title: Barriers to end-of-life care in the intensive care unit: perceptions vary by level of training, discipline, and institution.
abstract: OBJECTIVE
  Barriers to providing quality end-of-life (EOL) care in the intensive care unit (ICU) are common, but little is known about how these barriers vary by level of training or discipline.
  
  
  METHODS
  Medical residents and ICU fellows, attendings, and nurses at two teaching hospitals were surveyed about barriers to EOL care in the ICU. The survey consisted of questions about possible barriers in four domains: patient-family factors, clinician factors, institutional factors, and education-training factors.
  
  
  RESULTS
  There were significant differences in reported barriers to EOL care by level of training, discipline, and institution, particularly in the education-training domain. Insufficient resident training in EOL care was reported as a large or huge barrier by a smaller proportion of residents (20%) than attendings (62%), fellows (55%) or nurses (36%) (p=0.001). Nurses' perceptions of barriers to EOL care varied between institutions. Barriers that varied significantly between nurses included difficulty communicating due to language (p=0.008), and inadequate training in recognition of pain and anxiety (p=0.001).
  
  
  CONCLUSIONS
  We found that perceived barriers to EOL care differed significantly by level of training, discipline and institution, suggesting the interventions to improve EOL care may need to be locally targeted and specific to level of training and discipline.
authors.affiliation: Department of Medicine, Santa Clara Valley Medical Center, Stanford School of Medicine, San Jose, CA, USA. asfriedenberg@gmail.com
authors.forename: Allison S
authors.initials: AS
authors.lastname: Friedenberg
authors.forename: Mitchell M
authors.initials: MM
authors.lastname: Levy
authors.forename: Susan
authors.initials: S
authors.lastname: Ross
authors.forename: Laura E
authors.initials: LE
authors.lastname: Evans
mesh_terms: D016223:Advance Directives / Q000523:psychology*; D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D008505:Medical Staff, Hospital; D009741:Nursing Staff, Hospital; D010166:Palliative Care / Q000379:methods*; D011788:Quality of Life / Q000523:psychology*; D013223:Statistics as Topic