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23-08-2011 | Article

End-of-life care pathway developed for burns patients

Abstract

Free abstract

MedWire News: UK researchers report that a burns-modified Liverpool Care Pathway (LCP) can assist end-of-life care and appears to improve this care in burns patients for whom a decision of treatment futility has been made.

Furthermore, the tool appears easy to use and is well-received by staff implementing it, show the study findings.

"It is inevitable that despite advances in burn treatment, death will be the outcome for some burn victims," write Sarah Hemington-Gorse and colleagues from Broomfield Hospital in Chelmsford in the journal Burns.

"Prediction of poor outcome and recognizing the point of futility remains a challenge but should remain a priority as quality end-of-life care is arguably as important as life-sustaining life care," they add.

The team modified the LCP for use in burns, to include alleviation of physical symptoms such as nausea, pain, and agitation, and to address spiritual and cultural aspects of care including religious, patient, and family communication.

All deaths (n=32) that occurred during a 2-year period at a centre that utilized the burns-modified LCP were identified, of which 22 were available for analysis. Death was unexpected in 8 patients, leaving 14 patients with a clear decision of treatment futility, made by a multidisciplinary team including a consultant surgeon and anesthetist.

Adherence to the burns-modified LCP was well-documented, and showed no variance from the goals set out by the pathway "suggesting that the modifications made to the pathway were indeed appropriate for our patient group," say the researchers.

The mean time from LCP initiation until death was 11 hours, and all patients' families or next of kin were aware of the pathway and understood its goals, comment Hemington-Gorse et al.

"The LCP provides education and feedback to professionals involved in terminal care and identifies room for improvement by highlighting areas where goals have not been attained," comments the research team.

The group adds that LCP-delivered care can also have a positive effect on relatives of patients; levels of bereavement are significantly lower in relatives of those treated with the LCP compared with those not treated with the LCP after they have witnessed increased patient comfort and reduced symptom burden.

"It is our intention to re-audit the burns-modified LCP on a regular basis and we hope that it will become a useful tool in other units throughout the UK and beyond," conclude the investigators.

By Sarah Guy