Exploring clinicians’ decision-making processes about end-of-life care after burns: A qualitative interview study

• Published in: Burns Vol. 49; no. 3; pp. 595 - 606
• Main Authors: Reeder, Sandra, Cleland, Heather J., Gold, Michelle, Tracy, Lincoln M.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.05.2023
• Subjects: Burns; Burns - therapy; Decision Making; End of life; Humans; Palliative Care; Qualitative Research; Terminal care; Terminal Care - methods; Qualitative research; Decision-making; Palliative care; Terminal care; End of life; Burns
• ISSN: 0305-4179; 1879-1409
• DOI: 10.1016/j.burns.2022.12.001

Little 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. Eleven 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. Decision-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. The 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. •A small proportion of burn patients present with possible non-survivable injuries.•Burn care clinicians need to make treatment decisions for these patients.•The treatment decision-making process is complex, layered, and personalised.•There is room for greater palliative care service involvement in these decisions.