Page 8 - Wound Care at End of Life Content: A Guide for Hospice Professionals - DEMO

BUILDing the Goals of Care

Regardless of determined goal, Prevention and patient Preference are ALWAYS included in care plan:
Prescription: Goal is healing wound with appropriate treatment. Care plan includes interventions for
treatable wounds. Even at end‐of‐life, some wounds may be healable with appropriate treatments.
Interventions must:
 Treat the cause
 Remain patient‐centered
 Address quality of life concerns (eg: pain, odor)
Preservation: Goal is stabilizing wound condition; healing is unlikely, but deterioration is preventable
with appropriate treatment. Care plan recognizes that wound healing or improvement is limited;
maintenance becomes the desired outcome. The wound may have the potential to heal but overriding
factors (eg: patient refuses treatment, caregiver limitations, inadequate nutrition) result in preservation
as the care plan goal.
Palliation: Goal is comfort and symptom management; healing is not possible and wound may
deteriorate even with best care. Care plan focuses on patient comfort, not healing, and acknowledges
that wounds may deteriorate due to disease progression or dying process. Patients with palliative
wound care goals may benefit from modest interventions (eg: autolytic or enzymatic debridement,
support surfaces).
Prevention: Care plans should address excessive pressure, friction, shear, moisture, nutrition, and
patient mobility. See following sections on environmental, physiologic factors, and support surfaces.
Preference: Preference considers the preferences of the patient and the patient’s caregivers. For
example, the patient may choose “position of comfort” resulting in greater potential for skin
breakdown.
Adapted from SCALE: Skin Changes at Life’s End 1

Chapter 1 References
1. Sibbald RG, Krasner DL, Lutz J. SCALE: Skin changes at life’s end: final consensus statement: October 1,
2009. Adv Skin Wound Care 2010;23(5):225‐236
2. Krasner DL, Rodeheaver GT, Sibbald RG. Interprofessional wound caring. In Krasner DL, Rodeheaver GT,
th
Sibbald RG, eds. Chronic Wound Care: A Clinical Sourcebook for Healthcare Professionals. 4 ed. Malvern,
PA: HMP Communications. ©2007, p.3‐9
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