Latimer Sharon, Harbeck Emma, Walker Rachel M, Ray-Barruel Gillian, Shaw Joanie, Hunt Tracy, Gillespie Brigid M
At Griffith University, Queensland, Australia, Sharon Latimer, PhD, is Senior Lecturer; Emma Harbeck, PhD, is Senior Research Assistant; Rachel M. Walker, PhD, is Senior Research Fellow; and Gillian Ray-Barruel, PhD, is Senior Research Fellow. Joanie Shaw, MSN, RN, is Nurse Educator, Cancer and Specialty Services, Gold Coast Health Service, Queensland. Tracy Hunt, MSN, RN, is Clinical Nurse Consultant, Quality Health Care, Clinical Governance, Education and Research, Gold Coast University Hospital, Queensland. Brigid M. Gillespie, PhD, is Professor of Patient Safety, Griffith University.
Adv Skin Wound Care. 2023 Mar 1;36(3):142-150. doi: 10.1097/01.ASW.0000911992.83362.eb.
Some patients at end of life (EOL) develop wounds known as Kennedy terminal ulcers, terminal ulcers, and Skin Changes At Life's End. However, there is ambiguity around the defining wound characteristics of these conditions and a lack of validated clinical assessment tools available to identify them.
To gain consensus on the definition and characteristics of EOL wounds and establish the face and content validity of a wound assessment tool for use in adults at EOL.
Using a reactive online Delphi technique, international wound experts reviewed the 20 items in the tool. Over two iterative rounds, experts assessed item clarity, relevance, and importance using a four-point content validity index. The content validity index scores were calculated for each item, with a level of 0.78 or higher signifying panel consensus.
Round 1 included 16 panelists (100.0%). The agreement for item relevance and importance ranged from 0.54% to 0.94%, and item clarity scored between 0.25% and 0.94%. Following round 1, four items were removed, and seven others reworded. Other suggestions included changing the tool name and including Kennedy terminal ulcer, terminal ulcer, and Skin Changes At Life's End in the EOL wound definition. In round 2, the now 13 panel members agreed with the final 16 items included and suggested minor wording changes.
This tool could provide clinicians with an initially validated tool to accurately assess EOL wounds and gather much needed empirical prevalence data. Further research is needed to underpin accurate assessment and the development of evidence-based management strategies.
一些临终患者会出现被称为肯尼迪末期溃疡、末期溃疡和临终皮肤变化的伤口。然而，这些病症的伤口特征定义尚不明确，且缺乏可用于识别它们的经过验证的临床评估工具。
就临终伤口的定义和特征达成共识，并确立一种用于成年临终患者的伤口评估工具的表面效度和内容效度。
采用反应性在线德尔菲技术，国际伤口专家对该工具中的20个项目进行了审查。在两轮迭代过程中，专家们使用四分制内容效度指数评估项目的清晰度、相关性和重要性。计算每个项目的内容效度指数得分，得分在0.78或更高表示专家小组达成共识。
第一轮有16名专家小组成员（100.0%）。项目相关性和重要性的一致性范围为0.54%至0.94%，项目清晰度得分在0.25%至0.94%之间。第一轮之后，删除了4个项目，另外7个项目进行了重新措辞。其他建议包括更改工具名称，并在临终伤口定义中纳入肯尼迪末期溃疡、末期溃疡和临终皮肤变化。在第二轮中，现在的13名专家小组成员同意最终纳入的16个项目，并建议进行一些措辞上的小改动。
该工具可为临床医生提供一种初步经过验证的工具，以准确评估临终伤口并收集急需的实证患病率数据。需要进一步的研究来支持准确评估和制定循证管理策略。
