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Tam SH, Lai WS, Kao CY, Fang SY. "Maintain Professionalism": Nurses' Experiences in Caring for Patients with Malignant Fungating Wounds in Taiwan. J Pain Symptom Manage 2024; 68:69-77.e1. [PMID: 38621610 DOI: 10.1016/j.jpainsymman.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 03/30/2024] [Accepted: 04/04/2024] [Indexed: 04/17/2024]
Abstract
CONTEXT Malignant fungating wounds (MFWs) occur among 5%-15% of patients with terminal cancers, the uncontrollable symptoms result in serious psychosocial issues, thereby reducing the quality of life. Caring for MFWs impacts caregivers, including healthcare personnel. While existing studies are patient-focused, the impact of care experiences and associated support for nurses has not been examined. OBJECTIVES To explore the experiences in caring for patients with MFWs among nurses in Taiwan. METHODS Qualitative study with a phenomenological approach by thematic analysis was conducted with semi-structured interviews. About 15 nurses who cared for patients with MFWs at local district hospitals in Southern Taiwan. RESULTS Four themes were identified to describe the phenomenon: (1) Fear of Unpredictability (2) Maintaining Professionalism (3) Feeling Helpless (4) Rationalizing the Negatives. The themes illustrated the distress of managing physical symptoms and highlighted how nurses strived to promote comfort for patients. Nurses felt helpless about the incurable nature of MFWs but found a way to suppress their feelings. CONCLUSION The findings suggested the need for addressing the emotional well-being of nurses who take care of patients with MFWs. Future studies should identify effective coping strategies for nurses' health when caring for this population.
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Affiliation(s)
- Sin Hang Tam
- Medical Oncology and Palliative Care (S.H.T.), St George's University Hospitals NHS Foundation Trust, London, UK
| | - Wei-Sue Lai
- Department of Nursing, College of Medicine (W.S.L., C.Y.K., S.Y.F.), National Cheng Kung University, Tainan, Taiwan
| | - Chi-Yin Kao
- Department of Nursing, College of Medicine (W.S.L., C.Y.K., S.Y.F.), National Cheng Kung University, Tainan, Taiwan
| | - Su-Ying Fang
- Department of Nursing, College of Medicine (W.S.L., C.Y.K., S.Y.F.), National Cheng Kung University, Tainan, Taiwan; Department of Nursing (S.Y.F.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Firmino F, Santos J, Meira KC, de Araújo JL, Júnior VA, de Gouveia Santos VLC. Regenerated oxidised cellulose versus calcium alginate in controlling bleeding from malignant breast cancer wounds: randomised control trial study protocol. J Wound Care 2020; 29:52-60. [PMID: 31930944 DOI: 10.12968/jowc.2020.29.1.52] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Malignant wounds due to breast cancer can present with recurrent episodes of bleeding in the tumour tissue. This study will compare the efficacy of a calcium alginate dressing (Biatain, Coloplast A/S, Denmark) and a regenerated oxidised cellulose dressing (Surgicel, Ethicon, LLC, Puerto Rico). PROTOCOL A total of 24 patients with breast cancer and bleeding, malignant wounds will be enrolled in the randomised, controlled, open study, conducted at a hospital specialising in breast cancer treatment and at another hospital specialising in palliative care. Patients over 18 years old, with bleeding and willing to undergo venipuncture for blood collection will be included. All enrolled patients will be randomised for allocation to an experimental group (regenerated oxidised cellulose dressing) or a control group (calcium alginate dressing). The main intervention will consist of the application of the haemostatic product, assessment of digital pressure and estimation of the time required for haemostasis. OUTCOMES Key outcome measures will be the percentage of patients with haemostasis within 20 minutes, observation of haemostasis after three, five and 10 minutes, in addition to recurrence of bleeding and the quantity of product used. DISCUSSION To our knowledge, this is the first study to evaluate the effectiveness of haemostatic products in malignant wounds. This type of wound is poorly explored in the literature and, among its signs and symptoms, bleeding is poorly studied. The completion of this study will provide a more robust rationale for clinical decision-making related to the control of bleeding in malignant breast cancer wounds in the context of evidence-based nursing practices.
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Affiliation(s)
- Flávia Firmino
- School of Nursing of the University São Paulo, São Paulo, Brazil.,National Cancer Institute José Alencar Gomes da Silva. Palliative Care Unit - Hospital of Cancer IV/HC IV, Rio de Janeiro, Brazil
| | - Juliano Santos
- School of Nursing of the University São Paulo, São Paulo, Brazil.,National Cancer Institute José Alencar Gomes da Silva. Palliative Care Unit - Hospital of Cancer IV/HC IV, Rio de Janeiro, Brazil
| | - Karina Cardoso Meira
- School of Health of the Federal University of Rio Grande do Norte, Rio Grande do Norte, Brazil
| | | | - Valter Alvarenga Júnior
- Post-Graduate Program in Surgical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,National Cancer Institute José Alencar Gomes da Silva, Hospital of Cancer III, Unit of Treatment and Control of Breast Cancer, Rio de Janeiro, Brazil
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Tilley CP, Fu MR, Van Cleeve J, Crocilla BL, Comfort CP. Symptoms of Malignant Fungating Wounds and Functional Performance among Patients with Advanced Cancer: An Integrative Review from 2000 to 2019. J Palliat Med 2020; 23:848-862. [DOI: 10.1089/jpm.2019.0617] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charles P. Tilley
- New York University Rory Meyers College of Nursing, New York, New York, USA
- Calvary Hospital and Hospice, Bronx, New York, USA
| | - Mei R. Fu
- New York University Rory Meyers College of Nursing, New York, New York, USA
- Boston College William F. Connell School of Nursing, Boston, Massachusetts, USA
| | - Janet Van Cleeve
- New York University Rory Meyers College of Nursing, New York, New York, USA
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Žulec M, Rotar-Pavlič D, Puharić Z, Žulec A. "Wounds Home Alone"-Why and How Venous Leg Ulcer Patients Self-Treat Their Ulcer: A Qualitative Content Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E559. [PMID: 30769943 PMCID: PMC6406886 DOI: 10.3390/ijerph16040559] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/01/2019] [Accepted: 02/12/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Venous leg ulcers (VLUs), the most common type of leg ulcerations, have long healing times and high recurrence rates; reimbursement rules and a general shortage of nursing staff have put self-treatment into focus. The study aimed to investigate why and how patients with VLUs self-treat their ulcers. METHODS Patients with VLUs (N = 32) were selected by criterion sampling for a multicentric qualitative study using semi-structured interviews. The interviews were analyzed via inductive qualitative content analysis. RESULTS More than two-thirds of participants sometimes self-treated VLU and one quarter changed their prescribed treatment. Experiences were expressed through four themes as follows: (a) current local VLU therapy; (b) VLU self-treatment; (c) patient education; and (d) psychosocial issues. The main reasons for self-treatment were a lack of healthcare resources, reimbursement restrictions, and dissatisfaction with conventional treatment together with insufficient knowledge about the wound-healing process and possible side effects. No educational materials were provided for patients or caregivers. Many patients adopted homemade remedies. CONCLUSION Patients with VLUs practice self-care due to limited healthcare availability, a low awareness of the causes of their condition, and the effects of therapy on VLU healing. Future educational intervention is needed to enhance self-treatment.
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Affiliation(s)
- Mirna Žulec
- Medical Faculty, Department of Family Medicine, University of Ljubljana, Poljanski nasip 58, Ljubljana 1000, Slovenia.
- Study of Nursing, Bjelovar University of Applied Sciences, Trg. E.Kvaternika 4, Bjelovar 43000, Croatia.
| | - Danica Rotar-Pavlič
- Medical Faculty, Department of Family Medicine, University of Ljubljana, Poljanski nasip 58, Ljubljana 1000, Slovenia.
| | - Zrinka Puharić
- Study of Nursing, Bjelovar University of Applied Sciences, Trg. E.Kvaternika 4, Bjelovar 43000, Croatia.
| | - Ana Žulec
- Polyclinic Marija, Kneza Mislava 2, Zagreb 10000, Croatia.
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Lo SF, Hayter M, Hu WY, Tai CY, Hsu MY, Li YF. Symptom burden and quality of life in patients with malignant fungating wounds. J Adv Nurs 2011; 68:1312-21. [PMID: 22043819 DOI: 10.1111/j.1365-2648.2011.05839.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This study describes the relationship between symptoms and quality of life in patients with malignant fungating wounds. BACKGROUND Malignant fungating wounds are complex wounds that can bleed, become malodorous due to infection and are painful causing physical and psychological distress. However, there is a lack of literature on the impact that such wounds can have on quality of life. METHODS This was a descriptive, cross-sectional multi-centre study of patients with malignant fungating wounds. Participants were recruited from the palliative care, hospice, outpatient clinic and oncology units of three medical centres in Taiwan. Data were collected from February 2008 to August 2009. A structured questionnaire obtained socio-demographic information, medical details, wound assessment information and the Taiwanese version of the McGill quality of life questionnaire was administered by interview. RESULTS McGill quality of life scores indicated that the participants had the lowest quality of life. The participant's age, dressing change frequency, pain, wound dressing comfort, wound symptom, bleeding and malodour had statistically significant negative correlations with quality of life. Multiple regression analysis showed that age, malodour, pain issues and psychological issues explained 87% of the total variance in quality of life. CONCLUSION This study contributes to our understanding of the impact of malignant fungating wounds and how correct assessment and management is necessary to improve quality of life. Educational intervention research is needed for patients and caregivers in countries where this has not yet been performed. Further research should also identify whether nursing competence has a direct impact on quality of life.
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Affiliation(s)
- Shu-Fen Lo
- Department of Nursing, Tzu Chi College of Technology, Hualien, Taiwan
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An avalanche of ignoring--a qualitative study of health care avoidance in women with malignant breast cancer wounds. Cancer Nurs 2011; 34:277-85. [PMID: 21252644 DOI: 10.1097/ncc.0b013e3182025020] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A contributing factor to development of malignant wounds is patient-related delay caused by health care avoidance. OBJECTIVE The purpose of this study was to describe the experience of health care avoidance in women with advanced breast cancer who have developed malignant wounds. METHODS A qualitative study was conducted based on semistructured interviews. Seventeen women with advanced breast cancer (median age, 69 years; range, 47-90 years) who had avoided medical treatment despite development of malignant wounds participated. Systematic text-condensation analysis was used. RESULTS The women deliberately avoided health care for a median of 24 months (minimum, 3 months; maximum, 84 months). Despite being aware of the development of a malignant wound from a breast lump, the women avoided health care because of negative health care experiences and extremely burdening life situations. The women did not seek health care until their situations became unmanageable. The essence--"an avalanche of ignoring"--is pointing to the escalating, powerful development of destructive feelings behind health care avoidance. CONCLUSIONS Health care avoidance may be a way of coping both for women who are primary and/or bereaved caregivers. Oncologists and nurses may contribute to the prevention hereof by means of information about the early signs of cancer, benefits of early diagnosis and treatment, and by paying special attention to these women, who may be at high risk for avoidant behaviors. IMPLICATIONS FOR PRACTICE In a preventive perspective, it seems advantageous to bring into focus the health of primary and bereaved caregivers, thereby potentially reducing patient delay and ultimately improving survival.
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Lund-Nielsen B, Adamsen L, Kolmos HJ, Rørth M, Tolver A, Gottrup F. The effect of honey-coated bandages compared with silver-coated bandages on treatment of malignant wounds-a randomized study. Wound Repair Regen 2011; 19:664-70. [PMID: 22092836 DOI: 10.1111/j.1524-475x.2011.00735.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 08/15/2011] [Indexed: 12/31/2022]
Abstract
Malignant wounds (MWs) occur in 5-10% of all cancer patients. Malodor and exudation are the most common side effects. The aim was to determine the influence of honey-coated compared with silver-coated bandages on treatment of MWs. Patients were randomly selected to enter either group A (honey-coated bandages) or group B (silver-coated bandages). Parameters were the following: wound size, cleanliness, malodor, exudation, and wound pain. Digital photographs, visual analog scales (VAS), and wound morphology registration were used for measurement at baseline and following the 4-week intervention. Sixty-nine patients with MWs and advanced cancer, aged 47-90 (median 65.6), were included. No statistically significant difference was noted between the groups with respect to wound size, degree of cleanliness, exudation, malodor, and wound pain. There was a median decrease in wound size of 15 cm² and 8 cm² in group A and B, respectively (p = 0.63). Based on post-intervention pooled data from the groups, improvement was seen in 62% of the participants with respect to wound size and in 58% (n = 69) with respect to cleanliness. The VAS score for malodor (p = 0.007) and exudation (p < 0.0001) improved significantly post-intervention. Patients with reduced wound size had a median survival time of 387 days compared with 134 days in patients with no wound reduction (p = 0.003). The use of honey-coated and silver-coated bandages improved the outcome of MWs. No differences were found between the two regimens. Both types of bandages are recommended for use by patients with MWs containing tumor debris and necrosis.
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Affiliation(s)
- Betina Lund-Nielsen
- The University Hospitals Center for Nursing and Care Research, Copenhagen, Denmark.
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