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

Area of Science:

• Medical Ethics
• Trauma Surgery
• Palliative Care

Background:

• Limited understanding of specialist burn clinicians' experiences with end-of-life (EoL) decision-making for non-survivable burn injuries.
• Exploration of the rationale behind clinicians' attitudes in these complex situations is needed.

Purpose of the Study:

• To explore the decision-making processes of specialist burn clinicians regarding EoL care for patients with severe, potentially non-survivable burn injuries.
• To understand the factors influencing these critical care decisions.

Main Methods:

• Qualitative exploratory study involving interviews with 11 experienced clinicians.
• Data collected via telephone or video conferencing (June-August 2021).
• Thematic analysis using a framework approach.

Main Results:

• EoL decision-making is complex and multifactorial, though clearer for 'unsurvivable' injuries.
• Multidisciplinary teams were commonly used, with protocol/guideline utilization reported.
• Palliative care clinicians were rarely involved in EoL discussions.

Conclusions:

• EoL decision-making for severe burns is layered, complex, and individualized, often guided by protocols.
• Variations exist in multidisciplinary team composition for EoL decisions.
• Despite complexity, palliative care consultation remains infrequent.