Abstract
BACKGROUND: Devising therapy strategies for the care of a malignant fungating wound caused by cancer presents significant challenges to patients, their informal carers and health care professionals. Good management of malignant fungating wounds is important as such wounds can have significant physiological and psychological and emotional consequences and impact on quality of life. AIM OF STUDY: This study aims to examine the lived experiences of women with a malignant fungating breast wound and their informal carers. METHODOLOGY AND METHOD: To explore the lived experiences a methodological framework of the Heideggerian hermeneutic phenomenological approach was used. Semi-structured interviews were conducted with nine women and six informal carers. Van Manen’s hermeneutic analysis was used to analyse the data. RESULTS: Together the women and their carers had to learn how to live with an unbounded body as the wound became the centre of their life. The women and their carers report on the unpredictability, and uncontrollability of the wound due to symptoms such as malodour, bleeding, exudate, pain and itching. All the women and their carers developed strategies to bring the wound symptoms under control. Various methods were adopted often using inadequate products of the medicine chest or alternative medicine products. There were also psychosocial consequences to deal with such as embarrassment due to odour and exudate as well as the visibility of the wound, which was a constant reminder of having cancer. The loss of control of the body boundary due to uncontrollable symptoms led to significant levels of distress and suffering for both the women and their carers. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This study contributes to understanding that the care of women and their informal carers needs strategies that are integrated in a palliative, holistic, empathic approach. In particular skills for palliative wound care among medical and nursing staff need to be developed as the women and their carers report a lack of information and advice about how to manage the wound as well as the physical limitations and psychosocial consequences of struggling to maintain the boundedness of the body.