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Published Online: 6 November 2007

Incorporating Wound Healing Strategies to Improve Palliation (Symptom Management) in Patients with Chronic Wounds

Publication: Journal of Palliative Medicine
Volume 10, Issue Number 5

Abstract

Background: Palliative wound care should be centered on symptom management and is a viable option for patients whose chronic wounds do not respond to standard interventions, or when the demands of treatment are beyond the patient's tolerance or stamina. Palliative wound care is the incorporation of strategies that prioritize symptomatic relief and wound improvement ahead of wound healing (total closure). Palliative wound care strategies must also work in conjunction with curative treatment objectives as wounds often heal completely in spite of serious illness and advanced disease. Palliative wound care is much more than pain, exudate and odor management. Common curative treatment goals such as physical correction of the underlying pathology, addressing nutrition and other supportive aspects of care, and sensible (nonharmful) local wound treatments should never be ignored.
Objective: (1) To provide a fresh and effective approach to palliative wound care by integrating individual clinical expertise with clinical and laboratory evidence from the (curative) wound healing literature and (2) to share our (Calvary Hospital) experience and approach to palliative wound care in an inpatient, home, and outpatient setting. This approach can be summarized with the mnemonic S-P-E-C-I-A-L (S = stabilizing the wound, P = preventing new wounds, E = eliminate odor, C = control pain, I = infection prophylaxis, A = advanced, absorbent wound dressings, L = lessen dressing changes). Throughout this paper we will offer rationale, principles and recipes, for each of the steps of the “SPECIAL” approach in an effort to facilitate the caring for chronic wounds in palliative medicine.
Conclusions: A practical marriage of wound palliation (symptom management) with current wound healing concepts to provide options for the palliative care provider and improve the practice of palliative medicine.

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cover image Journal of Palliative Medicine
Journal of Palliative Medicine
Volume 10Issue Number 5October 2007
Pages: 1161 - 1189
PubMed: 17985974

History

Published online: 6 November 2007
Published in print: October 2007

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Oscar M. Alvarez
The Palliative Care Institute and The Center for Curative and Palliative Wound Care, Calvary Hospital, Bronx, New York.
Cathy Kalinski
The Palliative Care Institute and The Center for Curative and Palliative Wound Care, Calvary Hospital, Bronx, New York.
Jeanne Nusbaum
The Palliative Care Institute and The Center for Curative and Palliative Wound Care, Calvary Hospital, Bronx, New York.
Luz Hernandez
The Palliative Care Institute and The Center for Curative and Palliative Wound Care, Calvary Hospital, Bronx, New York.
Emanuel Pappous
The Palliative Care Institute and The Center for Curative and Palliative Wound Care, Calvary Hospital, Bronx, New York.
Charles Kyriannis
The Palliative Care Institute and The Center for Curative and Palliative Wound Care, Calvary Hospital, Bronx, New York.
Rachelle Parker
The Palliative Care Institute and The Center for Curative and Palliative Wound Care, Calvary Hospital, Bronx, New York.
Gail Chrzanowski
The Palliative Care Institute and The Center for Curative and Palliative Wound Care, Calvary Hospital, Bronx, New York.
Christopher P. Comfort
The Palliative Care Institute and The Center for Curative and Palliative Wound Care, Calvary Hospital, Bronx, New York.

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