Quality of life: Assessing the impact and benefits of care to patients with fungating wounds

Fungating malignant wounds are caused by tumor infiltration of the skin. Unless amenable to anti-cancer treatments, the infiltration extends, the wounds advance, and the management goals are palliative. Palliative care optimizes quality of life (QoL) through the control of physical symptoms and attention to patients' psychosocial needs. Quality of life in the context of palliative care and fungating wounds may therefore be conceptualized in terms of focused outcomes of interventions, including dimensions, such as hope, meaning, and self-esteem. Two disease-specific measurement tools have been identified and can be used to assess and measure the outcomes of fungating wound management together with the impact of the condition on the individual: the Wound and Symptoms Self-Assessment Chart (WoSSAC) and Treatment Evaluation by LE Roux's method (TELER(R)). Both focus on the palliative management of fungating wounds, and although not located in the QoL literature, they address QoL issues. The tools differ fundamentally in their approaches to assessment and measurement, which center on the differences between generic and individualized models of measurement and include the generalization of attributes and use of fixed-item formats. The conceptual framework that underpins the TELER system relates to key themes drawn from the QoL literature. These themes focus on the individual, reconciliation of expectations and hopes, needs as defined by individuals with health-care professionals, and continuous QoL assessment.