Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal.
Palliat Med. 2024 Mar;38(3):297-309. doi: 10.1177/02692163241229962. Epub 2024 Feb 19.
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.
To identify triggers for palliative care referral in critically burned patients based on professionals' views, experiences and practices.
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.
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.
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.
烧伤是一个全球性的公共卫生问题，每年导致约 30 万人死亡。烧伤对患者、家庭、医疗团队和系统都有重大影响。有证据表明，在烧伤重症监护病房中整合姑息治疗可以改善患者的舒适度、决策过程和家庭护理。需要研究如何优化姑息治疗的转介。
根据专业人员的观点、经验和实践，确定重症烧伤患者姑息治疗转介的触发因素。
使用深度访谈的定性研究。
地点/参与者：邀请了葡萄牙所有五个烧伤重症监护参考中心参与；其中三个参与了。纳入标准：有在这些环境中工作经验的专业人员。共有 15 名专业人员（12 名护士和 3 名医生）参与。进行了反思性主题分析。
确定了三个主要的姑息治疗转介触发因素：（一）烧伤的严重程度和范围，（二）合并症，（三）多器官衰竭。还产生了其他触发因素：（一）与患者痛苦和身体形象改变有关的康复姑息治疗，（二）家庭痛苦和/或功能障碍和复杂的家庭过程，（三）在烧伤重症监护病房的长时间停留，（四）无法控制的疼痛。
本研究根据专业人员的观点、临床经验和实践，确定了烧伤重症监护病房中姑息治疗的触发因素。触发因素的系统化和使用可以帮助简化转介途径，并加强姑息治疗在烧伤重症监护病房中的整合。需要研究这些触发因素在临床实践中的应用，以加强决策过程，早期和高质量的综合姑息治疗，并提供以患者和家庭为中心的适当护理。
