WOUND PAIN ASSESSMENT IN ITALIAN DOMICILIARY PALLIATIVE CARE: AN AUDIT OF LAW 38/2010 COMPLIANCE IN HOMENURSING

G. Fedelfranco | Social Health Local District of Bari, Unified Access Point (PUA) / Multidimensional Assessment Unit (UVM), Bari; University of Bari "Aldo Moro", Bari, Italy

Abstract

Background and Aims. Law 38/2010 guarantees access to palliative care and pain therapy in all settings, including home care. Chronic wound pain — prevalent in pressure injuries, diabetic foot ulcers, and vascular ulcers — is a cardinal palliative symptom in end-of-life patients. Italian nurses in palliative home care report feeling "alone during emergencies and sensitive communications" and identify inadequate training as a primary challenge (Iotti et al., PMC 2025; N=39 nurses, Reggio Emilia). No Italian study has assessed wound pain assessment competency specifically in home-based palliative nursing. This study aims to quantify the wound pain assessment gap in palliative care nursing for Italian patients at home.
Methods. Sequential mixed-methods. Phase 1: retrospective audit of palliative home care records in ASL Bari U.O. Cure Palliative Domiciliari (N=60 patients, January–March 2026): wound pain documentation frequency, validated scale use (NRS, PAINAD, and Edmonton Symptom Assessment Scale), and analgesic adequacy (Pain Management Index). Phase 2: focus groups with palliative home care nurses (N=12, ASL Bari) on wound pain barriers. Ethical approval: ASL Bari IRB.
Results. Preliminary audit (N=22 records): wound pain formally assessed in 31.8%; PAINAD or ESAS used in 9.1%; Pain Management Index negative (undertreated) in 63.6%. Focus group preliminary findings: wound pain perceived as "minor" compared to disease pain by 83.3% of nurses interviewed.
Conclusions. Wound pain in Italian domiciliary palliative care is systematically underassessed and undertreated. Integrating structured wound pain protocols into Law 38/2010 palliative home care pathways is an urgent, measurable imperative for patient dignity.