Perspectives of physicians and nurses regarding end-of-life care in the intensive care unit.
BACKGROUND
The delivery of end-of-life care (EOLC) in the intensive care unit (ICU) varies widely among medical care providers. The differing opinions of nurses and physicians regarding EOLC may help identify areas of improvement.


OBJECTIVE
To explore the differences of physicians and nurses on EOLC in the ICU and how these differences vary according to self-reported proficiency level and primary work unit.


METHODS
Cross-sectional survey of 69 ICU physicians and 629 ICU nurses.


METHODS
Single tertiary care academic medical institution.


RESULTS
A total of 50 physicians (72%) and 331 nurses (53%) participated in the survey. Significant differences between physicians and nurses were noted in the following areas: ability to safely raise concerns, do not resuscitate (DNR) decision making, discussion of health care directives, timely hospice referral, spiritual assessment documentation, utilization of social services, and the availability of EOLC education. In every domain of EOLC, physicians reported a more positive perception than nurses. Additional differences were noted among physicians based on experience, as well as among nurses based on their primary work unit and self-reported proficiency level.


CONCLUSIONS
Even with an increased focus on improving EOLC, significant differences continue to exist between the perspectives of nurses and physicians, as well as physicians among themselves and nurses among themselves. These differences may represent significant barriers toward providing comprehensive, consistent, and coordinated EOLC in the ICU.
Critical Care Medicine, Mayo Clinic, Jacksonville, FL 32224, USA. festic.emir@mayo.edu
Emir
E
Festic
Michael E
ME
Wilson
Ognjen
O
Gajic
Gavin D
GD
Divertie
Jeffrey T
JT
Rabatin
D000046:Academic Medical Centers; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards / Q000706:statistics & numerical data; D003422:Critical Care / Q000592:standards; D003430:Cross-Sectional Studies; D003657:Decision Making; D034462:Dissent and Disputes; D005257:Fellowships and Scholarships / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D008910:Minnesota; D009726:Nurses / Q000523:psychology* / Q000706:statistics & numerical data; D010820:Physicians / Q000523:psychology* / Q000706:statistics & numerical data; D011594:Psychometrics; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology*; D000078329:Workforce