Opportunities for Palliative Care in Patients With Burn Injury—A Systematic Review

• Published in: Journal of pain and symptom management 2020-04, Vol.59 (4), p.916-931.e1
• Main Authors: Cook, Allyson C., Langston, Jessica A., Jaramillo, Joshua D., Edwards, Kristin E., Wong, Hong-nei, Aslakson, Rebecca A., Aslakson, Rebecca, Ast, Katherine, Carroll, Thomas, Dzeng, Elizabeth, Frechman, Erica, Goett, Rebecca, Harrison, Krista L., Kaye, Erica C., Kotwal, Ashwin, LeBlanc, Thomas W., Lo, Shelly S., Nageswaran, Savithri, Powell, Victoria, Powers, James, Rotella, Joseph, Ullrich, Christina, Vickey, Theresa, Wong, Susan
• Format: Article
• Language: English
• Subjects: Burn; Burns; Decision making; domains of quality palliative care; Educational programs; End of life decisions; Ethics; Group therapy; Injuries; Intervention; Palliative care; Physical symptoms; Quality of life; Self care; Social factors; Systematic review
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2019.11.014

Patients with significant burn injuries likely have palliative care needs. We performed a systematic review of existing evidence concerning the palliative care needs of burn patients. Through November 26, 2018, we systematically searched PubMed, CINAHL, Embase, Web of Science, and Scopus, using terms representing burn injuries and the eight domains of quality palliative care as outlined by the National Consensus Project for Quality Palliative Care. Eligible articles involved burn-injured patients treated with an intervention targeting at least one of the eight domains. Our searches yielded 7532 unique records, which led to 238 articles for full review and 88 studies that met inclusion criteria. Seventy-five studies addressed the domain physical aspects of care and merit a separate systematic review; 13 studies were included in our final review. Four of the seven domains—processes of care, psychologic symptoms, social aspects, and end of life—were addressed by studies but three domains—spiritual, cultural, or ethics—were unaddressed. Included studies highlight potential benefits from peridischarge self-care education programs, peer support, and group therapy in improving quality of life. In patients with severe injuries, end-of-life decision-making protocols were associated with increased utilization of comfort-focused treatments. Most existing palliative care-related research in burn patients addresses interventions for physical symptoms with minimal literature concerning other domains. Opportunities exist for further research of palliative care in burn populations with emphasis on addressing interventions for all domains and better standardizing the language and outcomes for the palliative care interventions.