Prevalence, risk factors and management of pressure injuries and their implications for palliative care: A rapid overview of reviews

TL;DR

This study reviews the limited evidence on pressure injuries in palliative care, highlighting the need for better research to guide prevention and treatment.

Contribution

The paper provides a rapid overview of reviews on pressure injuries in palliative care, emphasizing gaps in high-quality evidence.

Findings

Frequent repositioning and some nutritional interventions may reduce pressure injuries, but evidence is very low certainty.

Most interventions have limited or inconclusive evidence due to poor trial design and variability in settings.

The evidence base for managing pressure injuries in palliative care is weak and insufficient for clinical guidance.

Abstract

Evidence around pressure injuries in palliative care settings is limited and fragmented.

To synthesize systematic review evidence regarding prevalence, risk factors, prevention and treatment of pressure injuries in non-acute care settings, and evaluate implications for specialist palliative care.

A rapid overview of reviews following the Cochrane guidance for overviews.

We searched four databases (MEDLINE, Cochrane Database of Systematic Reviews, JBI EBM Reviews, and CINAHL) from inception to October 2024. We included systematic reviews on adult patients in inpatient Palliative Care Units or settings likely involving end-of-life care.

Seventeen systematic reviews incorporating 149 unique studies (n = 5,856,293) were included. Thirteen of the reviews were high quality. Only one low-quality review specifically addressed palliative care, focusing on prevalence and risk factors. Interventions were categorized into nutritional, physical (e.g. repositioning, tilt strategies), topical/dressing-based, electrical stimulation and organizational approaches. Frequent repositioning and certain nutritional interventions may reduce incidence or surface area of pressure ulcers; however, certainty remains very low. Frequent repositioning, specific tilt strategies and specific nutritional interventions may help reduce the incidence of pressure injuries and decrease injury surface area; however certainty is very low. Other interventions have limited and inconclusive evidence and were rated low to very low certainty according to GRADE criteria due to poor trial design and population and setting variations.

The evidence base remains weak and largely indirect, offering insufficient guidance for clinical practice in palliative care. High-quality, targeted research is needed to inform effective pressure injury prevention and management in this population.

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