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Please use this identifier to cite or link to this item: http://hdl.handle.net/1860/3757

Title: Wounds at the End of Life: Wound Symptoms and Severity, Quality of Life, and Patient-Reported Symptoms and Preferences for Care
Authors: Emmons, Kevin Richard
Keywords: Nursing;Wounds;End of life
Issue Date: 12-Jul-2012
Abstract: Introduction. Wounds can impact all facets of life including physical, psychosocial, and spiritual aspects. Persons with advanced illness are at especially high risk for developing wounds, with over 43 types identified in this population. Hospice patients with cancer are exemplary of a population where patients have significantly advanced illness. 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. Methods. 22 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. The HQLI index mean score was 142.59 (SD 32.95) and the CWIS mean score was 115.45 (SD 44.31). 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 (p=0.021). In particular, the Physical Symptoms and Daily Living subscale was correlated to wound severity (p=0.009). Using a linear regression analysis, exudate type (p=0.000) and amount (p=0.051) has a significantly negative relationship with overall CWIS quality of life. Lack of granulation tissue (p=0.026), exudate amount (p=0.047) and type (p0.000), and necrotic tissue amount (p= 0.005) were factors that had a negatively significant relationship with the Physical Symptoms and Daily Living QoL subscale. 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.
URI: http://hdl.handle.net/1860/3757
Appears in Collections:Health Sciences Theses and Dissertations

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