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Kennedy Terminal Ulcers

A Scoping Review

Latimer, Sharon PhD; Shaw, Joanie GradCert; Hunt, Tracey MSN; Mackrell, Kristyn BSc; Gillespie, Brigid M. PhD

Journal of Hospice & Palliative Nursing: August 2019 - Volume 21 - Issue 4 - p 257–263
doi: 10.1097/NJH.0000000000000563
Symptom Management Series
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Kennedy terminal ulcers, a subset of pressure injuries, are associated with the dying process. This scoping review aimed to identify and map the published literature on Kennedy terminal ulcers in terms of its definition, prevalence, assessment, treatment, management, health care costs, and quality of life for patients in all health care settings. Using the Arksey and O’Malley scoping review framework, we systematically searched the Cochrane Library, CINAHL, EMBASE, MEDLINE, and ProQuest databases and 5 guideline repositories between 1983 and 2018. The following search terms were used: Kennedy ulcers, Kennedy terminal ulcers, terminal ulcer, skin failure, and Skin Changes at Life’s End. Data were extracted using a purposely developed data collection tool. Initial searches yielded 2997 sources, with 32 included in this review. Most Kennedy terminal ulcer literature was published by nurses in the United States. Kennedy terminal ulcer prevalence data are limited, with no validated assessment tools available. Kennedy terminal ulcers may be misclassified as pressure injuries, potentially resulting in financial penalties to the institution. This scoping review revealed significant knowledge and clinical practice gaps in patient assessment, management, and treatment of Kennedy terminal ulcers. Timely patient education may help them to make informed care and quality end-of-life decisions. Further research is needed to inform clinical practice to improve patient care.

Sharon Latimer, PhD, is research fellow (Patient Safety in Nursing), School of Nursing and Midwifery, Griffith University; and Nursing Midwifery Education and Research Unit, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.

Joanie Shaw, GradCert, is nurse educator, Cancer and Specialty Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.

Tracey Hunt, MSN, is clinical nurse consultant, Diagnostics and Subspecialty Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.

Kristyn Mackrell, BSc, is senior occupational therapist, Community & Palliative Care Occupational Therapy Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.

Brigid M. Gillespie, PhD, is professor (Patient Safety in Nursing), graduate certificate, School of Nursing and Midwifery, Griffith University; and Nursing Midwifery Education and Research Unit, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

The authors conceived and designed this review. The database searches were undertaken by S.L. and J.S. Literature screening and eligibility were completed by S.L., J.S., and B.M.G. Data extraction was carried out by S.L., T.H., and K.M. Manuscript drafting was led by S.L. and B.M.G. All authors made substantial manuscript contributions and approved the final submitted draft.

The authors have no conflicts of interest to disclose.

Address correspondence to Sharon Latimer, PhD, School of Nursing and Midwifery, Logan Campus, Griffith University, L05 3.44, Meadowbrook, Queensland, Australia 4131 (s.latimer@griffith.edu.au).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.jhpn.com).

Online date: April 1, 2019

© 2019 by The Hospice and Palliative Nurses Association.