Barriers, enablers and challenges to initiating end-of-life care in an Australian intensive care unit context.
BACKGROUND
Patients admitted to Australian intensive care units are often critically unwell, and present the challenge of increasing mortality due to an ageing population. Several of these patients have terminal conditions, requiring withdrawal of active treatment and commencement of end-of-life (EOL) care.


OBJECTIVE
The aim of the study was to explore the perspectives and experiences of physicians and nurses providing EOL care in the ICU. In particular, perceived barriers, enablers and challenges to providing EOL care were examined.


METHODS
An interpretative, qualitative inquiry was selected as the methodological approach, with focus groups as the method for data collection. The study was conducted in Melbourne, Australia in a 24-bed ICU. Following ethics approval intensive care physicians and nurses were recruited to participate. Focus group discussions were discipline specific. All focus groups were audio-recorded then transcribed for thematic data analysis.


RESULTS
Five focus groups were conducted with 11 physicians and 17 nurses participating. The themes identified are presented as barriers, enablers and challenges. Barriers include conflict between the ICU physicians and external medical teams, the availability of education and training, and environmental limitations. Enablers include collaboration and leadership during transitions of care. Challenges include communication and decision making, and expectations of the family.


CONCLUSIONS
This study emphasised that positive communication, collaboration and culture are vital to achieving safe, high quality care at EOL. Greater use of collaborative discussions between ICU clinicians is important to facilitate improved decisions about EOL care. Such collaborative discussions can assist in preparing patients and their families when transitioning from active treatment to initiation of EOL care. Another major recommendation is to implement EOL care leaders of nursing and medical backgrounds, and patient support coordinators, to encourage clinicians to communicate with other clinicians, and with family members about plans for EOL care.
School of Nursing and Midwifery, Faculty of Health, Deakin University, Australia; The Royal Melbourne Hospital, Australia. Electronic address: laura.brooks@deakin.edu.au.
Laura Anne
LA
Brooks
School of Nursing and Midwifery, Faculty of Health, Deakin University, Australia; The Royal Melbourne Hospital, Australia; Melbourne School of Health Sciences, The University of Melbourne, Australia.
Elizabeth
E
Manias
School of Nursing and Midwifery, Faculty of Health, Deakin University, Australia.
Patricia
P
Nicholson
D001291:Attitude of Health Personnel; D001315:Australia; D003657:Decision Making; D017144:Focus Groups; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D033183:Interdisciplinary Communication; D015279:Organizational Culture; D010348:Patient Care Team / Q000458:organization & administration; D036301:Qualitative Research; D013727:Terminal Care / Q000458:organization & administration*
Collaboration; Communication; Education; End-of-life care; Intensive care; Leadership; Shared-decision making