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King's College London

Health

Skin changes at the end of life

  • While there are tools that can provide an objective measure of someone’s health status (for example scales designed to measure functional status), changes in a patient’s general appearance may be the first sign that their health is deteriorating.
  • For people with advanced and life-limiting illness, these subtle cues can be a trigger for health care professionals to discuss goals of care, the risks and benefits of further treatment, or to refer to specialist palliative care teams.
  • We know that people from minoritised ethnic groups are less likely to access specialist palliative care and more likely to have frequent Emergency Department visits towards the end of life, though the reasons for this are not clear. We also know that identification of a diverse range of skin signs (such as rashes, pressure damage) can be challenging among people of colour.
  • If health professionals are less able to identify deteriorating health among people of colour, this could lead to higher rates of Emergency Department attendance near the end of life, or delay in referral to palliative care. Whether and how skin colour influences how health professionals make judgements about people’s health in advancing illness is unclear, but is a potential source of racial bias.

Research questions:

  • What are the skin changes that are used by health and care professionals as an indication that someone with an advanced illness is deteriorating?
  • How confident and competent are health and care professionals in identifying these skin changes in people of colour?

Aims

  • Ensuring people receive the right care towards the end of life is a policy priority. This aligns with the Chief Medical Officer report 2023 “Health in an Ageing Society”. Identifying sources of racial bias and ways to reduce them are also priorities.
  • Our focus of this rapid response project will be on mapping evidence and evidence gaps, and recommending priorities for research.

Methods

  • Workstream 1: A rapid review will be undertaken to identify published evidence on (i) changes in skin that may indicate that someone with an advanced illness is deteriorating, (ii) whether these changes are as readily identifiable among people of colour, and (iii) health and care professionals’ confidence and competence in identifying these changes.
  • Workstream 2: Two expert consultations will be held with health and care professionals to explore their experience in using skin changes to identify deterioration in health for people with advanced illnesses. One expert consultation will be for health and care professionals who practice in the UK, selecting those who practice in areas with high levels of ethnic diversity. Another will be for health and care professionals who practice outside the UK in countries where the majority of the population are people of colour.
Project status: Ongoing

Principal Investigator