Objective: To scope the literature to ascertain the components of palliative care (PC) interventions for burn patients, models of integration, and outcomes. Methods: Arksey and O’Malley scoping review design with narrative synthesis was employed and reported following the PRISMA-ScR guidelines. Primary studies reporting PC interventions in the burn unit were considered for inclusion. CINAHL via EBSCO, PubMed, EMBASE via OVID, Web of Science, and gray literature sources were searched from inception to June 2021. Results: Fifteen studies emerging from high-income settings were retained. Data were organized around three concepts: components of palliative/ end of life care in the burn unit; models of integration; and outcomes. The components of interventions based on the Robert Wood Johnson Foundation Critical Care End-of Life Group domains include decision-making, communication, symptom management and comfort care, spiritual support, and emotional and practical support for families. Consultative and integrative models were noted to be the strategies for integrating PC in the burn unit. The outcomes were varied with only few studies reporting healthcare staff related outcomes. Conclusion: PC may have the potential of improving end-of-life care in the burn unit albeit the limited studies and lack of standardized outcomes makes it difficult to draw stronger conclusions regarding what is likely to work best in the burn unit.
WallSAllortoNWealeR, et al.Ethics of burn wound care in a low-middle income country. AMA J Ethics. 2018;20(6):575‐580.
3.
CapekKDSousseLEHundeshagenG, et al.Contemporary burn survival. J Am Coll Surg. 2018;226(4):453‐463.
4.
BayuoJBristoweKHardingR, et al.The role of palliative care in burns: a scoping review. J Pain Symptom Manage. 2020;59(5):1089‐1108.
5.
EdwardsKWills-RinaldiKSavetamalA. Embers of hope: a palliative care/burn unit collaboration story (FR400). J Pain Symptom Manage. 2019;57:399.
6.
BayuoJBotchwayAE. Burns among older persons: a narrative review. Burns Open. 2017;1(1):2‐8.
7.
BayuoJ. Nurses’ experiences of caring for severely burned patients. Collegian. 2018;25(1):27‐32.
8.
BrusselaersNMonstreySVogelaersD, et al.Severe burn injury in Europe: a systematic review of the incidence, etiology, morbidity, and mortality. Crit Care. 2010;14(5):1‐12.
9.
DukeJMRandallSMFearMW, et al.Understanding the long-term impacts of burn on the cardiovascular system. Burns. 2016;42(2):366‐374.
10.
WillebrandMEkseliusL. Health-related quality of life 2 years to 7 years after burn injury. Journal of Trauma and Acute Care Surgery. 2011;71(5):1435‐1441.
11.
SpronkIPolinderSVan LoeyNE, et al.Health related quality of life 5–7 years after minor and severe burn injuries: a multicentre cross-sectional study. Burns. 2019;45(6):1291‐1299.
12.
BayuoJWongFKYAgyeiFB. “On the recovery journey:” an integrative review of the needs of burn patients from immediate pre-discharge to post-discharge period using the Omaha system. J Nurs Scholarsh. 2020;52(4):360‐368.
13.
BayuoJWongFKY. Issues and concerns of family members of burn patients: a scoping review. Burns. 2021;47(3):503‐524.
14.
BayuoJBristoweKHardingR, et al.“Managing uncertainty”: experiences of family members of burn patients from injury occurrence to the end-of-life period. Burns. 2021; 47(7):1647-1655.
15.
BayuoJBristoweKHardingR, et al.“Hanging in a balance”: a qualitative study exploring clinicians’ experiences of providing care at the end of life in the burn unit. Palliat Med. 2021;35(2):417‐425.
16.
GrahamFClarkD. WHO Definition of palliative care. Medicine (Baltimore). 2008;2(36):64‐66.
17.
RadbruchLDe LimaLKnaulF, et al.Redefining palliative care—A new consensus-based definition. J Pain Symptom Manage. 2020;60(4):754‐764.
18.
CookACLangstonJAJaramilloJD, et al.Opportunities for palliative care in patients with burn injury—A systematic review. J Pain Symptom Manage. 2020;59(4):916‐931.e911.
19.
FerrellBRTwaddleMLMelnickA, et al.National consensus project clinical practice guidelines for quality palliative care guidelines. J Palliat Med. 2018;21(12):1684‐1689.
20.
SleemanKEGomesBde BritoM, et al.The burden of serious health-related suffering among cancer decedents: global projections study to 2060. Palliat Med. 2021;35(1):231‐235.
21.
MosenthalACWeissmanDECurtisJR, et al.Integrating palliative care in the surgical and trauma intensive care unit: a report from the improving palliative care in the intensive care unit (IPAL-ICU) project advisory board and the center to advance palliative care. Crit Care Med. 2012;40(4):1199.
22.
HainesLWangWHarhayM, et al.Opportunities to improve palliative care delivery in trauma critical illness. American Journal of Hospice and Palliative Medicine®. 2021. https://doi.org/10.1177/10499091211042303.
23.
KupenskyDHilemanBMEmerickES, et al.Palliative medicine consultation reduces length of stay, improves symptom management, and clarifies advance directives in the geriatric trauma population. Journal of Trauma Nursing| JTN. 2015;22(5):261‐265.
24.
MosenthalACMurphyPABarkerLK, et al.Changing the culture around end-of-life care in the trauma intensive care unit. Journal of Trauma and Acute Care Surgery. 2008;64(6):1587‐1593.
25.
LilleyEJLeeKCScottJW, et al.The impact of inpatient palliative care on end of life care among older trauma patients who die after hospital discharge. J Trauma Acute Care Surg. 2018;85(5):992.
26.
MetaxaVAnagnostouDVlachosS, et al.Palliative care interventions in intensive care unit patients–a systematic review protocol. Syst Rev. 2019;8(1):1‐5.
27.
MercadanteSGregorettiCCortegianiA. Palliative care in intensive care units: why, where, what, who, when, how. BMC Anesthesiol. 2018;18(1):1‐6.
28.
AslaksonRACurtisJRNelsonJE. The changing role of palliative care in the ICU. Crit Care Med. 2014;42(11):2418.
29.
RibeiroAFMartins PereiraSGomesB, et al.Do patients, families, and healthcare teams benefit from the integration of palliative care in burn intensive care units? Results from a systematic review with narrative synthesis. Palliat Med. 2019;33(10):1241‐1254.
30.
ArkseyHO’MalleyL. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19‐32.
31.
TriccoACLillieEZarinW, et al.PRISMA Extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467‐473.
32.
MunnZSternCAromatarisE, et al.What kind of systematic review should I conduct? A proposed typology and guidance for systematic reviewers in the medical and health sciences. BMC Med Res Methodol. 2018;18(1):1‐9.
33.
PageMJShamseerLTriccoAC. Registration of systematic reviews in PROSPERO: 30,000 records and counting. Syst Rev. 2018;7(1):1‐9.
34.
ClarkeEBCurtisJRLuceJM, et al.Quality indicators for end-of-life care in the intensive care unit. Crit Care Med. 2003;31(9):2255‐2262.
35.
CarmichaelHBrackettHScottMC, et al.Early palliative care consultation in the burn unit: a quality improvement initiative to increase utilization. J Burn Care Res. 2021;42(6):1128-1135.
36.
CunninghamHBScielzoSANakoneznyPA, et al.Burn surgeon and palliative care physician attitudes regarding goals of care delineation for burned geriatric patients. J Burn Care Res. 2018;39(6):1000‐1005.
37.
CurtisEEYenikomshianHACarrougherGJ, et al.Early patient deaths after transfer to a regional burn center. Burns. 2020;46(1):97‐103.
38.
Hemington-GorseSCloverAMacdonaldC, et al.Comfort care in burns: the burn modified liverpool care pathway (BM-LCP). Burns. 2011;37(6):981‐985.
39.
IsmailALongJMoiemenN, et al.. End of life decisions and care of the adult burn patient. burns. 2011;37(2):288‐293.
40.
O’MaraMSChapyakDGreenhalghDG, et al.End of life in the pediatric burn patient. J Burn Care Res. 2006;27(6):803‐808.
41.
PartainNSSubramanianMHodgmanEI, et al.Characterizing end-of-life care after geriatric burns at a verified level I burn center. J Palliat Med. 2016;19(12):1275‐1280.
42.
PhamTNOttoAYoungSR, et al.Early withdrawal of life support in severe burn injury. J Burn Care Res. 2012;33(1):130‐135.
43.
SheckterCCHungKSRochlinD, et al.Trends and inpatient outcomes for palliative care services in major burn patients: a 10-year analysis of the nationwide inpatient sample. Burns. 2018;44(8):1903‐1909.
44.
WachtelTFrankHNielsenJ. Comfort care: an alternative treatment programme for seriously burned patients. Burns. 1987;13(1):1‐5.
45.
FratianneRBBrandtCP. Determining when care for burns is futile. J Burn Care Rehabil. 1997;18(3):262‐267.
46.
DokterJFelixMKrijnenP, et al.Mortality and causes of death of Dutch burn patients during the period 2006–2011. Burns. 2015;41(2):235‐240.
47.
MaharPDWasiakJClelandH, et al.Clinical differences between major burns patients deemed survivable and non-survivable on admission. Injury. 2015;46(5):870‐873.
48.
WessmanBTSonaCSchallomM. Improving caregivers’ perceptions regarding patient goals of care/end-of-life issues for the multidisciplinary critical care team. J Intensive Care Med. 2017;32(1):68‐76.
49.
MetaxaVLavrentievaA. End-of-life decisions in burn intensive care units–an international survey. Burns. 2015;41(1):53‐57.
50.
RayDEKarlekarMBCrouseDL, et al.Care of the critically ill burn patient. An overview from the perspective of optimizing palliative care. Ann Am Thorac Soc. 2017;14(7):1094‐1102.
51.
AslaksonRChengJVollenweiderD, et al.Evidence-based palliative care in the intensive care unit: a systematic review of interventions. J Palliat Med. 2014;17(2):219‐235.
52.
WolfSERoseJKDesaiMH, et al.Mortality determinants in massive pediatric burns. An analysis of 103 children with> or = 80% TBSA burns (> or = 70% full-thickness). Ann Surg. 1997;225(5):554.
53.
den HollanderDAlbertynRAmblerJ. Palliation, end-of-life care and burns; concepts, decision-making and communication–A narrative review. African Journal of Emergency Medicine. 2020;10(2):95‐98.
54.
StokesMJohnsonW. Burns in the third world: an unmet need. Ann Burns Fire Disasters. 2017;30(4):243.
55.
ClelandH. Death and the burn patient: who, how and when. Burns. 2014;40(5):786‐787.
56.
TQIPA. Best practices in the management of traumatic brain injury. ACS Committee on Trauma. 2015:3‐23.
