Utilization and determinants of palliative care in the trauma intensive care unit: results of a national survey.
BACKGROUND
There is a paucity of data evaluating utilization of palliative care in trauma intensive care units.


OBJECTIVE
We sought to determine current indications and determinants of palliative care consultation in the trauma intensive care units.


METHODS
Using a cross-sectional assessment, we surveyed trauma surgeons to understand indications, benefits, and barriers trauma surgeons perceive when consulting palliative care.


METHODS
A total of 1232 surveys were emailed to all members of the Eastern Association for the Surgery of Trauma.


RESULTS
A total of 362 providers responded (29% response rate). Majority of respondents were male (n = 287, 80.2%) and practiced in Level 1 (n = 278, 77.7%) trauma centers. Most common indicators for referral to palliative care were expected survival 1 week to 1 month, multisystem organ dysfunction >3 weeks, minimal neurologic responsiveness >1 week, and referral to hospice. In post hoc analysis, there was a significant difference in frequency of utilization of palliative care when respondents had access to board-certified palliative care physicians (χ(2) = 56.4, p < 0.001). Although half of the respondents (n = 199, 55.6%) reported palliative care consults beneficial all or most of the time, nearly still half (n = 174, 48.6%) felt palliative care was underutilized. Most frequent barriers to consultation included resistance from families (n = 144, 40.2%), concerns that physicians were "giving up" (n = 109, 30.4%), and miscommunication of prognosis (n = 98, 27.4%) or diagnosis (n = 58, 16.2%) by the palliative care physician.


CONCLUSIONS
Although a plurality of trauma surgeons reported palliative care beneficial, those surveyed indicate that palliative care is underutilized. Barriers identified provide important opportunities to further appropriate utilization of palliative care services.
Vanderbilt University, Nashville, TN, USA mohana.b.karlekar@vanderbilt.edu.
Mohana
M
Karlekar
Carilion Roanoke Memorial Hospital, Roanoke, VA, USA.
Bryan
B
Collier
School of Nursing, Vanderbilt University, Nashville, TN, USA.
Abby
A
Parish
University of Kansas Medical Center, Kansas City, KS, USA.
Lori
L
Olson
Vanderbilt University, Nashville, TN, USA.
Tom
T
Elasy
D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D010166:Palliative Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D066231:Surgeons / Q000523:psychology*; D014193:Trauma Centers
Utilization; end of life; intensive care unit; palliative care; trauma