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

Abstract

Objectives The aim of this article is to review and synthesize the evidence on end-of-life in burn intensive care units. Methods Systematic scoping review: Preferred Reporting Items for Systemic Reviews extension for Scoping Reviews was used as a reporting guideline. Searches were performed in 3 databases, with no time restriction and up to September 2021. Results A total of 16,287 documents were identified; 18 were selected for analysis and synthesis. Three key themes emerged: (i) characteristics of the end-of-life in burn intensive care units, including end-of-life decisions, decision-making processes, causes, and trajectories of death; (ii) symptom control at the end-of-life in burn intensive care units focusing on patients’ comfort; and (iii) concepts, models, and designs of the care provided to burned patients at the end-of-life, mainly care approaches, provision of care, and palliative care. Significance of results End-of-life care is a major step in the care provided to critically ill burned patients. Dying and death in burn intensive care units are often preceded by end-of-life decisions, namely forgoing treatment and do-not-attempt to resuscitate. Different dying trajectories were described, suggesting the possibility to develop further studies to identify triggers for palliative care referral. Symptom control was not described in detail. Palliative care was rarely involved in end-of-life care for these patients. This review highlights the need for early and high-quality palliative and end-of-life care in the trajectories of critically ill burned patients, leading to an improved perception of end-of-life in burn intensive care units. Further research is needed to study the best way to provide optimal end-of-life care and foster integrated palliative care in burn intensive care units.

A bioethical perspective on the meanings behind a wish to hasten death: a meta-ethnographic review

“…A data extraction table was purposively built for this study to extract data from included studies. This form was adapted from previous reviews conducted by members from this research team [ 41 – 43 ] and is based on PICOD [ 44 , 45 ] as follows: P = Participants:…”

“…This is a 9-item tool where the minimum score is 9 and the maximum score is 36 [ 68 ]. This tool has been widely used in literature since its nine questions are easily scored to assess the quality of the study and can be transformed into a quantitative scale [ 41 – 43 , 68 – 72 ]. All the included studies were independently assessed by the three reviewers (P.J.B., P.H.M., S.M.P.).…”

What are the triggers for palliative care referral in burn intensive care units? Results from a qualitative study based on healthcare professionals’ views, clinical experiences and practices

“…10 Nevertheless, while evidence suggests that the integration of palliative care in burn intensive care units improves patients' comfort, decision-making processes and family care, 11 it also shows that palliative care is rarely involved in the care provided to these patients. 12 The International Society for Burn Injuries 13 considers palliative care a continuation of treatment once futile medical treatment is observed. This is challenging since futility is often perceived as a 'grey zone' where goals of care might be difficult to define 14 and treatments that improve patients' comfort and minimise suffering of both patients and their families are as important as those aimed at saving patients' lives.…”

“… 10 Nevertheless, while evidence suggests that the integration of palliative care in burn intensive care units improves patients’ comfort, decision-making processes and family care, 11 it also shows that palliative care is rarely involved in the care provided to these patients. 12 …”

“…Palliative care is still suboptimal in burn intensive care units. 12 , 17 A recent review suggests that further research is needed to (i) better understand how the specific set of palliative competencies can enable improved quality-of-life, comfort and optimum family support and (ii) study the best way to provide optimal end-of-life care and foster integrated palliative care in burn intensive care units. 12 Identifying triggers for palliative care referral in burn intensive care units could help to better integrate palliative care when needed.…”