Characterizing End-of-Life Care after Geriatric Burns at a Verified Level I Burn Center

Partain, Natalia; Subramanian, Madhu; Hodgman, Erica I.; Isbell, Claire L.; Wolf, Steven E.; Arnoldo, Brett D.; Kowalske, Karen; Phelan, Herbert

doi:10.1089/jpm.2016.0152

Cited by 21 publications

(34 citation statements)

References 29 publications

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“…Though Sheppard and colleagues have argued for the need to consider biochemical markers in prognostication 26 , there is a global agreement that total burn surface area (TBSA) and age are central. 2,27 Findings from the current study suggest that although participants are familiar with these variables, prognostic uncertainty is a reality. Moreover, the Ghanaian socio-cultural system does not encourage discussing death as it is considered a taboo to do so 28 , thus, limiting readiness to discuss poor prognosis.…”

Section: Availability Of Supportmentioning

confidence: 77%

“Hanging in a balance”: A qualitative study exploring clinicians’ experiences of providing care at the end of life in the burn unit

et al. 2020

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Background: Although the culture in burns/critical care units is gradually evolving to support the delivery of palliative/end of life care, how clinicians experience the end of life phase in the burn unit remains minimally explored with a general lack of guidelines to support them. Aim: To explore the end of life care experiences of burn care staff and ascertain how their experiences can facilitate the development of clinical guidelines. Design: Interpretive-descriptive qualitative approach with a sequential two phased multiple data collection strategies was employed (face to face semi-structured in-depth interviews and follow-up consultative meeting). Thematic analysis was used to analyze the data. Setting/participants: The study was undertaken in a large teaching hospital in Ghana. Twenty burn care staff who had a minimum of 6 months working experience completed the interviews and 22 practitioners participated in the consultative meeting. Results: Experiences of burn care staff are complex with four themes emerging: (1) evaluating injury severity and prognostication, (2) nature of existing system of care, (3) perceived patient needs, and (4) considerations for palliative care in burns. Guidelines in this regard should focus on facilitating communication between the patient and family and staff, holistic symptom management at the end of life, and post-bereavement support for family members and burn care practitioners. Conclusions: The end of life period in the burn unit is poorly defined coupled with prognostic uncertainty. Collaborative model of practice and further training are required to support the integration of palliative care in the burn unit.

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Section: Availability Of Supportmentioning

confidence: 77%

“Hanging in a balance”: A qualitative study exploring clinicians’ experiences of providing care at the end of life in the burn unit

et al. 2020

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“…As noted in the above studies, a major concern for the primary team is often that a PCS consult will translate to "giving up," to the patient or their family. In the current burn ICU culture, where GoC discussions are often inspired by injury severity alone and patient perceptions of GoC conversations are based on communication failures, 22 this concern will likely continue to thrive for both patients and physicians. Perhaps, earlier and more routine inclusion of PCS would facilitate better communication, fewer feelings of hopelessness, and a better overall experience for the patient, their family, and possibly the surgeon.…”

Section: Discussionmentioning

confidence: 99%

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

Cunningham

Scielzo

Nakonezny

et al. 2018

Journal of Burn Care &Amp; Research

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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.

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“…43 A strong framework is important toward a shared decision-making, involving healthcare providers, patient's wishes, and families' perspectives. 42,[44][45][46] Although specialists from burn units are the core elements to analyze the extension and magnitude of injuries, other healthcare providers are mentioned to participate in decision-making process, suggesting predominantly a combined model to integrate palliative care in burn intensive care units. Another idea is the creation of a training program to improve end-oflife care/goals of care suggesting empowerment in multidisciplinary teams, which could be considered as a way of integrating palliative care in burn intensive care units.…”

Section: Reference and Countrymentioning

confidence: 99%

“…The decision-making process is presented as complex, due to the severity of complications in patients, 43,44 in which family participation appears to be highly relevant, using conference setting as a strengthening element. 42 Communication strategies are also mentioned as a significant subtopic, 45 mainly related to the importance of the content and way that information is provided to patients and families. 46 Because some patients are unable to express their preferences, in burn intensive care units, families usually share and participate in the decision-making process.…”

Section: Benefits and Outcomes Of The Integrationmentioning

confidence: 99%

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

et al. 2019

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Background: Burn units are intensive care facilities specialized in the treatment of patients with severe burns. As burn injuries have a major impact in physical, psychosocial, and spiritual health, palliative care can be a strengthening component of integrated care. Aim: To review and appraise the existing evidence about the integration of palliative care in burn intensive care units with respect to (1) the concept, model and design and (2) the benefits and outcomes of this integration. Design: A systematic review was conducted following PRISMA guidelines. Protocol registered with PROSPERO (CRD42018111676). Data sources: Five electronic databases were searched (PubMed/NLM, Web of Science, MEDLINE/TR, Ovid, and CINAHL/EBSCO) until May 2019. A narrative synthesis of the findings was constructed. Hawker et al.’s tool was used for quality appraisal. Results: A total of 299 articles were identified, of which five were included for analysis involving a total of 7353 individuals. Findings suggest that there may be benefits from integrating palliative care in burn units, specifically in terms of patients’ comfort, decision-making processes, and family care. Multidisciplinary teams may experience lower levels of burden as result of integrating palliative care in burn units. Conclusion: This review reflects the challenging setting of burn intensive care units. Evidence from these articles suggests that the integration of palliative care in burn intensive care units improves patients’ comfort, decision-making process, and family care. Further research is needed to better understand how the integration of palliative care in burn intensive care units may be fostered and to identify the outcomes of this integration.

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Characterizing End-of-Life Care after Geriatric Burns at a Verified Level I Burn Center

Cited by 21 publications

References 29 publications

“Hanging in a balance”: A qualitative study exploring clinicians’ experiences of providing care at the end of life in the burn unit

“Hanging in a balance”: A qualitative study exploring clinicians’ experiences of providing care at the end of life in the burn unit

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

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

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