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Expert Panel Issues Final Consensus Statement on Skin Changes at Life’s End (SCALE)

Panel determines that current understanding of this complex phenomenon is limited and that additional research is necessary

York, PA, December 02, 2009 --( An expert panel assembled to explore Skin Changes At Life’s End (SCALE) today announced the completion of a final consensus statement designed to facilitate the implementation of knowledge-transfer-into-practice techniques for quality patient outcomes.

Launched in April 2008 in Chicago with an unrestricted educational grant from Gaymar Industries, members of the SCALE Panel have concluded that there are observable changes in the skin at the end of life, and they used a modified, three-phase Delphi Method approach to reach consensus on 10 statements.

The SCALE Panel determined that current understanding of this complex phenomenon is limited, and additional research is necessary to assess the etiology of SCALE, to clinically describe and diagnose the related skin changes, and to recommend appropriate pathways of care. Also, the panel recommends that clinicians, laypeople, and policy makers need to be better educated in the medical, social, legal and financial ramifications of SCALE.

“In the first attempt to examine the concept of unavoidable pressure ulcers that can occur at the end of life, we formulated consensus from an 18-member expert panel and 51 additional internationally recognized clinicians, caregivers, medical researchers, legal experts, academicians and leaders of professional organizations,” said Dr. R. Gary Sibbald, Professor of Public Health Sciences and Medicine at the University of Toronto and co-chair of the SCALE Panel. “The effects of SCALE are far-reaching, and we are encouraging further discussion and research to advance the body of scientific knowledge on end-of-life skin changes.”

The SCALE Final Consensus Statement as well as an annotated bibliography on SCALE are available from the Gaymar website at

“Educating clinicians, caregivers, families and patients about end-of-life skin changes can help everyone prepare for, address and accept that skin changes often accompany the dying process and cannot be prevented from occurring,” noted Dr. Diane Krasner, an internationally recognized expert in wound care and co-chair of the SCALE Panel.

The SCALE Panel encourages distribution of the SCALE document to healthcare professionals and stakeholders, and also welcomes feedback on the Final Consensus Statement. Comments may be directed to Dr. Krasner at

Contact Information
Bob Chase, APR

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