Principles of palliative care for major burns

den Hollander, 2020Griggs, 2017Ray, 2017

Major burns are usually unexpected and sudden, and many patients do not have an advance care plan or clear goals of care. Introducing a palliative approach to care can benefit patients with major burns, as they often have a poor prognosis and may decide not to proceed with (or to stop) treatment. A multidisciplinary team including palliative care healthcare professionals is essential when supporting patients, their families and the staff caring for them.

Integrate a needs-focused approach to palliative care alongside burns management for patients with major burns. At a minimum, provide the following aspects of palliative care:

• educate the patient (if possible) and their carer(s) about prognosis—see Overview of communicating with and supporting patients with palliative care needs
• determine goals of care with ongoing planning and discussions with the patient (if possible) and their carer(s).
• support advance care planning including the appointment of a substitute decision-maker if possible
• support the family and carer.

The goals of wound management in patients with burns change when they are in the last days of life, from promoting healing and preventing complications to minimising suffering for both the patient and their family—see Principles of care in the last days of life for information on managing symptoms. Preparing the wound bed for healing is no longer the primary focus; instead, reducing pain and odour by controlling infection and exudate become the main priorities.