avoidable, end of life, Kennedy terminal ulcer, KTU, pressure injury, SCALE, Skin Changes At Life's End, skin failure, terminal ulcers, TB-TTI, Trombley-Brennan terminal tissue injury, unavoidable



  1. Sibbald, R. Gary MD, BSc, MEd, FRCPC, FAAD
  2. Ayello, Elizabeth PhD, RN, CWON, ETN, FAAN


OBJECTIVE: To summarize the major findings of a survey first conducted in 2019 and repeated in 2022 and review new concepts (angiosomes and pressure injuries) and challenges due to the COVID-19 pandemic.


METHODS: This survey captures participants' ranking of agreement or disagreement with 10 statements on Kennedy terminal ulcers, Skin Changes At Life's End, Trombley-Brennan terminal tissue injuries, skin failure, and unavoidable/avoidable pressure injuries. The survey was hosted online by SurveyMonkey from February 2022 until June 2022. All interested persons were able to participate in this voluntary, anonymous survey.


RESULTS: Overall, 145 respondents participated. The same nine statements achieved at least 80% agreement (somewhat agree or strongly agree) as in the previous survey. The one statement that did not reach consensus also failed to reach consensus in the 2019 survey: "The concept of skin failure does not include pressure injuries."


CONCLUSIONS: It is the authors' hope that this will stimulate more research into terminology and etiology of skin changes in persons at end of life and encourage more research regarding terminology and criteria to define which skin lesions are unavoidable or avoidable.