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Address Patient-Centred Concerns

Pain and Quality of Life (QoL)

  • Overall QoL – on a scale of Delighted (0) to Terrible (10), how do you feel about your life today?:          
  • Have you had to change your life style as a result of this ulcer?   Yes   No
  • Do you feel that you are no longer able to do the things you would like to do?   Yes   No
  • Does the wound impact your social activities?   Yes   No
  • Do you believe that your wound is   healable?   non-healable?
  • Why?    

Algorithm for Interventions for Skin Changes at Life’s End (SCALE)

The interventions to prevent a Kennedy’s terminal ulcer due to changes in the skin at the end of life are very similar to those of preventing and treating any pressure ulcer (Prevention and Prescription - heal if possible), with the additional considerations of Preservation (Maintenance), Palliation (comfort and care) and Patient Preference (desires or wishes) influencing the plan of care. An example of this may be that at the end of life, an individual with difficulty breathing may not tolerate being in any position except in a high fowler’s with the head of the bed elevated to 45° or more, or an individual with intractable pain may not wish to be repositioned every two hours. Caring for the individual who is dying within these parameters may mean that a Kennedy’s terminal ulcer is unavoidable.

Algorithm for Care of individual at risk for SCALE1

Person at Risk for SCALE - The SOAPIE mnemonic with 5P enabler

Provide Local Wound Care
  1. Sibbald RG, Krasner DL, Lutz JB, et al. The SCALE Expert Panel: Skin Changes At Life’s End. Final Consensus Document. October 1, 2009.

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