Burn Surgeon and Palliative Care Physician Attitudes Regarding Goals of Care Delineation for Burned Geriatric Patients

Abstract

Palliative care specialists (PCS) and burn surgeons (BS) were surveyed regarding: 1) importance of goals of care (GoC) conversations for burned seniors; 2) confidence in their own specialty's ability to conduct these conversations; and 3) confidence in the ability of the other specialty to do so. A 13-item survey was developed by the steering committee of a multicenter consortium dedicated to palliative care in the injured geriatric patient and beta-tested by BS and PCS unaffiliated with the consortium. The finalized instrument was electronically circulated to active physician members of the American Burn Association and American Academy for Hospice and Palliative Medicine. Forty-five BS (7.3%) and 244 PCS (5.7%) responded. Palliative physicians rated being more familiar with GoC, were more comfortable having a discussion with laypeople, were more likely to have reported high-quality training in performing conversations, believed more palliative specialists were needed in intensive care units, and had more interest in conducting conversations relative to BS. Both groups believed themselves to perform GoC discussions better than the other specialty perceived them to do so. BS favored leading team discussions, whereas palliative specialists preferred jointly led discussions. Both groups agreed that discussions should occur within 72 hours of admission. Both groups believe themselves to conduct GoC discussions for burned seniors better than the other specialty perceived them to do so, which led to disparate views on perceptions for the optimal leadership of these discussions.

What do we know about experiencing end-of-life in burn intensive care units? A scoping review

“…Although PC is applicable in burn care, its current role is mostly confined to the end-of-life, suggesting that it is not fully integrated in the care process (Bayuo et al 2019). PC specialists and burn surgeons perceive that end-of-life discussions, particularly those concerning goals of care, should occur within the first 72 h of admission (Carmichael et al 2021a(Carmichael et al , 2021bCunningham et al 2018). This shows the need for an early identification of PC needs, timely PC referrals, and identification and standardization of triggers for PC referrals.…”

Components, Models of Integration, and Outcomes Associated with Palliative/ end-of-Life Care Interventions in the Burn Unit: A Scoping Review

“…Fifteen studies were retained in the review. 26,[35][36][37][38][39][40][41][42][43][44][45][46][47][48] Twelve studies employed a retrospective design, 35,[37][38][39][40][41][42][43][44][45][46][47] two employed In adapting the pathway, we have made a number of additions and subtle changes which make it more appropriate for burn patients. These include an additional sub section End of life care; adherence to the BM-LCP and to assess any variance from the pathway.…”

“…(continued) a survey approach, 26,36 and one was a pre-intervention/postintervention survey. 48 The majority of the studies focused on adult burn patients aged ≥18 years, with one focusing on pediatric burn patients.…”

“…48 The majority of the studies focused on adult burn patients aged ≥18 years, with one focusing on pediatric burn patients. 40 Ten studies emerged from the United States, [35][36][37][40][41][42][43][44][45]48 two from the United Kingdom, 38,39 one each from The Netherlands 46 and Australia. 47 The concepts were broadly formulated based on the review objectives: (1) components of palliative/ end of life care in the burn unit (2) models of integration and (3) outcomes.…”

Do patients, families, and healthcare teams benefit from the integration of palliative care in burn intensive care units? Results from a systematic review with narrative synthesis

“…However, the definition of the specific role of each specialty (palliative care and intensive care) still needs to be clarified, while approaching an interdisciplinary and integrated practice pattern. 26 This integration should begin at patients' admission, in order to foster a person-centered care approach, proportionate care, and advance care planning, making potential discussions around end of life easier 27 and avoiding in-hospital death. 28 Some studies suggest that this integration is also highly desired by patients, being associated with improved quality of life, cost savings, and better survival.…”