A Focus on Palliative and Hospice Wounds
This month, Corstrata turns attention to a uniquely complex and often underserved area of wound care: palliative and hospice wounds. In these patients, the goal shifts from complete wound healing to symptom management, comfort, and quality of life. Early identification of wound healability and proactive symptom control can significantly improve the patient and caregiver experience — while preventing avoidable escalations.

What We See: A Patient Example
Setting: Home Hospice | Consult Type: Store-and-forward

A 75-year-old female with advanced Stage IV cancer and multiple metastases presented with a large sacral Stage 4 pressure injury. She was bedbound, with significant pain, pruritus, odor, and heavy exudate, signs of local infection, declining appetite, and social withdrawal.

The Corstrata clinical team determined the wound to be non-healable and shifted the goal from healing to symptom management, recommending:

Antimicrobial cleansing (hypochlorous acid)
Superabsorbent silicone dressings to reduce dressing frequency
Periwound skin protection
Odor management (topical and environmental strategies)
Pressure offloading (low air loss mattress, turning schedule)
Coordinated pain management (topical and systemic)
Clinical outcome: Expedited reduction in odor and exudate, decreased pain and pruritus within days, improved appetite and increased family interaction, and enhanced overall quality of life.

Common Myths, Challenges, and Mistakes
Myth: "All wounds should be treated as healable." Reality: Not all wounds can be healed. In hospice and palliative care, accurately assessing healability is critical to avoid burdensome or unnecessary interventions, focus on comfort and dignity, and align care with patient goals.

Myth: "Pressure injuries require in-person specialty consults to manage appropriately." A common mistake is continuing aggressive, healing-focused treatment on non-healable wounds — which can increase pain from frequent dressing changes and debridement, cause emotional distress for patients and families, and overuse resources without meaningful benefit.

Clinical tip: Symptom control, not closure, is often the primary goal. Dressing selection should prioritize comfort, wear time, and minimal disruption.

Healability Assessment: Why It Matters
All wounds fall into one of three categories:

Healable — adequate blood supply and a treatable cause
Maintenance — potential to heal, but barriers exist (e.g., adherence, resources)
Non-healable — irreversible causes (e.g., advanced malignancy, critical ischemia)
Determining healability early helps guide treatment intensity, frequency of interventions, and patient/caregiver expectations. The related Palliative Wound Symptom Checklist focuses on controlling key symptoms: pain, odor, exudate (drainage), infection/bioburden, bleeding risk, and pruritus (itching).

What's New in Wound & Ostomy Care
Clinical pearl: In hospice patients, reducing dressing frequency is one of the most impactful interventions available. Strategies include using superabsorbent or advanced dressings to extend wear time, selecting atraumatic (silicone) contact layers to reduce pain, and matching dressing choice to drainage level. Small changes in approach can meaningfully improve patient comfort, caregiver burden, and overall quality of life.

When to Consider a Corstrata Consult
Uncertainty about wound healability
High symptom burden (pain, odor, exudate, bleeding)
Suspected infection in a palliative wound
Difficulty managing dressing frequency or tolerance
Need to align wound care with goals of care
Where Corstrata Fits
Corstrata's virtual wound and ostomy specialists support palliative and hospice wound care across the continuum:

Home Health & Hospice: Symptom management, healability assessment, caregiver support
Hospital at Home: Complex wound oversight in high-acuity patients
Post-Acute & SNFs: Aligning treatment plans with goals of care
Our team helps establish realistic care goals, guide symptom-focused treatment plans, and reduce unnecessary escalations and transfers. Consults are available via store-and-forward image review or live video.

Ready to bring virtual wound and ostomy expertise to your palliative and hospice patients? Reach out to your Corstrata team to schedule a consult.