliative wound care is ideal for those wounds in which the underlying etiology does not respond to treatment and or the demands of treatment are beyond the patient’s tolerance or stamina. Palliative principles introduced early into wound care provides the patient and their families options that maximize functional status and quality of life, shifting the priorities from curative to palliative as the progressive nature of the disease demands. Surprisingly, good palliative care can result in wound healing in nearly half of patients (2).

The Third Annual Palliative Wound Conference in Stevenson, Washington, May 17-19, 2012 will teach multiple aspects of palliative wound care. It includes presentations by nationally acclaimed faculty and hands-on workshops. For more information, visit www.hopeofhealing.org.

Sources
1. Cuddigan, J. NPUAP-EPUAP Pressure Ulcer Prevention & Treatment Guidelines. NPUAP & EPUAP, 2009. Available at: http://www.npuap.org.
2. Tippett, A. Wounds at the End of Life. Wounds. 2005:17(4):91-98.

About The Author
Aletha Tippett MD is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, family physician, and international speaker on wound care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.