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Pressure ulcers in individuals receiving palliative care: a National Pressure Ulcer Advisory Panel white paper.

INTRODUCTION About 300 million individuals, or 3% of the world’s population, need palliative or end-of-life care each year. Palliative care is designed to provide relief from suffering and enhance the quality of both the living and dying processes for the patient and family, while neither hastening nor prolonging death. Many professionals concur that pressure ulcers (PrUs) occurring at the end of life are often not preventable and that efforts to prevent them are complicated because of the patient’s frail condition. Many professionals also agree that it may be impossible to eradicate PrUs in the terminally ill because of the multiple risk factors and comorbid conditions. PrU development, however, can decrease quality of life physically, emotionally, socially, and mentally. A systematic review of research on PrUs and quality of life reported that PrUs had significant impact in all aspects of life. Usual care of a PrU is designed to promote healing; however, healing or closing the ulcer in patients receiving palliative care is often improbable. Therefore, the focus of care is better directed to reduce or eliminate pain, odor, and infection and allow for an environment that can promote ulcer closure, as well as improve self-image to help prevent social isolation. Healthcare providers also need to advocate for and develop products that control complications and deliver symptomatic relief to promote a desirable quality of life of the patient and family. The purpose of this white paper is to review and summarize the current scientific evidence for prevention and care of a PrU in a palliative care patient. Although randomized controlled studies are few, a moderately sufficient informed clinical consensus, as well as less rigorous scientific studies, does exist to support a variety of care approaches for the palliative individual with a PrU. Gaps in the literature will be identified, and current recommendations for practice will also be reviewed. The recommendations presented are those included in the 2009 National Pressure Ulcer Advisory Panel (NPUAP)–European Pressure Ulcer Advisory Panel (EPUAP) International Pressure Ulcer Prevention and Treatment Guidelines.