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. 2024 Mar;38(3):297-309.
doi: 10.1177/02692163241229962. Epub 2024 Feb 19.

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

André Filipe Ribeiro  1   2 , Sandra Martins Pereira  3 , Rui Nunes  1   4 , Pablo Hernández-Marrero  3   5
Affiliations

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

André Filipe Ribeiro et al. Palliat Med. 2024 Mar.

Abstract

Background: Burns are a global public health problem, accounting for around 300,000 deaths annually. Burns have significant consequences for patients, families, healthcare teams and systems. Evidence suggests that the integration of palliative care in burn intensive care units improves patients' comfort, decision-making processes and family care. Research is needed on how to optimise palliative care referrals.

Aim: To identify triggers for palliative care referral in critically burned patients based on professionals' views, experiences and practices.

Design: Qualitative study using in-depth interviews.

Setting/participants: All five Burn Intensive Care Units reference centres across Portugal were invited; three participated. Inclusion criteria: Professionals with experience/working in these settings. A total of 15 professionals (12 nurses and 3 physicians) participated. Reflexive thematic analysis was performed.

Results: Three main triggers for palliative care referral were identified: (i) Burn severity and extension, (ii) Co-morbidities and (iii) Multiorgan failure. Other triggers were also generated: (i) Rehabilitative palliative care related to patients' suffering and changes in body image, (ii) Family suffering and/or dysfunctional and complex family processes, (iii) Long stay in the burn intensive care unit and (iv) Uncontrolled pain.

Conclusions: This study identifies triggers for palliative care in burn intensive care units based on professionals' views, clinical experiences and practices. The systematisation and use of triggers could help streamline referral pathways and strengthen the integration of palliative care in burn intensive care units. Research is needed on the use of these triggers in clinical practice to enhance decision-making processes, early and high-quality integrated palliative care and proportionate patient and family centred care.

Keywords: Palliative care; burns; critical care; qualitative research; referral; triggers.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Illustrates the study flowchart.
Figure 2.
Figure 2.
Systematises the main findings of this study.
Figure 3.
Figure 3.
Theoretical representation of parameters to be evaluated for referral decision-making taking critical trajectory into account.
See this image and copyright information in PMC

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