Nurse-perceived barriers to effective communication regarding prognosis and optimal end-of-life care for surgical ICU patients: a qualitative exploration.
BACKGROUND
Integration of palliative care for intensive care unit (ICU) patients is important but often challenging, especially in surgical ICUs (SICUs), in part because many surgeons equate palliative care with terminal care and failure of restorative care. SICU nurses, who are key front-line clinicians, can provide insights into barriers for delivery of optimal palliative care in their setting.


METHODS
We developed a focus group guide to identify barriers to two key components of palliative care-optimal communication regarding prognosis and optimal end-of-life care-and used the tool to conduct focus groups of nurses providing bedside care in three SICUs at a tertiary care, academic, inner city hospital. Using content analysis technique, responses were organized into thematic domains that were validated by independent observers and a subset of participating nurses.


RESULTS
Four focus groups included a total of 32 SICU nurses. They identified 34 barriers to optimal communication regarding prognosis, which were summarized into four domains: logistics, clinician discomfort with discussing prognosis, inadequate skill and training, and fear of conflict. For optimal end-of-life care, the groups identified 24 barriers in four domains: logistics, inability to acknowledge an end-of-life situation, inadequate skill and training, and cultural differences relating to end-of-life care.


CONCLUSIONS
Nurses providing bedside care in SICUs identify barriers in several domains that may impede optimal discussions of prognoses and end-of-life care for patients with surgical critical illness. Consideration of these perceived barriers and the underlying SICU culture is relevant for designing interventions to improve palliative care in this setting.
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA. raslaks1@jhmi.edu
Rebecca A
RA
Aslakson
Rhonda
R
Wyskiel
Imani
I
Thornton
Christina
C
Copley
Dauryne
D
Shaffer
Marylou
M
Zyra
Judith
J
Nelson
Peter J
PJ
Pronovost
D001291:Attitude of Health Personnel; D015142:Baltimore; D003144:Communication Barriers; D017144:Focus Groups; D006801:Humans; D007362:Intensive Care Units; D009723:Nurse-Patient Relations; D009726:Nurses / Q000523:psychology*; D010166:Palliative Care / Q000523:psychology*; D011379:Prognosis; D036301:Qualitative Research; D013727:Terminal Care / Q000523:psychology*; D000078329:Workforce