209 Attitudes Among Burn Surgeons and Palliative Care Physicians Regarding Goals of Care for Geriatric Burn Patients

Abstract

The significance of delineating goals of care (GoC) for geriatric patients has been well known to the palliative care community but is a relatively new concept to burn surgeons. We surveyed palliative care specialists (PCS) and burn surgeons (BS) to elicit their attitudes regarding: 1) the importance of goal setting for burned seniors; 2) each specialty’s confidence in their own ability to conduct GoC conversations; and 3) their confidence in the ability of the other specialty to do so. A 13-item survey was developed by the steering committee of a multi-center consortium dedicated to palliative care in the burned geriatric patient. The instrument draft was sent to burn and palliative care providers unaffiliated with the consortium for beta-testing. The finalized instrument was electronically circulated to all active physician members of the American Burn Association (ABA) and the American Academy for Hospice and Palliative Medicine (AAHPM). Surveys underwent review and approval by the research committees of each organization. Responses were received from 45 subjects categorized as BS (7.3%) and 244 PCS (5.7%). PCS rated being more familiar with GoC, were more comfortable having a GoC discussion with laypeople, were more likely to have reported high quality training in performing GoC conversations, believed more palliative care physicians were needed in ICUs, and had more interest in conducting GoC conversations relative to BS. Interestingly, both sets of physicians believed themselves to perform GoC discussions better than their peers perceived them to do so. In regard to perceptions of the best model for conducting GoC discussions, BS favored leading team discussions, where PCS endorsed both PCS and BS led discussions. Both also generally agreed that GoC discussions should occur with 72 hours of admission. PCS were more likely to have reported training in determining GoC in fellowship and on-the-job training, have fewer years of experience in their specialty, and less frequently deliver care to burned seniors relative to BS. Regarding work setting, BS reported working predominantly in academic private centers and academic safety net hospitals, and PCS representing a wider array of contexts. Both BS and PCS believe themselves to conduct GoC discussions for burned seniors better than the other specialty perceived them to do so, which led to disparate views on perceptions on the optimal leadership of these discussions. A dichotomy of views regarding the roles and responsibilities of BS and PCS in the conduct of GoC discussions for burned seniors highlights the need for future work to inform best practices.