Improving ICU-Based Palliative Care Delivery: A Multicenter, Multidisciplinary Survey of Critical Care Clinician Attitudes and Beliefs.
OBJECTIVE
Addressing the quality gap in ICU-based palliative care is limited by uncertainty about acceptable models of collaborative specialist and generalist care. Therefore, we characterized the attitudes of physicians and nurses about palliative care delivery in an ICU environment.


METHODS
Mixed-methods study.


METHODS
Medical and surgical ICUs at three large academic hospitals.


METHODS
Three hundred three nurses, intensivists, and advanced practice providers.


RESULTS
Clinicians completed written surveys that assessed attitudes about specialist palliative care presence and integration into the ICU setting, as well as acceptability of 23 published palliative care prompts (triggers) for specialist consultation. Most (n = 225; 75%) reported that palliative care consultation was underutilized. Prompting consideration of eligibility for specialist consultation by electronic health record searches for triggers was most preferred (n = 123; 41%); only 17 of them (6%) felt current processes were adequate. The most acceptable specialist triggers were metastatic malignancy, unrealistic goals of care, end of life decision making, and persistent organ failure. Advanced age, length of stay, and duration of life support were the least acceptable. Screening led by either specialists or ICU teams was equally preferred. Central themes derived from qualitative analysis of 65 written responses to open-ended items included concerns about the roles of physicians and nurses, implementation, and impact on ICU team-family relationships.


CONCLUSIONS
Integration of palliative care specialists in the ICU is broadly acceptable and desired. However, the most commonly used current triggers for prompting specialist consultation were among the least well accepted, while more favorable triggers are difficult to abstract from electronic health record systems. There is also disagreement about the role of ICU nurses in palliative care delivery. These findings provide important guidance to the development of collaborative care models for the ICU setting.
1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University, Durham, NC.2Duke Clinical Research Institute, Durham, NC.3Department of Anesthesia, Columbia University, New York, NY.4Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA.5School of Nursing, Duke University, Durham, NC.6Division of Neurointensive Care, Department of Neurology, Duke University, Durham, NC.7Palliative Care Medicine Program, Duke University, Durham, NC.8Program to Support People and Enhance Recovery, Duke University, Durham, NC.
Nicholas G
NG
Wysham
May
M
Hua
Catherine L
CL
Hough
Stephanie
S
Gundel
Sharron L
SL
Docherty
Derek M
DM
Jones
Owen
O
Reagan
Haley
H
Goucher
Jessica
J
Mcfarlin
Christopher E
CE
Cox
D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D057286:Electronic Health Records; D007722:Health Knowledge, Attitudes, Practice; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D024802:Nurse's Role; D009726:Nurses / Q000523:psychology*; D010166:Palliative Care / Q000592:standards; D010819:Physician's Role; D010820:Physicians / Q000523:psychology*; D058996:Quality Improvement; D012017:Referral and Consultation; D013038:Specialization; D011795:Surveys and Questionnaires; D014481:United States