An end-of-life wound assessment tool for dying hospitalised adults: A feasibility study.

Background: End-of-life (EOL) wounds, including unavoidable pressure injuries (PIs) and skin failure, are similar to PIs. Differentiating between these wounds is difficult, so we developed an EOL wound assessment tool for use in dying adults to aid clinicians. The study aim was to determine the feasibility of a larger multisite study by testing the study protocol and establishing the interrater reliability of a new EOL wound assessment tool. Methods: This feasibility study was conducted in medical and palliative care units at three hospitals across southeast Queensland, Australia. We gathered quantitative data on study screening, recruitment, consent, and data collection procedures in dying hospitalised adult patients with a new pressure injury (PI). We recruited and trained four research assistants (RAs) and an independent blinded outcome assessor. Following recruitment, clinical data and a deidentified wound photograph were collected. The RAs used the EOL wound assessment tool to determine if the PI was an EOL wound. An off-site independent blinded outcome assessor accessed the same research data and undertook the same assessment using the EOL wound assessment tool. Frequencies and percentages were computed for the feasibility outcomes. Cohen’s kappa statistic was calculated to determine the interrater reliability agreement. Results: Over 20 months, 140 patients with a new PI were screened, with 23 (16.4%) eligible for recruitment, exceeding our ≥10% target. Ten (43.5%) participants were recruited, which fell short of our ≥50% target, with study refusal and imminent death being the reasons for nonrecruitment. Among the 10 recruited study participants, 13 wounds were observed on the sacrum, coccyx, and lower extremities. The interrater reliability between the two assessors was moderate (n=8/13; 61.5%), with disagreement on five wounds, all located on the heels and toes. One participant with two wounds, was assessed by the independent outcome assessor as having an EOL wound and a PI. Conclusions: With minor study protocol adjustments, conducting a larger multisite study testing the inter- and intrarater reliability of the EOL wound assessment tool is feasible. Differentiating between PI and unavoidable EOL wounds in dying patients is a clinical imperative that will help clinicians make informed comfort-based clinical decisions.