Wound at End of Life: Wound Symptoms and Severity, Quality of Life, and Patient-Reported Symptoms and Preferences for Care

Introduction. Greater than one third of patients in hospice will have or develop a wound. The purpose of this research is to determine the impact wounds have on quality of life (QoL) among cancer patients in hospice and to identify patient preferences for symptom control and relevant outcomes/endpoints. Subjects were recruited from a hospice that serves the Philadelphia metropolitan area. Three instruments were used: the Hospice Quality of Life Index (HQLI) for general QoL measurement; the Cardiff Wound Impact Schedule (CWIS) for wound- specific QoL; and the Bates-Jensen Wound Assessment Tool (BWAT) to assess wound severity. In addition, a Maxdiff preference scaling program was used to examine patient preferences related to symptoms and relevant endpoints. Results. A pilot sample was obtained. The HQLI QoL scores and subscores among these subjects were the lowest than any reported in the literature. Wound scores indicated that wounds experienced by the subjects were either moderate or severe regarding BWAT wound severity. Correlation and regression analyses revealed that wound severity significantly correlated with CWIS quality of life. In particular, the Physical Symptoms and Daily Living subscale was correlated to wound severity. Through a Maxdiff preference scaling technique, subjects identified pain, odor, drainage, and bleeding as the most important factors to manage in wound care over wound healing. Conclusion. These results indicate that the more severe the wound the worse the quality of life of among cancer patients in hospice. Wound factors such as drainage and dead tissue had the greatest impact on quality of life. Subjects preferred wound care to reflect symptom management over wound healing endpoints.

This was funded by a WOCN CCI grant.