Dr Sandra Reeder^1,2, Associate Professor Heather Cleland⁴, Dr Michelle Gold³, Dr Lincoln Tracy¹

¹School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, ²Central Clinical School, Monash University, Melbourne, Australia, ³Palliative Care Service, Alfred Health, Melbourne, Australia, ⁴Victorian Adult Burns Service, The Alfred, Melbourne, Australia

Abstract:

Survival rates for patients with severe and potentially non-survivable burn injuries have improved in recent decades. However, specialist burn care clinicians are still required to make decisions on whether to withhold (not deliver) or withdraw (cease delivery) of life-sustaining treatment for a small proportion of patients with potentially non-survivable burn injuries. There is little research providing detailed insight into the decision-making experience and how/why particular attitudes and beliefs exist amongst specialist burn clinicians. This study aimed to explore clinicians’ decision-making processes for initiating end of life care after a severe and potentially non-survivable burn injury using an exploratory qualitative study design. Eleven clinicians (burns surgeons, burns nurses, and intensivists) involved in providing care and end of life decision-making for people with severe burns were interviewed via telephone or video conferencing in June-August 2021. A thematic analysis was undertaken using a framework approach. Decision making about initiating end of life care was described as typically complex and multifactorial, but on rare occasions when people presented with ‘non-survivable’ injuries, clinical decision-making was clear. Most clinicians incorporated a team approach to initiating end of life. Further, while protocols and/or guidelines guided decision-making, decisions were tailored to each case. This is the first study to explore clinician decision-making processes when treating patients with potentially non-survivable burns and enhances our understanding of the nuanced approach required during this time. The results highlight the need for ongoing discussions between surgeons and other clinicians regarding the best way to make end of life decisions in burns patients.

Biography:

Dr Lincoln Tracy is a Research Fellow within the School of Public Health and Preventive Medicine, Monash University. He undertakes research identifying objective and verifiable data on treatment, outcomes, and quality of care to encourage higher standards of burn injury prevention and care.