Principles of wound care in palliative care

Wound management and the choice of dressing in palliative care depend on the characteristics of the patient’s wound and whether the wound is expected to heal. Consider the potential benefits and burdens of treatment and the patient’s prognosis, preferences and goals of care—see Principles of symptom management in palliative care.

Specific considerations for wound care in palliative care are discussed in this topic, including:

• bleeding wounds
• cutaneous malignant wounds
• exudative wounds
• malodorous wounds
• painful wounds
• pressure injuries.

For general information on assessing and managing wounds, see the Ulcer and Wound Management guidelines.

In patients with advanced life-limiting illness who have wounds not expected to heal (eg cancer-associated wounds [often called fungating wounds], pressure injuries), choose a dressing that provides comfort, minimises odour and improves quality of life. It may be necessary to try a number of different dressings to find one that meets the needs of the patient and carer and does not exacerbate symptoms.

If the aim of management is comfort rather than wound healing, reduce the frequency of dressing changes to optimise wound care while minimising distress associated with dressing changes. Ensure dressings are well moistened before gentle removal, to prevent trauma, bleeding and pain; nonadherent dressings are preferred. If a dressing change is likely to be painful or distressing, give adequate analgesic therapy with enough time to take effect beforehand (see Incident pain in palliative care). In some cases, it may also be necessary to prescribe an anxiolytic; seek specialist advice if required.

Aim to achieve the best cosmetic effect possible with dressings. Different approaches may be tried; for example, avoid bulky, unsightly dressings and use minimal skin strapping for social occasions. Cosmetics and perfumes may help to mask the wound or associated odour. Relaxation techniques and psychological support can be helpful.

Dressings and wound care supplies are provided by some nursing and palliative care services, or may be accessible on prescription (eg patients with Department of Veterans’ Affairs entitlements) or privately purchased. Wound care or stomal therapy nurses can provide advice and assistance with wound management. Alternatively, seek advice from a specialist palliative care service.

The psychological and social impact of living with a wound that is not expected to heal should not be underestimated. Wounds that are unsightly, malodorous or weeping can cause distress and be disabling for patients, and difficult for family and carers to manage. A holistic approach to care with meticulous attention to detail can improve a patient’s confidence, morale and wellbeing, and reduce their sense of isolation. It is important to negotiate the goals of care and discuss realistic expectations with the patient, family and carers. Explain and provide written information about how to care for wounds not expected to heal.