Incidence and prevalence of pressure ulcers in cancer patients admitted to hospice: A multicentre prospective cohort study

Abstract

Pressure ulcers lead to discomfort for patients and may have an important impact on a patient's quality of life. Measure the incidence and prevalence of pressure ulcers in a Hospice environment; evaluate the risk factors associated with pressure ulcers; and calculate the incidence of Kennedy Terminal Pressure Ulcers. This multicentre prospective cohort study enrolled 440 cancer patients in advanced phase, consecutively admitted to five hospices of the AUSL della Romagna (Italy), during a period of 1 year. Five hundred more patients were excluded from the study because of inability to sign the consent form or refusal to participate. All patients were adults above 18 years of age. The National Pressure Advisory Panel Classification System was used to evaluate the pressure ulcers. Potential risk predictors were evaluated through the Braden Scale, the Numerical Scale, and the Pain Assessment in Advanced Dementia Scale. Starting in September 2016, 214 (48.6%) females and 226 (51.4%) males were analysed. The incidence of pressure ulcers in the total population was 17.3%. The risk factors that influence the development of pressure ulcers were age, proximity to death, and duration of stay in Hospice. The incidence of Kennedy Terminal Pressure Ulcers was 2.7%. This study demonstrates that 17.3% of all patients admitted to a hospice setting developed a pressure ulcer. The longer the patients stay in hospice and the clinical condition deteriorates, the higher the risk of developing a pressure ulcer.

Palliative Care in Primary and Metastatic Brain Tumors

“…We thought that such high rates of tracheostomy and PEG could be explained by the longer-term survival of primary brain tumor patients compared to patients with metastatic brain tumors. The study by Jakobsen et al [21] demonstrated that advanced age, proximity to death, long hospital stays, and a poor clinical condition increased the risk of PU development.…”

Development of a Wound Assessment Tool for Use in Adults at End of Life: A Modified Delphi Study

“…The lack of a TU classification system and assessment tool has unintended consequences for clinicians and researchers because it compels them to use tools designed for the assessment, classification, and subsequent reporting of PI 14,16,21 . For example, care and management strategies for PI in individuals at EOL are described in the international PI clinical practice guidelines; however, care and management strategies for unavoidable injuries such as KTU and TB-TTI are not 22 .…”

Relationship between predisposing and facilitating factors: Does it influence the risk of developing peri‐operative pressure injuries?

“…The factors that influence peri‐operative PI formation are complex, which mainly include predisposing factors that affect personal health, 10 such as age, 11 , 12 gender, 13 comorbidities (eg, diabetes, cancer, or nervous system diseases), 14 , 15 , 16 malnutrition or obesity, 14 , 17 anaemia, 18 , 19 and smoking, 20 as well as facilitating factors, which refer to factors that exacerbate PIs during surgery, 10 such as the method of anaesthesia, 21 the duration of anaesthesia, 22 , 23 the amount of blood loss, 24 , 25 and patient positioning. 21 , 26 …”

“…For these reasons, preventing PI formation, especially severe PIs, is extremely crucial. 3,9 The factors that influence peri-operative PI formation are complex, which mainly include predisposing factors that affect personal health, 10 such as age, 11,12 gender, 13 comorbidities (eg, diabetes, cancer, or nervous system diseases), [14][15][16] malnutrition or obesity, 14,17 anaemia, 18,19 and smoking, 20 as well as facilitating factors, which refer to factors that exacerbate PIs during surgery, 10 such as the method of anaesthesia, 21 the duration of anaesthesia, 22,23 the amount of blood loss, 24,25 and patient positioning. 21,26 The above discussion demonstrates that both facilitating factors during surgery and personal predisposing factors influence the severity of PIs in patients.…”