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

Abstract

Background: Burn units are intensive care facilities specialized in the treatment of patients with severe burns. As burn injuries have a major impact in physical, psychosocial, and spiritual health, palliative care can be a strengthening component of integrated care. Aim: To review and appraise the existing evidence about the integration of palliative care in burn intensive care units with respect to (1) the concept, model and design and (2) the benefits and outcomes of this integration. Design: A systematic review was conducted following PRISMA guidelines. Protocol registered with PROSPERO (CRD42018111676). Data sources: Five electronic databases were searched (PubMed/NLM, Web of Science, MEDLINE/TR, Ovid, and CINAHL/EBSCO) until May 2019. A narrative synthesis of the findings was constructed. Hawker et al.’s tool was used for quality appraisal. Results: A total of 299 articles were identified, of which five were included for analysis involving a total of 7353 individuals. Findings suggest that there may be benefits from integrating palliative care in burn units, specifically in terms of patients’ comfort, decision-making processes, and family care. Multidisciplinary teams may experience lower levels of burden as result of integrating palliative care in burn units. Conclusion: This review reflects the challenging setting of burn intensive care units. Evidence from these articles suggests that the integration of palliative care in burn intensive care units improves patients’ comfort, decision-making process, and family care. Further research is needed to better understand how the integration of palliative care in burn intensive care units may be fostered and to identify the outcomes of this integration.

Palliative care provision in acute and critical care settings: What are the challenges?

“…8 The findings do however suggest that integration of palliative care in the burns ICU was beneficial for decision-making, symptom control, spiritual care and patient’s quality of life. 8 An interesting finding was that when burns patients were unable to express their preferences, just as described earlier, families were asked to share and participate in the decision-making process. Yet this had negative psychological consequences for family members, thought to be attributed to the sudden life changing nature of a critical event like a burn, especially compared to a chronic illness.…”

“…In cases such as these, end-of-life care may be the primary focus of care following a planned withdrawal of life-sustaining treatment. 7 Ribiero, Pereira, Gomes and Nunes 8 provide a systematic review, included in this issue, in which they investigated whether patients, families and healthcare teams benefit from the integration of palliative care in burns ICUs, prioritising comfort according to the patient’s needs, particularly when there is no hope for recovery. 8 Their review identified that all included studies referred to the integration of palliative care in this setting, yet none of the studies specified how palliative care was integrated, or what was meant by integration.…”

“…7 Ribiero, Pereira, Gomes and Nunes 8 provide a systematic review, included in this issue, in which they investigated whether patients, families and healthcare teams benefit from the integration of palliative care in burns ICUs, prioritising comfort according to the patient’s needs, particularly when there is no hope for recovery. 8 Their review identified that all included studies referred to the integration of palliative care in this setting, yet none of the studies specified how palliative care was integrated, or what was meant by integration. 8 The findings do however suggest that integration of palliative care in the burns ICU was beneficial for decision-making, symptom control, spiritual care and patient’s quality of life.…”

“…8 Their review identified that all included studies referred to the integration of palliative care in this setting, yet none of the studies specified how palliative care was integrated, or what was meant by integration. 8 The findings do however suggest that integration of palliative care in the burns ICU was beneficial for decision-making, symptom control, spiritual care and patient’s quality of life. 8 An interesting finding was that when burns patients were unable to express their preferences, just as described earlier, families were asked to share and participate in the decision-making process.…”

“…Yet this had negative psychological consequences for family members, thought to be attributed to the sudden life changing nature of a critical event like a burn, especially compared to a chronic illness. 8…”