The palliative management of fungating malignant wounds.

Abstract

This study focused on the palliative management of fungating malignant wounds and individual experiences of living with such a wound. Dressings were evaluated for the ability to contain these wounds and reduce their impact on daily life. The project extended to collaboration with industry for the development and evaluation of dressings designed to meet patient needs. A longitudinal multiple case study design was adopted. The methodology evolved through three principal phases: quasi-experimental design; emergent collaborative design; and emergent theory-driven evaluation. The radical departure from the initial approach was in response to the methodological problems encountered in a study of individuals with uncontrolled disease. A non-probability sampling plan was adopted, mainly because of the lack of homogeneity in the patient population; 45 participants were included. The length of time patients remained in the study depended on how long they lived. This ranged from a few days to more than two years. A sampling plan was, however, adopted for the data collection. The study had a dual focus: methodology, and the generation of explanations for dressing performance and the management of fungating wounds. The methodological aspect included development of the Teler system as a method of measuring dressing performance against goals of optimal practice in fungating wound management. The second component was a system of reasoning developed as an analytical strategy for abstracting general issues from individual case study data in order to construct explanations. Theory was used to generalize beyond the individual cases. Two forms of explanation for fungating wound management were constructed. These included explanations of individual experiences of living with such a wound and knowledge of the elements of fungating wound management. The impact on the individual was explained in terms of the stigma attached to public disability and a revulsion in society for uncontrolled body fluids. A pivotal relationship emerged between exudate and other wound management problems, including psychosocial aspects. A final critical explanation was developed for the qualification of the theory of moist wound healing to explain the phenomenon of exudate management in fungating and, possibly, other exuding chronic wounds.