Background:Burns are a global public health problem, accounting for around 300,000 deaths annually. Burns have significant consequences for patients, families, healthcare teams and systems. Evidence suggests that the integration of palliative care in burn intensive care units improves patients’ comfort, decision-making processes and family care. Research is needed on how to optimise palliative care referrals.Aim:To identify triggers for palliative care referral in critically burned patients based on professionals’ views, experiences and practices.Design:Qualitative study using in-depth interviews.Setting/participants:All five Burn Intensive Care Units reference centres across Portugal were invited; three participated. Inclusion criteria: Professionals with experience/working in these settings. A total of 15 professionals (12 nurses and 3 physicians) participated. Reflexive thematic analysis was performed.Results:Three main triggers for palliative care referral were identified: (i) Burn severity and extension, (ii) Co-morbidities and (iii) Multiorgan failure. Other triggers were also generated: (i) Rehabilitative palliative care related to patients’ suffering and changes in body image, (ii) Family suffering and/or dysfunctional and complex family processes, (iii) Long stay in the burn intensive care unit and (iv) Uncontrolled pain.Conclusions:This study identifies triggers for palliative care in burn intensive care units based on professionals’ views, clinical experiences and practices. The systematisation and use of triggers could help streamline referral pathways and strengthen the integration of palliative care in burn intensive care units. Research is needed on the use of these triggers in clinical practice to enhance decision-making processes, early and high-quality integrated palliative care and proportionate patient and family centred care.

中文翻译：

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烧伤重症监护病房转诊姑息治疗的触发因素是什么？基于医疗保健专业人员的观点、临床经验和实践的定性研究结果

背景：烧伤是一个全球性的公共卫生问题，每年造成约 30 万人死亡。烧伤对患者、家庭、医疗团队和系统产生重大影响。有证据表明，将姑息治疗纳入烧伤重症监护室可以改善患者的舒适度、决策过程和家庭护理。需要研究如何优化姑息治疗转诊。目标：根据专业人士的观点、经验和实践，确定危重烧伤患者姑息治疗转诊的触发因素。设计：使用深度访谈进行定性研究。设置/参与者：全部五人葡萄牙各地烧伤重症监护室参考中心受邀；三人参加。纳入标准：在这些环境中具有经验/工作的专业人士。共有 15 名专业人员（12 名护士和 3 名医生）参加。进行了反思性主题分析。结果：确定了姑息治疗转诊的三个主要触发因素：（i）烧伤严重程度和范围，（ii）合并症和（iii）多器官衰竭。还产生了其他触发因素：（i）与患者的痛苦和身体形象变化相关的康复姑息治疗，（ii）家庭痛苦和/或功能失调和复杂的家庭过程，（iii）长期留在烧伤重症监护室和（ iv) 不受控制的疼痛。结论：本研究根据专业人士的观点、临床经验和实践确定了烧伤重症监护病房姑息治疗的触发因素。触发器的系统化和使用可以帮助简化转诊途径并加强烧伤重症监护病房中姑息治疗的整合。需要对这些触发因素在临床实践中的使用进行研究，以加强决策过程、早期和高质量的综合姑息治疗以及以患者和家庭为中心的适当护理。