• Sandra Reeder, Heather J Cleland, Michelle Gold, and Lincoln M Tracy.
• School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; Central Clinical School, Monash University, Melbourne, VIC 3004, Australia.
• Burns. 2023 May 1; 49 (3): 595606595-606.

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.Copyright © 2022 Elsevier Ltd and ISBI. All rights reserved.

12 keywords...

hide…