Exploring clinicians’ decision-making processes about end-of-life care after burns: A qualitative interview study |
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| Institution: | 1. School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;2. Central Clinical School, Monash University, Melbourne, VIC 3004, Australia;3. Victorian Adult Burns Service, Alfred Hospital, Melbourne, VIC 3004, Australia;4. Palliative Care Service, Alfred Health, Melbourne, VIC 3004, Australia;1. Leicester Royal Infirmary Hospital, United Kingdom;2. University of Cambridge, United Kingdom;1. Department of Plastic Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu, China;2. Department of Plastic and Aesthetic Surgery, Changzhi People''s Hospital of Changzhi Medical College, Changzhi 046000, Shanxi, China;3. Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou 510515, Guangdong, China;1. St. Andrew’s Centre of Burns and Plastic Surgery, Court Road, Broomfield, Chelmsford, United Kingdom;2. Karolinska University Hospital, Karolinska Vägen 22, 171 64 Solna, Sweden;3. Department of Anaesthetics, Broomfield Hospital, Court Road, Broomfield, Chelmsford, United Kingdom;1. Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran;2. Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran;3. Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran;4. Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran;5. Laboratory of Experimental Therapies in Oncology, IRCCS Istituto Giannina Gaslini, Genova, Italy;6. Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran;7. Department of Infectious Diseases, Imam Musa Kazem Hospital, Isfahan University of Medical Sciences, Isfahan, Iran;1. Institute of Regenerative Medicine, Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang 212001, Jiangsu, China;2. Department of Dermatology, Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang, Jiangsu 212001, China;3. School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212001, China;1. Department of Plastic Surgery, Fujian Maternal and Child Health Hospital, Fuzhou, Fujian 350000, China;2. Department of Pediatric Burn and Plastic Surgery, Fujian Children''s Hospital, Fuzhou, Fujian 350000, China |
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| Abstract: | IntroductionLittle is known about treatment decision-making experiences and how/why particular attitudes exist amongst specialist burn clinicians when faced with patients with potentially non-survivable burn injuries. This exploratory qualitative study aimed to understand clinicians’ decision-making processes regarding end-of-life (EoL) care after a severe and potentially non-survivable burn injury.MethodsEleven clinicians experienced in EoL decision-making were interviewed via telephone or video conferencing in June-August 2021. A thematic analysis was undertaken using a framework approach.ResultsDecision-making about initiating EoL care was described as complex and multifactorial. On occasions when people presented with ‘unsurvivable’ injuries, decision-making was clear. Most clinicians used a multidisciplinary team approach to initiate EoL; variations existed on which professions were included in the decision-making process. Many clinicians reported using protocols or guidelines that could be personalised to each patient. The use of pathways/protocols might explain why clinicians did not report routine involvement of palliative care clinicians in EoL discussions.ConclusionThe process of EoL decision-making for a patient with a potentially non-survivable burn injury was layered, complex, and tailored. Processes and approaches varied, although most used protocols to guide EoL decisions. Despite the reported complexity of EoL decision-making, palliative care teams were rarely involved or consulted. |
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| Keywords: | Burns Qualitative research Decision-making End of life Palliative care Terminal care |
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