Peter was a 62 year old gentleman with a large, rapidly progressing fungating neck wound. Community based palliative wound management was challenging due to pain, exudate, malodour, risk of catastrophic bleeding and psychosocial issues. The integrity of Peter's wound care as well as his sense of self was maintained by a collaborative approach within the wider interdisciplinary team and trust was built between patient and clinicians, bolstered by Peter's active engagement.
To develop an integrated, multidisciplinary wound management plan for Peter who wanted to be actively involved in the decision making process.
A literature review resulted in a paucity of evidence to guide care planning for fungating wounds. Experienced wound care nurses were consulted. Due to the complexity, a weekly case presentation at the palliative care multidisciplinary team meeting was instigated. An open dialogue was maintained with Peter and his family, so they could provide feedback. Flexible teamwork combined with clear clinical communication facilitated care which took place in a range of locations and by a number of disciplines.
The management of Peter's fungating neck wound was complex and challenging. It was a significant learning experience for all those involved.
Peter specified that his experience was to be used to teach others and this gave meaning to his illness experience and was part of his spiritual care.
Early conversations regarding goals of care enabled the building of trust between patient and the clinicians, supporting patient centred outcomes, for example, clinicians were responsive to Peter's preferences regarding style and type of dressings.
Implication for Practice:
Due to limited evidence in the literature regarding the management of fungating wounds, this work supports the importance of a patient centred approach and palliative care clinicians presenting their complex case studies and findings, as the sharing of knowledge can help guide future care.
This flexible, evolving, multidisciplinary team approach to the management of a person with a fungating wound shows how combining limited evidence, clinician experience and patient preference meets the goals of care and leads to high levels of satisfaction with the care provided.